121 research outputs found
Treatment patterns of patients diagnosed with major headache disorders: A retrospective claims analysis
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 \u3e1 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 \u3e1 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 (
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
Chronic paroxysmal hemicrania in paediatric age: report of two cases
Chronic paroxysmal hemicrania (CPH) is a rare primary headache syndrome, which is classified along with hemicrania continua and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) as trigeminal autonomic cephalalgia (TACs). CPH is characterised by short-lasting (2–30 min), severe and multiple (more than 5/day) pain attacks. Headache is unilateral, and fronto-orbital-temporal pain is combined with cranial autonomic symptoms. According to the International Classification of Headache Disorders, 2nd edition, the attacks are absolutely responsive to indomethacin. CPH has been only rarely and incompletely described in the developmental age. Here, we describe two cases concerning a 7-year-old boy and a 11-year-old boy with short-lasting, recurrent headache combined with cranial autonomic features. Pain was described as excruciating, and was non-responsive to most traditional analgesic drugs. The clinical features of our children’s headache and the positive response to indomethacin led us to propose the diagnosis of CPH. Therefore, our children can be included amongst the very few cases of this trigeminal autonomic cephalgia described in the paediatric age
A review of diagnostic and functional imaging in headache
The neuroimaging of
headache patients has revolutionised
our understanding of the pathophysiology
of primary headaches and provided
unique insights into these syndromes.
Modern imaging studies
point, together with the clinical picture,
towards a central triggering
cause. The early functional imaging
work using positron emission
tomography shed light on the genesis
of some syndromes, and has
recently been refined, implying that
the observed activation in migraine
(brainstem) and in several trigeminal-autonomic headaches (hypothalamic
grey) is involved in the pain
process in either a permissive or
triggering manner rather than simply
as a response to first-division nociception
per se. Using the advanced
method of voxel-based morphometry,
it has been suggested that there
is a correlation between the brain
area activated specifically in acute
cluster headache — the posterior
hypothalamic grey matter — and an
increase in grey matter in the same
region. No structural changes have
been found for migraine and medication
overuse headache, whereas
patients with chronic tension-type
headache demonstrated a significant
grey matter decrease in regions
known to be involved in pain processing.
Modern neuroimaging thus
clearly suggests that most primary
headache syndromes are predominantly
driven from the brain, activating
the trigeminovascular reflex and
needing therapeutics that act on both
sides: centrally and peripherally
Safety and tolerability of monthly galcanezumab injections in patients with migraine: integrated results from migraine clinical studies (vol 20, 25, 2020)
Paroxysmal Cerebral Disorder
Safety and tolerability of monthly galcanezumab injections in patients with migraine: integrated results from migraine clinical studies
Background Galcanezumab, a humanized monoclonal antibody that selectively binds to calcitonin gene-related peptide, has demonstrated a significant reduction in monthly migraine headache days in phase 2 and 3 trials. In these analyses, we aimed to evaluate the safety and tolerability of galcanezumab compared with placebo for prevention of episodic or chronic migraine. Methods Data were integrated from three double-blind clinical studies for the up to 6-month galcanezumab exposure group (N = 1435), and from five clinical studies for the up to 1-year all-galcanezumab exposure group (N = 2276). Patients received a monthly 120 mg subcutaneous injection of galcanezumab (with a 240 mg loading dose in month 1), 240 mg galcanezumab, or placebo. Outcomes measured were treatment-emergent adverse events (TEAEs), serious AEs (SAEs), and discontinuation due to AEs (DCAEs). Laboratory results, vital signs, electrocardiogram (ECG), suicidal ideation and behavior results were evaluated. Results TEAEs that occurred more frequently in galcanezumab-treated patients included injection site pain, injection site reactions excluding pain, constipation, vertigo, and pruritus. The proportion of DCAEs among galcanezumab-treated patients ranged between 1.8 and 3.0%, and differed from placebo group for galcanezumab 240 mg (P < 0.05). Fewer than 2.0% of patients in either galcanezumab dose-group compared with 1.0% of placebo-treated patients reported a SAE. There were no clinically meaningful differences between galcanezumab and placebo in laboratory measures, vital signs including blood pressure, ECGs, cardiovascular-related AEs, or suicidal ideation and behavior. Conclusions Galcanezumab demonstrated a favorable safety and tolerability profile for up to 1 year of treatment for the prevention of migraine.Paroxysmal Cerebral Disorder
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ScaffCC: Scalable compilation and analysis of quantum programs
Abstract We present ScaffCC, a scalable compilation and analysis framework based on LLVM (Lattner and Adve, 2004), which can be used for compiling quantum computing applications at the logical level. Drawing upon mature compiler technologies, we discuss similarities and differences between compilation of classical and quantum programs, and adapt our methods to optimizing the compilation time and output for the quantum case. Our work also integrates a reversible-logic synthesis tool in the compiler to facilitate coding of quantum circuits. Lastly, we present some useful quantum program analysis scenarios and discuss their implications, specifically with an elaborate discussion of timing analysis for critical path estimation. Our work focuses on bridging the gap between high-level quantum algorithm specifications and low-level physical implementations, while providing good scalability to larger and more interesting problem
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