Pub Date : 2020-03-24DOI: 10.1177/2515816320913992
D. Kudrow, S. Munjal, Leah Bensimon, T. Lokhandwala, B. Yue, Anna D. Coutinho, S. Silberstein
Objective: To describe patient characteristics, treatment patterns, and health care costs among patients diagnosed with major headache disorders overall and by type (tension-type headache [TTH], migraine, cluster headache [CH], or >1 primary headache type), and secondarily to evaluate drug treatment patterns among triptan initiators with a major headache diagnosis. Methods: Using US claims data from January 2012 through December 2017, we identified adults with evidence of a major headache disorder: TTH, migraine, or CH; the first diagnosis date was deemed the index date. To evaluate triptan use specifically, patients who initiated triptans were identified; the first triptan claim date was deemed the index date. Patient characteristics, treatment patterns (concomitant treatments, adherence, number of fills), and annual health care costs data were obtained. Results: Of the 418,779 patients diagnosed with major headache disorders, the following 4 cohorts were created: TTH (8%), migraine (87%), CH (1%), and >1 primary headache type (4%). The majority used analgesic (54–73%) and psychotropic (57–81%) drugs, primarily opioids (36–53%). Headache-related costs accounted for one-fifth of all-cause costs. Of the 229,946 patients who initiated triptans, the following 7 study cohorts were analyzed: sumatriptan (68%), rizatriptan (21%), eletriptan (5%), zolmitriptan (3%), naratriptan (2%), frovatriptan (1%), and almotriptan (<1%). The major concomitant analgesic medication classes were opioids (41%) and nonsteroidal anti-inflammatory drugs (34%). Conclusion: The primary headache disorder treatment paradigm is complex, with significant variability. Predominant concomitant use of opioids and switching to opioids is of concern, necessitating solutions to minimize opioid use. Switching to non-oral/fast-acting or targeted preventive therapies should be considered.
{"title":"Treatment patterns of patients diagnosed with major headache disorders: A retrospective claims analysis","authors":"D. Kudrow, S. Munjal, Leah Bensimon, T. Lokhandwala, B. Yue, Anna D. Coutinho, S. Silberstein","doi":"10.1177/2515816320913992","DOIUrl":"https://doi.org/10.1177/2515816320913992","url":null,"abstract":"Objective: To describe patient characteristics, treatment patterns, and health care costs among patients diagnosed with major headache disorders overall and by type (tension-type headache [TTH], migraine, cluster headache [CH], or >1 primary headache type), and secondarily to evaluate drug treatment patterns among triptan initiators with a major headache diagnosis. Methods: Using US claims data from January 2012 through December 2017, we identified adults with evidence of a major headache disorder: TTH, migraine, or CH; the first diagnosis date was deemed the index date. To evaluate triptan use specifically, patients who initiated triptans were identified; the first triptan claim date was deemed the index date. Patient characteristics, treatment patterns (concomitant treatments, adherence, number of fills), and annual health care costs data were obtained. Results: Of the 418,779 patients diagnosed with major headache disorders, the following 4 cohorts were created: TTH (8%), migraine (87%), CH (1%), and >1 primary headache type (4%). The majority used analgesic (54–73%) and psychotropic (57–81%) drugs, primarily opioids (36–53%). Headache-related costs accounted for one-fifth of all-cause costs. Of the 229,946 patients who initiated triptans, the following 7 study cohorts were analyzed: sumatriptan (68%), rizatriptan (21%), eletriptan (5%), zolmitriptan (3%), naratriptan (2%), frovatriptan (1%), and almotriptan (<1%). The major concomitant analgesic medication classes were opioids (41%) and nonsteroidal anti-inflammatory drugs (34%). Conclusion: The primary headache disorder treatment paradigm is complex, with significant variability. Predominant concomitant use of opioids and switching to opioids is of concern, necessitating solutions to minimize opioid use. Switching to non-oral/fast-acting or targeted preventive therapies should be considered.","PeriodicalId":9702,"journal":{"name":"Cephalalgia Reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2515816320913992","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46246552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-05DOI: 10.1177/2515816320911032
Stephanie A Ihezie, M. Chandalia, Mark J. Burish
Pituitary hormone testing is recommended in refractory cluster headache (CH), but supporting evidence is limited. We present a patient with cluster-like headaches and a negative brain magnetic resonance imaging (MRI) 1 year after headache onset. He failed multiple medication trials. Three years after headache onset, additional workup showed abnormal pituitary labs including hyperprolactinemia and a brain MRI with a 15 × 15 × 14 mm3 enhancing pituitary lesion. With cabergoline 0.25 mg twice weekly, the patient has been headache-free for over 2 years. This case supports the recommendations for pituitary testing in refractory CH, even if imaging is initially negative for a pituitary tumor.
{"title":"A triad of cluster-like headaches with delayed development of a macroscopic prolactinoma: A case report","authors":"Stephanie A Ihezie, M. Chandalia, Mark J. Burish","doi":"10.1177/2515816320911032","DOIUrl":"https://doi.org/10.1177/2515816320911032","url":null,"abstract":"Pituitary hormone testing is recommended in refractory cluster headache (CH), but supporting evidence is limited. We present a patient with cluster-like headaches and a negative brain magnetic resonance imaging (MRI) 1 year after headache onset. He failed multiple medication trials. Three years after headache onset, additional workup showed abnormal pituitary labs including hyperprolactinemia and a brain MRI with a 15 × 15 × 14 mm3 enhancing pituitary lesion. With cabergoline 0.25 mg twice weekly, the patient has been headache-free for over 2 years. This case supports the recommendations for pituitary testing in refractory CH, even if imaging is initially negative for a pituitary tumor.","PeriodicalId":9702,"journal":{"name":"Cephalalgia Reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2515816320911032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45474522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-25DOI: 10.1177/2515816320908642
A. Nagai, Daiki Tanaka, K. Kuroshima, S. Ura, Kazuto Yoshida, Yuji Takahashi, I. Yabe
The aim of this article is to provide neuroimaging data on cases with familial hemiplegic migraine (FHM). A 14-year-old male presented normal diffusion-weighted magnetic resonance imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) findings during his first hemiplegic migraine attack. However, magnetic resonance angiography (MRA) showed diffuse narrowing of the right middle cerebral artery. Cerebral blood flow–single-photon emission computed tomography showed right hypoperfusion. A follow-up study showed no abnormal findings. His mother had normal DWI, FLAIR, and MRA findings during her migraine attack. Both patients were diagnosed with FHM2 (p.R763H mutation in ATP1A2). This study highlights the importance of neurovascular examinations during the FHM2 headache phase. Further cases are required to clarify the pathophysiology of migraine.
{"title":"Neurovascular changes in magnetic resonance imagining and single-photon emission computed tomography during migraine attack in patients with FHM2 mutations","authors":"A. Nagai, Daiki Tanaka, K. Kuroshima, S. Ura, Kazuto Yoshida, Yuji Takahashi, I. Yabe","doi":"10.1177/2515816320908642","DOIUrl":"https://doi.org/10.1177/2515816320908642","url":null,"abstract":"The aim of this article is to provide neuroimaging data on cases with familial hemiplegic migraine (FHM). A 14-year-old male presented normal diffusion-weighted magnetic resonance imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) findings during his first hemiplegic migraine attack. However, magnetic resonance angiography (MRA) showed diffuse narrowing of the right middle cerebral artery. Cerebral blood flow–single-photon emission computed tomography showed right hypoperfusion. A follow-up study showed no abnormal findings. His mother had normal DWI, FLAIR, and MRA findings during her migraine attack. Both patients were diagnosed with FHM2 (p.R763H mutation in ATP1A2). This study highlights the importance of neurovascular examinations during the FHM2 headache phase. Further cases are required to clarify the pathophysiology of migraine.","PeriodicalId":9702,"journal":{"name":"Cephalalgia Reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2515816320908642","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45145110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-21DOI: 10.1177/2515816320908241
J. J. Ong, Devanshi Patnaik, Y. Chan, Oliver Simon, E. Finkelstein
Objective: Despite the high prevalence and disabling nature of migraine, studies evaluating its economic burden in Singapore remain scant. This study aims to quantify the per capita and aggregate economic cost of episodic migraine (EM; ≤14 monthly headache days) without aura among full-time employees in Singapore. Methods: We administered a cross-sectional online survey to full-time employees in Singapore who met the International Classification of Headache Disorders (third edition, 2018) criteria for EM without aura. Eligible participants were classified by the frequency of monthly migraine days (MMDs): lower end episodic migraine (LEM; ≤3 MMDs) and upper end episodic migraine (UEM; 4–14 MMDs). The survey captured per capita healthcare resource utilization and lost work productivity (absenteeism and presenteeism) for each subgroup. Healthcare costs were obtained by multiplying unit costs by healthcare utilization. Finally, per capita (patient) costs of each subgroup were then imputed and multiplied by prevalence data to quantify the aggregate burden of migraine in Singapore. Results: Of the 606 participants who completed the survey, 81% experienced ≤3 MMDs. Total annual per capita costs were SGD4925 (USD 3620; 95% confidence interval (CI): SGD 4438–5411) and SGD14,476 (USD 10,639; 95% CI: SGD 11,908–17,045) for the LEM and UEM subgroup, respectively. Healthcare costs on average accounted for 17.6% of per capita costs, of which was driven primarily by diagnostic tests (33.6%), followed by consultations (17.1%), medications (16.7%), alternative medications (16.6%) and hospitalizations (14.8%). Lost productivity accounted for 82.4% of costs, chiefly attributable to absenteeism in the LEM group (38.2%), followed by presenteeism in the UEM group (26.0%), absenteeism in the UEM group (18.8%) and presenteeism in the LEM group (17.1%). The total cost to Singapore for EM in 2018 was approximately SGD 1 billion (USD 0.75 billion; SGD 1.00 = USD 0.74). Conclusion: Overall, EM imposes a substantial economic burden on society in Singapore. Total migraine cost per capita is greater in the UEM (4–14 MMDs) as compared to the LEM subgroup. Majority of the overall costs result from missed workdays and lost work productivity. Future research should determine the extent to which optimized migraine treatments could improve productivity, and by extension, mitigate the staggering costs of this disorder.
{"title":"Economic burden of migraine in Singapore","authors":"J. J. Ong, Devanshi Patnaik, Y. Chan, Oliver Simon, E. Finkelstein","doi":"10.1177/2515816320908241","DOIUrl":"https://doi.org/10.1177/2515816320908241","url":null,"abstract":"Objective: Despite the high prevalence and disabling nature of migraine, studies evaluating its economic burden in Singapore remain scant. This study aims to quantify the per capita and aggregate economic cost of episodic migraine (EM; ≤14 monthly headache days) without aura among full-time employees in Singapore. Methods: We administered a cross-sectional online survey to full-time employees in Singapore who met the International Classification of Headache Disorders (third edition, 2018) criteria for EM without aura. Eligible participants were classified by the frequency of monthly migraine days (MMDs): lower end episodic migraine (LEM; ≤3 MMDs) and upper end episodic migraine (UEM; 4–14 MMDs). The survey captured per capita healthcare resource utilization and lost work productivity (absenteeism and presenteeism) for each subgroup. Healthcare costs were obtained by multiplying unit costs by healthcare utilization. Finally, per capita (patient) costs of each subgroup were then imputed and multiplied by prevalence data to quantify the aggregate burden of migraine in Singapore. Results: Of the 606 participants who completed the survey, 81% experienced ≤3 MMDs. Total annual per capita costs were SGD4925 (USD 3620; 95% confidence interval (CI): SGD 4438–5411) and SGD14,476 (USD 10,639; 95% CI: SGD 11,908–17,045) for the LEM and UEM subgroup, respectively. Healthcare costs on average accounted for 17.6% of per capita costs, of which was driven primarily by diagnostic tests (33.6%), followed by consultations (17.1%), medications (16.7%), alternative medications (16.6%) and hospitalizations (14.8%). Lost productivity accounted for 82.4% of costs, chiefly attributable to absenteeism in the LEM group (38.2%), followed by presenteeism in the UEM group (26.0%), absenteeism in the UEM group (18.8%) and presenteeism in the LEM group (17.1%). The total cost to Singapore for EM in 2018 was approximately SGD 1 billion (USD 0.75 billion; SGD 1.00 = USD 0.74). Conclusion: Overall, EM imposes a substantial economic burden on society in Singapore. Total migraine cost per capita is greater in the UEM (4–14 MMDs) as compared to the LEM subgroup. Majority of the overall costs result from missed workdays and lost work productivity. Future research should determine the extent to which optimized migraine treatments could improve productivity, and by extension, mitigate the staggering costs of this disorder.","PeriodicalId":9702,"journal":{"name":"Cephalalgia Reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2515816320908241","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45826463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-21DOI: 10.1177/2515816320905082
Chi-Chung Li, J. Palcza, Jialin Xu, B. Thornton, Wendy Ankrom, Abhijeet S. Jakate, E. Marcantonio
Background: Ubrogepant is a novel, oral calcitonin gene–related peptide receptor antagonist for acute treatment of migraine. This study evaluated potential drug–drug interactions between ubrogepant and an oral contraceptive containing ethinyl estradiol (EE) and norgestimate (NGM). Methods: This open-label, single-center, two-period, fixed-sequence study enrolled healthy, postmenopausal or oophorectomized, adult women. In period 1, participants received a single oral dose of EE 0.035 mg/NGM 0.25 mg (EE-NGM) followed by a 7-day washout. In period 2, participants received oral ubrogepant 50 mg daily on days 1–14; single-dose EE-NGM was coadministered with ubrogepant on day 10. Pharmacokinetic parameters for plasma EE and norelgestromin (NGMN) were compared with and without ubrogepant. Results: Twenty-two participants aged 46–66 years were enrolled; 21 completed the study. Geometric mean ratios and 90% confidence intervals for the comparison of EE-NGM + ubrogepant to EE-NGM alone were contained within 0.80 and 1.25 for area under the plasma drug concentration–time curve (AUC) from time zero to infinity (AUC0–∞; 0.96 [0.91, 1.01]) and C max (0.91 [0.82, 1.004]) of NGMN and AUC0–∞ (0.97 [0.93, 1.01]) of EE, but not C max of EE (0.74 [0.69, 0.79]). Median t max of EE was delayed following EE-NGM + ubrogepant (3.0 h) versus EE-NGM alone (median of 1.5 h), whereas median t max of NGMN was unchanged (1.5 h). Geometric mean apparent terminal half-life (t ½) was similar with and without ubrogepant for EE (23 vs. 21 h) and NGMN (36 h both conditions). All ubrogepant-related adverse events were mild or moderate. Conclusion: Ubrogepant did not demonstrate potential for clinically meaningful drug–drug interactions with an EE-NGM oral contraceptive. Trial registration: Not applicable (phase 1 trial)
{"title":"The effect of multiple doses of ubrogepant on the pharmacokinetics of an oral contraceptive in healthy women: Results of an open-label, single-center, two-period, fixed-sequence study","authors":"Chi-Chung Li, J. Palcza, Jialin Xu, B. Thornton, Wendy Ankrom, Abhijeet S. Jakate, E. Marcantonio","doi":"10.1177/2515816320905082","DOIUrl":"https://doi.org/10.1177/2515816320905082","url":null,"abstract":"Background: Ubrogepant is a novel, oral calcitonin gene–related peptide receptor antagonist for acute treatment of migraine. This study evaluated potential drug–drug interactions between ubrogepant and an oral contraceptive containing ethinyl estradiol (EE) and norgestimate (NGM). Methods: This open-label, single-center, two-period, fixed-sequence study enrolled healthy, postmenopausal or oophorectomized, adult women. In period 1, participants received a single oral dose of EE 0.035 mg/NGM 0.25 mg (EE-NGM) followed by a 7-day washout. In period 2, participants received oral ubrogepant 50 mg daily on days 1–14; single-dose EE-NGM was coadministered with ubrogepant on day 10. Pharmacokinetic parameters for plasma EE and norelgestromin (NGMN) were compared with and without ubrogepant. Results: Twenty-two participants aged 46–66 years were enrolled; 21 completed the study. Geometric mean ratios and 90% confidence intervals for the comparison of EE-NGM + ubrogepant to EE-NGM alone were contained within 0.80 and 1.25 for area under the plasma drug concentration–time curve (AUC) from time zero to infinity (AUC0–∞; 0.96 [0.91, 1.01]) and C max (0.91 [0.82, 1.004]) of NGMN and AUC0–∞ (0.97 [0.93, 1.01]) of EE, but not C max of EE (0.74 [0.69, 0.79]). Median t max of EE was delayed following EE-NGM + ubrogepant (3.0 h) versus EE-NGM alone (median of 1.5 h), whereas median t max of NGMN was unchanged (1.5 h). Geometric mean apparent terminal half-life (t ½) was similar with and without ubrogepant for EE (23 vs. 21 h) and NGMN (36 h both conditions). All ubrogepant-related adverse events were mild or moderate. Conclusion: Ubrogepant did not demonstrate potential for clinically meaningful drug–drug interactions with an EE-NGM oral contraceptive. Trial registration: Not applicable (phase 1 trial)","PeriodicalId":9702,"journal":{"name":"Cephalalgia Reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2515816320905082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49032726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-07DOI: 10.1177/2515816320903292
K. Peng, Shih-Pin Chen, L. S. Gudmundsson
In the year 2019 in research on headache disorders, migraine remains the focus of attention as the antibodies against calcitonin gene-related peptide (CGRP) and its receptor have become available in several countries along with the publication of phase 3 clinical trials of the newer generation oral CGRP receptor antagonists. Aside from the overshadowing CGRP research, several other interesting studies have been published. Herewith, we provide an overview of the publications that, in our opinion, contribute greatly to the understanding and treatment of headache disorders. Of note, the selection for the list is subjective and does not include all research works in the year of 2019 worthy of mention. We hope that our selection serves as a short summary and a catalyst to increase the interests of headache researchers. In the current editorial, we will discuss preclinical and clinical studies, which provide a better understanding of the disease mechanisms or a potential to future treatment targets.
{"title":"Headache highlights 2019: Junior editors’ choice","authors":"K. Peng, Shih-Pin Chen, L. S. Gudmundsson","doi":"10.1177/2515816320903292","DOIUrl":"https://doi.org/10.1177/2515816320903292","url":null,"abstract":"In the year 2019 in research on headache disorders, migraine remains the focus of attention as the antibodies against calcitonin gene-related peptide (CGRP) and its receptor have become available in several countries along with the publication of phase 3 clinical trials of the newer generation oral CGRP receptor antagonists. Aside from the overshadowing CGRP research, several other interesting studies have been published. Herewith, we provide an overview of the publications that, in our opinion, contribute greatly to the understanding and treatment of headache disorders. Of note, the selection for the list is subjective and does not include all research works in the year of 2019 worthy of mention. We hope that our selection serves as a short summary and a catalyst to increase the interests of headache researchers. In the current editorial, we will discuss preclinical and clinical studies, which provide a better understanding of the disease mechanisms or a potential to future treatment targets.","PeriodicalId":9702,"journal":{"name":"Cephalalgia Reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2515816320903292","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41933708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-13DOI: 10.1177/2515816319898867
H. Deng, Qiushi Wang, D. P. Turner, Katherine E Sexton, S. Burns, M. Eikermann, Dianbo Liu, Dan Cheng, T. Houle
Background: Migraine is a highly prevalent disorder that is typically episodic in nature. Social network data reflecting personal commentary on everyday life patterns, including those interrupted by migraine, represent a unique window into the real-life experience of those willing to share them. The experience of a migraine attack might be captured by twitter text data, and this information might be used to complement our current knowledge of activity in the general population and even lead to enhanced prediction. Objective: To characterize tweets reporting migraine activity and to explore their social-behavior features as foundation for further investigations. Methods: A longitudinal cohort study utilizing 1 month of Twitter data from November to December 2014 was conducted. Tweets containing the word “migraine” were extracted, preprocessed, and managed using natural language processing (NLP) techniques. User behavior profiles including tweeting frequencies, high-frequency words, and sentimental presentations were reported and analyzed. Results: During the observation period, 98,622 tweets were captured from 77,335 different users. The overall sentiment of tweets was slightly negative for expressive tweets but neutral for informative tweets. Among posted negative expressive tweets, we found a strong tendency that high-frequent expressions were those with the extreme sentiment, and profanity was common. Conclusions: Twitter users with migraine showed distinct sentimental patterns while suffering from disease onsets exemplified by posting tweets with extreme negative sentiments.
{"title":"Sentiment analysis of real-world migraine tweets for population research","authors":"H. Deng, Qiushi Wang, D. P. Turner, Katherine E Sexton, S. Burns, M. Eikermann, Dianbo Liu, Dan Cheng, T. Houle","doi":"10.1177/2515816319898867","DOIUrl":"https://doi.org/10.1177/2515816319898867","url":null,"abstract":"Background: Migraine is a highly prevalent disorder that is typically episodic in nature. Social network data reflecting personal commentary on everyday life patterns, including those interrupted by migraine, represent a unique window into the real-life experience of those willing to share them. The experience of a migraine attack might be captured by twitter text data, and this information might be used to complement our current knowledge of activity in the general population and even lead to enhanced prediction. Objective: To characterize tweets reporting migraine activity and to explore their social-behavior features as foundation for further investigations. Methods: A longitudinal cohort study utilizing 1 month of Twitter data from November to December 2014 was conducted. Tweets containing the word “migraine” were extracted, preprocessed, and managed using natural language processing (NLP) techniques. User behavior profiles including tweeting frequencies, high-frequency words, and sentimental presentations were reported and analyzed. Results: During the observation period, 98,622 tweets were captured from 77,335 different users. The overall sentiment of tweets was slightly negative for expressive tweets but neutral for informative tweets. Among posted negative expressive tweets, we found a strong tendency that high-frequent expressions were those with the extreme sentiment, and profanity was common. Conclusions: Twitter users with migraine showed distinct sentimental patterns while suffering from disease onsets exemplified by posting tweets with extreme negative sentiments.","PeriodicalId":9702,"journal":{"name":"Cephalalgia Reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2515816319898867","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44803534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-08DOI: 10.1177/2515816319897054
T. Mathew, S. John
Essential oils are widely used by people for common ailments like headache and backache. We report a case of chronic daily headache in an adolescent migraineur refractory to most antimigraine drugs secondary to topical application of essential oils containing camphor and eucalyptus. A 14-year-old boy presented with chronic daily headache of 1-year duration, refractory to four antimigraine drugs including valproate and topiramate. He was daily applying a balm called Amruthanjan (10% camphor and 14.5% eucalyptus) on his forehead to relieve headache. Patient had complete relief of headache in 2 weeks after stopping the balm application. All his antimigraine drugs were tapered and stopped over a period of 3 months. At 1-year follow-up, he is headache free. Brain-stimulant essential oils of camphor and eucalyptus may be an important unrecognized cause of medication overuse headache.
{"title":"An unsuspected and unrecognized cause of medication overuse headache in a chronic migraineur—essential oil-related medication overuse headache: A case report","authors":"T. Mathew, S. John","doi":"10.1177/2515816319897054","DOIUrl":"https://doi.org/10.1177/2515816319897054","url":null,"abstract":"Essential oils are widely used by people for common ailments like headache and backache. We report a case of chronic daily headache in an adolescent migraineur refractory to most antimigraine drugs secondary to topical application of essential oils containing camphor and eucalyptus. A 14-year-old boy presented with chronic daily headache of 1-year duration, refractory to four antimigraine drugs including valproate and topiramate. He was daily applying a balm called Amruthanjan (10% camphor and 14.5% eucalyptus) on his forehead to relieve headache. Patient had complete relief of headache in 2 weeks after stopping the balm application. All his antimigraine drugs were tapered and stopped over a period of 3 months. At 1-year follow-up, he is headache free. Brain-stimulant essential oils of camphor and eucalyptus may be an important unrecognized cause of medication overuse headache.","PeriodicalId":9702,"journal":{"name":"Cephalalgia Reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2515816319897054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43212801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1177/2515816320921186
Abhijeet S. Jakate, R. Boinpally, M. Butler, K. Lu, K. Womack, D. McGeeney, A. Periclou
Background: Ubrogepant is a novel, oral calcitonin gene–related peptide receptor antagonist approved by the US Food and Drug Administration for acute treatment of migraine with or without aura in adults. Objectives: To assess potential pharmacokinetic (PK) drug–drug interactions in healthy participants and inform the safety and tolerability of ubrogepant alone and in combination with acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) in healthy participants and participants with migraine. Methods: Two phase 1, three-way crossover studies randomized healthy adults to 100 mg ubrogepant alone, 1000 mg acetaminophen or 500 mg naproxen alone, and 100 mg ubrogepant plus 1000 mg acetaminophen or 500 mg naproxen. Geometric mean ratios (GMRs) and 90% confidence intervals were calculated based on statistical comparison of maximum plasma drug concentration (C max) and area under the plasma drug concentration–time curve (AUC) for treatment in combination versus alone. Two phase 3 randomized trials included adults with migraine. Treatment-emergent adverse events (TEAEs) were evaluated. Results: Time to C max and terminal elimination half-life for all treatments were unchanged when coadministered. Ubrogepant C max and AUC increased by approximately 40% when coadministered with acetaminophen. Acetaminophen C max decreased by 24% (GMR = 0.76) when coadministered with ubrogepant. There were no significant PK interactions between ubrogepant and naproxen. TEAE rates in the acetaminophen and NSAID rescue medication groups were similar to ubrogepant alone. Conclusions: Coadministration of ubrogepant and acetaminophen resulted in a statistically significant increase in ubrogepant exposure and a decrease in acetaminophen C max; however, these changes were not clinically relevant. No statistically or clinically relevant changes in PK were associated with ubrogepant and naproxen coadministration. No safety concerns were identified for ubrogepant alone or in combination with acetaminophen or NSAIDs.
{"title":"Evaluation of the pharmacokinetic interaction and safety of ubrogepant coadministered with acetaminophen or nonsteroidal anti-inflammatory drugs: A randomized trial","authors":"Abhijeet S. Jakate, R. Boinpally, M. Butler, K. Lu, K. Womack, D. McGeeney, A. Periclou","doi":"10.1177/2515816320921186","DOIUrl":"https://doi.org/10.1177/2515816320921186","url":null,"abstract":"Background: Ubrogepant is a novel, oral calcitonin gene–related peptide receptor antagonist approved by the US Food and Drug Administration for acute treatment of migraine with or without aura in adults. Objectives: To assess potential pharmacokinetic (PK) drug–drug interactions in healthy participants and inform the safety and tolerability of ubrogepant alone and in combination with acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) in healthy participants and participants with migraine. Methods: Two phase 1, three-way crossover studies randomized healthy adults to 100 mg ubrogepant alone, 1000 mg acetaminophen or 500 mg naproxen alone, and 100 mg ubrogepant plus 1000 mg acetaminophen or 500 mg naproxen. Geometric mean ratios (GMRs) and 90% confidence intervals were calculated based on statistical comparison of maximum plasma drug concentration (C max) and area under the plasma drug concentration–time curve (AUC) for treatment in combination versus alone. Two phase 3 randomized trials included adults with migraine. Treatment-emergent adverse events (TEAEs) were evaluated. Results: Time to C max and terminal elimination half-life for all treatments were unchanged when coadministered. Ubrogepant C max and AUC increased by approximately 40% when coadministered with acetaminophen. Acetaminophen C max decreased by 24% (GMR = 0.76) when coadministered with ubrogepant. There were no significant PK interactions between ubrogepant and naproxen. TEAE rates in the acetaminophen and NSAID rescue medication groups were similar to ubrogepant alone. Conclusions: Coadministration of ubrogepant and acetaminophen resulted in a statistically significant increase in ubrogepant exposure and a decrease in acetaminophen C max; however, these changes were not clinically relevant. No statistically or clinically relevant changes in PK were associated with ubrogepant and naproxen coadministration. No safety concerns were identified for ubrogepant alone or in combination with acetaminophen or NSAIDs.","PeriodicalId":9702,"journal":{"name":"Cephalalgia Reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2515816320921186","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41956326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1177/2515816320915711
Jack Bearpark, D. Mujong, S. Seri, A. Cavanna
Aim: To systematically review the available literature on the prevalence and clinical characteristics of headache in patients with Tourette syndrome (TS), a neurodevelopmental condition characterized by the chronic presence of motor and vocal tics. Design: We conducted a systematic literature review of original studies using three clinical databases (Medline, EMBASE and PsycInfo), according to the standards outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome measures included both tic severity and tic frequency. Results: Our systematic literature review identified six studies on the prevalence and characteristics of headache in patients with TS (data on paediatric patients were available from five studies and data on adult patients from four studies). The proportion of patients with TS who had a diagnosis of headache ranged from 29% to 62%. Migraine was the most commonly investigated headache disorder in this patient population. The findings of the reviewed studies showed that the prevalence of migraine in patients with TS ranges between 13% and 43% and is significantly higher compared to the two control groups (p < 0.05). Discussion: The prevalence of headache in patients with TS could be higher than in the general population, with the most reliable data being available for migraine. Overall, the literature on the prevalence and characteristics of headache in TS is sparse and highly heterogeneous. Further research on the prevalence and clinical correlates of migraine, tension-type headache and other types of headache in patients with TS across the lifespan is needed to inform clinical practice aimed at improving health-related quality of life in patients with tics.
{"title":"Headache in patients with Tourette syndrome: A systematic literature review","authors":"Jack Bearpark, D. Mujong, S. Seri, A. Cavanna","doi":"10.1177/2515816320915711","DOIUrl":"https://doi.org/10.1177/2515816320915711","url":null,"abstract":"Aim: To systematically review the available literature on the prevalence and clinical characteristics of headache in patients with Tourette syndrome (TS), a neurodevelopmental condition characterized by the chronic presence of motor and vocal tics. Design: We conducted a systematic literature review of original studies using three clinical databases (Medline, EMBASE and PsycInfo), according to the standards outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome measures included both tic severity and tic frequency. Results: Our systematic literature review identified six studies on the prevalence and characteristics of headache in patients with TS (data on paediatric patients were available from five studies and data on adult patients from four studies). The proportion of patients with TS who had a diagnosis of headache ranged from 29% to 62%. Migraine was the most commonly investigated headache disorder in this patient population. The findings of the reviewed studies showed that the prevalence of migraine in patients with TS ranges between 13% and 43% and is significantly higher compared to the two control groups (p < 0.05). Discussion: The prevalence of headache in patients with TS could be higher than in the general population, with the most reliable data being available for migraine. Overall, the literature on the prevalence and characteristics of headache in TS is sparse and highly heterogeneous. Further research on the prevalence and clinical correlates of migraine, tension-type headache and other types of headache in patients with TS across the lifespan is needed to inform clinical practice aimed at improving health-related quality of life in patients with tics.","PeriodicalId":9702,"journal":{"name":"Cephalalgia Reports","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2515816320915711","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49315191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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