Medication-overuse headache

Glavobolja uzrokovana prekomjernom upotrebom lijekova (GUPUL) definira se kao sekundarna glavobolja u bolesnika s prethodnom primarnom glavoboljom, najčešće migrenom ili tenzijskom glavoboljom, koja se javlja u prosjeku 15 i više dana mjesečno kao posljedica redovite prekomjerne primjene akutne simptomatske terapije za glavobolju (10 i više ili 15 i više dana mjesečno, ovisno o lijeku koji se upotrebljava) tijekom više od 3 mjeseca. Temeljem radova nađenih pretraživanjem baze podataka PubMed u zadnjih 15 godina raspravljamo o definiciji, epidemiologiji, patofiziologiji, kliničkoj slici, dijagnostici, terapiji, prognozi i prevenciji GUPUL-a. Cilj ovog preglednog rada jest probuditi svijest među liječnicima da je GUPUL česta dijagnoza u bolesnika s primarnim glavoboljama koju treba adekvatno tretirati, a čiji je razvoj moguće prevenirati već na razini primarne zdravstvene zaštite.Medication-overuse headache (MOH) is defined as a secondary headache in patients with previous primary headache, mostly migraine or tension headache, present for 15 or more days per month due to the overuse of acute symptomatic therapy for headache (10 or more or 15 or more days per month, depending on the medication used) and persisting for more than 3 months. Based on the papers published in the past 15 years on the topic, identified by searching the PubMed database, definition, epidemiology, pathophysiology,clinical picture, diagnosis, therapy, prognosis and prevention of MOH are discussed. The aim of this review is to make physicians aware of the fact that MOH is a frequent diagnosis among patients with primary headaches, which needs to be treated appropriately but the development of which can be prevented at the primary healthcare level

Medication-overuse headache

Glavobolja uzrokovana prekomjernom upotrebom lijekova (GUPUL) definira se kao sekundarna glavobolja u bolesnika s prethodnom primarnom glavoboljom, najčešće migrenom ili tenzijskom glavoboljom, koja se javlja u prosjeku 15 i više dana mjesečno kao posljedica redovne prekomjerne primjene akutne simptomatske terapije za glavobolju (10 i više ili 15 i više dana mjesečno, ovisno o lijeku koji se upotrebljava) tijekom više od 3 mjeseca. Temeljem radova nađenih pretraživanjem baze podataka „PubMed“ u razdoblju od 2003. godine do 2018. godine raspravljamo o definiciji, epidemiologiji, patofiziologiji, kliničkoj slici, dijagnostici, terapiji, prognozi i prevenciji GUPUL-a. Cilj ovog preglednog rada je probuditi svijest među liječnicima da je GUPUL česta dijagnoza u bolesnika s primarnim glavoboljama koju treba adekvatno tretirati, a čiji je razvoj moguće prevenirati već na razini primarne zdravstvene zaštite.Medication-overuse headache (MOH) is defined as secondary headache in patients with previous primary headache, mostly migraine or tension headache, present for 15 or more days per month due to the overuse of acute symptomatic therapy for headache (10 or more or 15 or more days per month, depending on the medication used) and persisting for more than 3 months. Based on the papers published in the past 15 years on the topic, identified by searching the PubMed database, definition, epidemiology, pathophysiology, clinical picture, diagnosis, therapy, prognosis and prevention of MOH are discussed. The aim of this review is to make physicians aware of the fact that MOH is a frequent diagnosis among patients with primary headaches, which needs to be treated appropriately but development of which can be prevented at the primary healthcare level

Medication-overuse headache

Glavobolja uzrokovana prekomjernom upotrebom lijekova (GUPUL) definira se kao sekundarna glavobolja u bolesnika s prethodnom primarnom glavoboljom, najčešće migrenom ili tenzijskom glavoboljom, koja se javlja u prosjeku 15 i više dana mjesečno kao posljedica redovne prekomjerne primjene akutne simptomatske terapije za glavobolju (10 i više ili 15 i više dana mjesečno, ovisno o lijeku koji se upotrebljava) tijekom više od 3 mjeseca. Temeljem radova nađenih pretraživanjem baze podataka „PubMed“ u razdoblju od 2003. godine do 2018. godine raspravljamo o definiciji, epidemiologiji, patofiziologiji, kliničkoj slici, dijagnostici, terapiji, prognozi i prevenciji GUPUL-a. Cilj ovog preglednog rada je probuditi svijest među liječnicima da je GUPUL česta dijagnoza u bolesnika s primarnim glavoboljama koju treba adekvatno tretirati, a čiji je razvoj moguće prevenirati već na razini primarne zdravstvene zaštite.Medication-overuse headache (MOH) is defined as secondary headache in patients with previous primary headache, mostly migraine or tension headache, present for 15 or more days per month due to the overuse of acute symptomatic therapy for headache (10 or more or 15 or more days per month, depending on the medication used) and persisting for more than 3 months. Based on the papers published in the past 15 years on the topic, identified by searching the PubMed database, definition, epidemiology, pathophysiology, clinical picture, diagnosis, therapy, prognosis and prevention of MOH are discussed. The aim of this review is to make physicians aware of the fact that MOH is a frequent diagnosis among patients with primary headaches, which needs to be treated appropriately but development of which can be prevented at the primary healthcare level

Medication-overuse headache

Glavobolja uzrokovana prekomjernom upotrebom lijekova (GUPUL) definira se kao sekundarna glavobolja u bolesnika s prethodnom primarnom glavoboljom, najčešće migrenom ili tenzijskom glavoboljom, koja se javlja u prosjeku 15 i više dana mjesečno kao posljedica redovne prekomjerne primjene akutne simptomatske terapije za glavobolju (10 i više ili 15 i više dana mjesečno, ovisno o lijeku koji se upotrebljava) tijekom više od 3 mjeseca. Temeljem radova nađenih pretraživanjem baze podataka „PubMed“ u razdoblju od 2003. godine do 2018. godine raspravljamo o definiciji, epidemiologiji, patofiziologiji, kliničkoj slici, dijagnostici, terapiji, prognozi i prevenciji GUPUL-a. Cilj ovog preglednog rada je probuditi svijest među liječnicima da je GUPUL česta dijagnoza u bolesnika s primarnim glavoboljama koju treba adekvatno tretirati, a čiji je razvoj moguće prevenirati već na razini primarne zdravstvene zaštite.Medication-overuse headache (MOH) is defined as secondary headache in patients with previous primary headache, mostly migraine or tension headache, present for 15 or more days per month due to the overuse of acute symptomatic therapy for headache (10 or more or 15 or more days per month, depending on the medication used) and persisting for more than 3 months. Based on the papers published in the past 15 years on the topic, identified by searching the PubMed database, definition, epidemiology, pathophysiology, clinical picture, diagnosis, therapy, prognosis and prevention of MOH are discussed. The aim of this review is to make physicians aware of the fact that MOH is a frequent diagnosis among patients with primary headaches, which needs to be treated appropriately but development of which can be prevented at the primary healthcare level

GUIDELINES FOR TREATMENT OF PRIMARY HEADACHES BY THE CROATIAN SOCIETY FOR NEUROVASCULAR DISORDERS OF THE CROATIAN MEDICAL ASSOCIATION AND CROATIAN SOCIETY FOR PAIN PREVENTION, REFERENCE CENTER FOR THE HEADACHE OF THE MINISTRY OF HEALTH OF THE REPUBLIC OF CROATIA, REFERENCE CENTER CROATIA FOR DIAGNOSIS AND TREATMENT OF ACUTE AND CHRONIC PAIN BY THE MINISTRY OF HEALTH OF REPUBLIC OF CROATIA AND HEADACHE SECTION OF CROATIAN NEUROLOGICAL SOCIETY OF THE CROATIAN MEDICAL ASSOCIATION

Glavobolja je jedno od najčešćih neuroloških stanja što upućuje za veliku potrebu za lijekovima i ostalim metodama liječenja same akutne faze glavobolje, a po potrebi i prevenciju ostalih napada glavobolje. Prema Međunarodnoj klasifi kaciji glavobolja razlikujemo primarne glavobolje (migrena i njeni podtipovi, tenzijska glavobolja i njeni podtipovi, trigeminalne autonomne glavobolje i njeni podtipovi) i sekundarne glavobolje (povezane s infekcijom, traumom glave i vrata, kranijalnim ili cervikalnim vaskularnim poremećajima, nevaskularnim intrakranijalnim poremećajima, prestankom uzimanja određenih tvari, psihijatrijskim poremećajima, poremećajima kranija, vrata, očiju, ušiju, nosa, sinusa, ustiju te drugih facijalnih ili kranijalnih struktura). Najvažnije je prije uvođenja terapije razlučiti radi li se o primarnoj ili sekundarnoj glavobolji, postaviti dijagnozu primarne glavobolje te se odlučiti za liječenje akutne ili preventivne faze. Od analgetika se najčešće primjenjuju nespecifi čni analgetici koji djeluju na široku paletu boli te specifi čni anagetici koji djeluju samo na određenu vrstu glavobolje (npr. triptani kod migrenoznih napada). Osim navedenog, u tekstu su navedene i ostale metode koje se koriste u liječenju glavobolja, a one uključuju promjenu životnog stila, izbjegavanje provocirajućih faktora, akupunktura te primjena botulinum toksina. Smjernice koje smo objavili 2018. godine nadopunili smo novim lijekovima koji su u međuvremenu registrirani za liječenje akutnih napada te profi laksu migrenskog napada (1).Introduction: Headache is one of the most frequent neurological conditions, so a big need for medications for headache treatment and other methods is needed for acute pain relief and chronic prevention of headaches. Aim: Knowing that headache is one of the most frequent conditions we wanted to summarise its treatment. Methods: We explored MEDLINE searches about the treatment of primary headaches. We also explored the Croatian scientifi c base Hrčak. Results: We found articles on both scientifi c bases, but have chosen only the most systemised. Discussion: According to International Headache Classifi cation there are two main types of headaches: primary headaches (migraine and its subtypes, tensiontype headache and its subtypes, trigeminal autonomic cephalgias) and secondary headaches (attributed to infection, head or neck trauma, cranial or cervical vascular disorders, non-vascular intracranial disorders, substance withdrawal, psychiatric conditions, pain attributed to the disorders of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure). When managing a diagnosis of primary headache, it is important to make a difference between the primary and secondary headache, manage the right diagnosis of primary headache and decide on the right treatment for the acute or preventive phase of headache. The most used medications in headache treatment are nonspecifi c analgetics which can treat headaches, but also other pain disorders. Specifi c headache medication includes medications which can treat only specifi c types of headaches. Except for the above, there are other methods in headache treatment which include a change of lifestyle, avoiding provocative factors, acupuncture and treatment with botulinum toxin. Conclusion: For primary headache treatment it is important to establish the right diagnosis and act fast in the treatment of acute headache attacks. For some patients, it is important to start a prophylactic treatment but also try to prevent a medication overuse headache. When treating a headache of any kind it is also important to take a whole picture of a patient and his/hers comorbidities and think about possible side effects. Changing a lifestyle and some complementary methods can help us in treating chronic headaches. We supplemented the guidelines published in 2018 with new drugs that have since been registered for the treatment of acute attacks and prophylaxis of migraine attacks

GUIDELINES FOR TREATMENT OF PRIMARY HEADACHES BY THE CROATIAN SOCIETY FOR NEUROVASCULAR DISORDERS OF THE CROATIAN MEDICAL ASSOCIATION AND CROATIAN SOCIETY FOR PAIN PREVENTION, REFERENCE CENTER FOR THE HEADACHE OF THE MINISTRY OF HEALTH OF THE REPUBLIC OF CROATIA, REFERENCE CENTER CROATIA FOR DIAGNOSIS AND TREATMENT OF ACUTE AND CHRONIC PAIN BY THE MINISTRY OF HEALTH OF REPUBLIC OF CROATIA AND HEADACHE SECTION OF CROATIAN NEUROLOGICAL SOCIETY OF THE CROATIAN MEDICAL ASSOCIATION

Glavobolja je jedno od najčešćih neuroloških stanja što upućuje za veliku potrebu za lijekovima i ostalim metodama liječenja same akutne faze glavobolje, a po potrebi i prevenciju ostalih napada glavobolje. Prema Međunarodnoj klasifi kaciji glavobolja razlikujemo primarne glavobolje (migrena i njeni podtipovi, tenzijska glavobolja i njeni podtipovi, trigeminalne autonomne glavobolje i njeni podtipovi) i sekundarne glavobolje (povezane s infekcijom, traumom glave i vrata, kranijalnim ili cervikalnim vaskularnim poremećajima, nevaskularnim intrakranijalnim poremećajima, prestankom uzimanja određenih tvari, psihijatrijskim poremećajima, poremećajima kranija, vrata, očiju, ušiju, nosa, sinusa, ustiju te drugih facijalnih ili kranijalnih struktura). Najvažnije je prije uvođenja terapije razlučiti radi li se o primarnoj ili sekundarnoj glavobolji, postaviti dijagnozu primarne glavobolje te se odlučiti za liječenje akutne ili preventivne faze. Od analgetika se najčešće primjenjuju nespecifi čni analgetici koji djeluju na široku paletu boli te specifi čni anagetici koji djeluju samo na određenu vrstu glavobolje (npr. triptani kod migrenoznih napada). Osim navedenog, u tekstu su navedene i ostale metode koje se koriste u liječenju glavobolja, a one uključuju promjenu životnog stila, izbjegavanje provocirajućih faktora, akupunktura te primjena botulinum toksina. Smjernice koje smo objavili 2018. godine nadopunili smo novim lijekovima koji su u međuvremenu registrirani za liječenje akutnih napada te profi laksu migrenskog napada (1).Introduction: Headache is one of the most frequent neurological conditions, so a big need for medications for headache treatment and other methods is needed for acute pain relief and chronic prevention of headaches. Aim: Knowing that headache is one of the most frequent conditions we wanted to summarise its treatment. Methods: We explored MEDLINE searches about the treatment of primary headaches. We also explored the Croatian scientifi c base Hrčak. Results: We found articles on both scientifi c bases, but have chosen only the most systemised. Discussion: According to International Headache Classifi cation there are two main types of headaches: primary headaches (migraine and its subtypes, tensiontype headache and its subtypes, trigeminal autonomic cephalgias) and secondary headaches (attributed to infection, head or neck trauma, cranial or cervical vascular disorders, non-vascular intracranial disorders, substance withdrawal, psychiatric conditions, pain attributed to the disorders of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure). When managing a diagnosis of primary headache, it is important to make a difference between the primary and secondary headache, manage the right diagnosis of primary headache and decide on the right treatment for the acute or preventive phase of headache. The most used medications in headache treatment are nonspecifi c analgetics which can treat headaches, but also other pain disorders. Specifi c headache medication includes medications which can treat only specifi c types of headaches. Except for the above, there are other methods in headache treatment which include a change of lifestyle, avoiding provocative factors, acupuncture and treatment with botulinum toxin. Conclusion: For primary headache treatment it is important to establish the right diagnosis and act fast in the treatment of acute headache attacks. For some patients, it is important to start a prophylactic treatment but also try to prevent a medication overuse headache. When treating a headache of any kind it is also important to take a whole picture of a patient and his/hers comorbidities and think about possible side effects. Changing a lifestyle and some complementary methods can help us in treating chronic headaches. We supplemented the guidelines published in 2018 with new drugs that have since been registered for the treatment of acute attacks and prophylaxis of migraine attacks

Burden and attitude to resistant and refractory migraine: a survey from the European Headache Federation with the endorsement of the European Migraine & Headache Alliance

Background: New treatments are currently offering new opportunities and challenges in clinical management and research in the migraine field. There is the need of homogenous criteria to identify candidates for treatment escalation as well as of reliable criteria to identify refractoriness to treatment. To overcome those issues, the European Headache Federation (EHF) issued a Consensus document to propose criteria to approach difficult-to-treat migraine patients in a standardized way. The Consensus proposed well-defined criteria for resistant migraine (i.e., patients who do not respond to some treatment but who have residual therapeutic opportunities) and refractory migraine (i.e., patients who still have debilitating migraine despite maximal treatment efforts).The aim of this study was to better understand the perceived impact of resistant and refractory migraine and the attitude of physicians involved in migraine care toward those conditions. Methods: We conducted a web-questionnaire-based cross-sectional international study involving physicians with interest in headache care. Results: There were 277 questionnaires available for analysis. A relevant proportion of participants reported that patients with resistant and refractory migraine were frequently seen in their clinical practice (49.5% for resistant and 28.9% for refractory migraine); percentages were higher when considering only those working in specialized headache centers (75% and 46% respectively). However, many physicians reported low or moderate confidence in managing resistant (8.1% and 43.3%, respectively) and refractory (20.7% and 48.4%, respectively) migraine patients; confidence in treating resistant and refractory migraine patients was different according to the level of care and to the number of patients visited per week. Patients with resistant and refractory migraine were infrequently referred to more specialized centers (12% and 19%, respectively); also in this case, figures were different according to the level of care. Conclusions: This report highlights the clinical relevance of difficult-to-treat migraine and the presence of unmet needs in this field. There is the need of more evidence regarding the management of those patients and clear guidance referring to the organization of care and available opportunities