Focus on headache as an adverse reaction to drugs

There are a large number of drugs inducing headache as an adverse reaction. Nevertheless, headaches as adverse reactions to drugs have received limited attention. Non-serious adverse reactions, such as headache, are not quantified and described as accurately as serious, life threatening ones. However, non-serious reactions can also be extremely troublesome, above all when they are chronic: they can affect patients' quality of life and contribute to non-compliance. It is absolutely possible that the number of patients with headache as an adverse reaction, which is going to increase, considering the growing use of medications. Physicians should, therefore, be aware of this issue. Indeed, it is difficult to attribute the diagnosis of adverse drug reaction to a condition, headache, which is also a very common symptom in general population

Pharmacokinetics of sumatriptan in non-respondent and in adverse drug reaction reporting migraine patients

Sumatriptan is a selectiveagonist of 5HT1 (1B/1D) receptors,which has proved to be effectiveand safe for the acute treatment ofmigraine attacks. Nevertheless, itsuse by migraine sufferers is stilllimited and some patients consideradverse reactions related to sumatriptan,especially chest symptoms,unacceptable even if not serious.Moreover, in clinical trials, almostone third and one sixth of patients,respectively, fail to experienceheadache relief either after oral orafter subcutaneous sumatriptanadministration. Our aim was to verifywhether differencies in sumatriptanpharmacokinetics couldexplain non-response and/oradverse drug reactions. Sumatriptanlevels were determined by HPLCwith electrochemical detection.Pharmacokinetic parameters werecalculated using a computer program(PK Solutions 2.0; non compartmentalPharmacokinetics DataAnalysis). After oral administration,sumatriptan is rapidly absorbed andsometimes displays multiple peaksof plasma concentration. This “multiplepeaking” gives rise to considerableinter-subject variability inthe time of reaching maximumplasma concentration.Pharmacokinetic parameters ofsumatriptan, both after oral andsubcutaneous administration, weresimilar in the three patient groups.Blood pressure and heart rate didnot show any significant differencesbetween groups. Pharmacokineticparameters and bioavailability ofsumatriptan did not seem to be correlatedeither to the lack of efficacyor the appearance of side effects.These results could depend on thelimited number of patients studied

Why pharmacokinetic differences among oral triptans have little clinical importance: a comment

Triptans, selective 5-HT1B/1D receptor agonists, are specific drugs for the acute treatment of migraine that have the same mechanism of action. Here, it is discussed why the differences among kinetic parameters of oral triptans have proved not to be very important in clinical practice. There are three main reasons: (1) the differences among the kinetic parameters of oral triptans are smaller than what appears from their average values; (2) there is a large inter-subject, gender-dependent, and intra-subject (outside/during the attack) variability of kinetic parameters related to the rate and extent of absorption, i.e., those which are considered as critical for the response; (3) no dose-concentration–response curves have been defined and it is, therefore, impossible both to compare the kinetics of triptans, and to verify the objective importance of kinetic differences; (4) the importance of kinetic differences is outweighed by non-kinetic factors of variability of response to triptans. If no oral formulations are found that can allow more predictable pharmacokinetics, the same problems will probably also arise with new classes of drugs for the acute treatment of migraine

Nuove prospettive d'impiego del naltrexone nelle tossicodipendenze

Il naltrexone potrà essere impiegato nel trattamento della dipendenza da eroina e da alcol, sempre in aggiunta a interventi riabilitativi e sanitari a lungo termine

Interazioni farmacologiche clinicamente significative dei farmaci utilizzati nelle cefalee

La cefalea come effetto di interazioni farmacologiche è sicuramente meno segnalata ma certamente si verifica: In generale c’è interazione farmacologica quando l’effetto o la tossicità di un farmaco sono modificati da un altro somministrato contemporaneamente Sono di due tipi: FARMACODINAMICHE: entrambi i farmaci agiscono sullo stesso bersaglio FARMACOCINETICHE: la co-somministrazione dei 2 farmaci produce cambiamenti nella distribuzione, nel metabolismo, nell’escrezione oppure nel legame proteic

Cefalea: tassonomia e problematiche diagnostiche

. La classificazione dell’International Headache Society del 1988 per la prima volta inserisce la cefalea drug-induced come una entità diagnostica distinta, tra le cefalee secondarie, nel sottotipo 8.2 Headache induced by chronic substance use or exposure. Nella second edition of the International Headache classification (2004) questa denominazione viene sostituita con medication-overuse headache, si stabilisce che la diagnosi “definite” di medication-overuse headache richiede il miglioramento del disturbo sospendendo l’overuse di farmaci, e vengono indicate le specifiche caratteristiche delle diverse subforms che la compongono. Le revisioni successive che, eliminano prima queste caratteristiche delle cefalee, e poi la diagnosi di probabile medication-overuse headache rendono più facilmente utilizzabile la diagnosi di medication-overuse headache ai fini clinici e di studio. Allo stesso tempo però, eliminando la necessità della prova del ruolo causale dei farmaci, cioè che la cefalea migliori sospendendo l’overuse, si modifica anche la base classificatoria della medication-overuse headache come cefalea secondaria. Di conseguenza nei trials clinici potranno venir inclusi, come uno stesso gruppo omogeneo, pazienti con cefalee primarie e drug overuse e pazienti con medication-overuse headache. Noi proponiamo di continuare ad utilizzare la diagnosi di probabile medication-overuse headache a scopo di studio. Inoltre, per analizzare meglio il ruolo dei diversi farmaci sullo sviluppo di questa cefalea e sugli esiti dei trattamenti, proponiamo di ristrutturare la classificazione delle subforms di medication-overuse headache according to the presence or absence of a dependence producing property of overused drugs

Analgesic drug taking: Beliefs and behavior among headache patients

Objective.-To explore beliefs and behavior with respect to analgesic drug taking in headache patients. To compare episodic headache to chronic headache sufferers. Methods.-A consecutive series of 280 headache patients, newly admitted to the Headache Center of the University of Modena, all referred by their general practitioner, were asked to fill out a brief questionnaire, specially compiled for this survey. The questionnaire invited patients to indicate how they themselves thought they should best cope with their headache, and how they actually did so in practice. Results.-The majority of our patients had a positive attitude towards over-the-counter analgesics, which they believed to be more adequate than prescription drugs for acute treatment of their headache. They handled analgesics very carefully, believing it correct to take the drug only when the pain became unbearable, if it was not possible for them to stop work. Chronic headache patients tended to consume more prescription drugs than episodic headache sufferers. Furthermore, the majority of chronic sufferers, as opposed to episodic sufferers, took the analgesic even when not at work. Conclusions.-The use of over-the-counter drugs is considered the best way to treat acute headache even by subjects suffering from severe idiopathic headache and seeking professional care in specialized clinics. Prescribed analgesics are underused by patients with serious episodic headache, which is precisely the group for which they are principally intended

Medication overuse and chronic migraine: a critical review according to clinical pharmacology

Chronic migraine is often complicated by medication-overuse headache (MOH), a headache due to excessive intake of acute medications. Chronic migraine and MOH are serious and disabling disorders. Since chronic migraine derives from the progression of originally episodic migraine, the fundamental therapeutic strategy is prevention. This narrative review describes how to try to prevent the development of MOH and how to manage it once it has appeared. Areas covered: A PubMed database search (from 1988 to January 2015) and a review of published studies on chronic migraine and MOH were conducted. Expert opinion: In spite of progress in migraine treatment, the prevalence of chronic headaches and MOH has not changed in the course of time. Today, a large number of migraine patients have turned to numerous expert physicians and experienced all sorts of prophylactic treatments without decisive benefits. Their condition seems to have crystallized even more as chronic and intractable. This means that to prevent chronification and MOH, we need more effective drugs and better strategies to use them. In particular, we must detect disease biomarkers and predictive factors for drug response that allow for personalized treatment when migraine is still episodic and make analgesic overuse pointless

Pharmacoepidemiology of triptans in a headache centre

Aims: The aims of this survey were: (i) to examine the pharmacoepidemiology of triptans in a headache centre; (ii) tocompare the characteristics of patients who continued to take triptans with those of patients who had discontinued them.Methods: We enrolled all migraine patients according to ICHD-II criteria, ensuring they were over 18 years of age,consecutively examined during a follow-up visit at the Headache Centre of the University Hospital of Modena fromOctober 2008 to March 2009. Only patients who had used or were using a triptan were included. A specific questionnaireabout the use and tolerability of triptans was created for the study and administered to every patient.Results: On the whole, 343 patients (migraine without aura: 72%; chronic migraine: 26%; migraine with aura: 2%; mean age40.410 years) had used or were using triptans. Most patients (72%) continued to use triptans, above all for their efficacy.The minority (28%) discontinuing them were younger and suffered from less severe migraine; 59% of them had discontinuedtriptans because of adverse effects. Indeed, 92% of these patients versus 57% of patients who were currently usingtriptans reported adverse effects (p<.0001, Fisher’s exact test). The number of patients reporting adverse effectssignificantly decreased with age (r¼0.230, p<.005, simple linear regression analysis). The triptan discontinued by thehighest percentage of patients (84%) was subcutaneous 6 mg sumatriptan. Significantly more patients reported adverseeffects with subcutaneous 6 mg (89%) and tablet 100 mg sumatriptan (67%) than with any other triptan.Conclusions: The increase of the tolerability of triptans with age could partly explain why younger patients suffering from lesssevere migraine tend to discontinue triptans more than older patients suffering from more severe migraine. In the latter, theefficacy and better tolerability (but not necessarily safety) of triptans could foster the overuse of these medications

Adolescenza, sostanze stupefacenti, riti di passaggio

L'evento biologico che caratterizza l'et\ue0 dell'adolescenza \ue8 la pubert\ue0. Nella pubert\ue0 gli effetti delle sostanze stupefacenti possono essere pi\uf9 intensi ed avere conseguenze negative per la maturazione dell'adolescent