Migraine Disorders: Láinez JM

Láinez JM, Castillo J, González VM, Otero M, Mateos V, Leira R, Pascual J, Anonymous00353. · Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología. · Rev Clin Esp. · Pubmed #17475183 No free full text.

Abstract: Migraine is the most frequent neurological reason for consultation. The differences regarding health care system, type of professional seeing these patients and therapeutic armamentarium available in the different countries are important, which makes it very recommendable to have an action guide that reflects the local clinical practice. Following the year 2005 WHO recommendations in its "Global Campaign" against migraine, the coordinators of the Headache Study Groups of the Spanish Society of Neurology, the Spanish Society of Family and Community Medicine, the Spanish Society of Rural and General Medicine, the Spanish Society of General Medicine and the Global Campaign decided to jointly make this guide. To do so, they made a search in MEDLINE, using the terms "migraine", "migraine treatment" and "headache guidelines" and "migraine guidelines". The most relevant articles were analyzed, including the references that we considered to be of interest. Furthermore, we reviewed the most important textbooks on headache and migraine. In this paper, we detail the recommendations agreed on, according to the evidence grade, on symptomatic and preventive treatment of migraine.

Edmeads J, Láinez JM, Brandes JL, Schoenen J, Freitag F. · Department of Medicine, University of Toronto, Ontario, Canada. · Neurology. · Pubmed #11294957 No free full text.

Abstract: Migraine is not always well managed in clinical practice, often being under-diagnosed and under-treated. As a result, many sufferers never consult a physician or lapse from care after physician contact. Although most migraine care is provided by general practitioners, others, including specialists, emergency room physicians, pharmacists, and alternative practitioners, may also be involved. A method of standardizing clinical information about migraine is essential for coordinated, logical, and systematic care. The impact of migraine on the patient is an important clinical parameter but one that is seldom inquired about, perhaps because it exhibits such marked variability among and within individuals. Headache-related disability can be an objective and measurable index of this impact. The Migraine Disability Assessment (MIDAS) Questionnaire is a simple and validated instrument with potential for use in clinical practice, research, and public health. It can improve communication between patients and health-care professionals regarding the impact of migraine which, in turn, allows tailoring of the intensity of treatment to the severity of the illness. Changes in the MIDAS score may serve as an end point in assessing treatment efficacy. In populations, MIDAS scores may indicate the burden of migraine in the community and spark public health initiatives to improve management.

Pascual J, Leira R, Láinez JM, Alberca R, Titus F, Morales F, Díez-Tejedor E, García de Polavieja J. · Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, Santander. · Neurologia. · Pubmed #10377720 No free full text.

Abstract: OBJECTIVES: The response to the different antimigraine medications is variable. In this study we have analysed the profile of prescription of these antimigraine medications, both preventive and symptomatic, by a group of spanish neurologists and examined the subjective efficacy of these compounds. PATIENTS AND METHODS: Neurologists from 7 hospitals in different spanish regions interviewed 305 patients (at least 40 per hospital) who met migraine diagnostic criteria. They used an ad hoc questionnaire in which the antimigraine medications, both symptomatic and preventive, taken by the patients, as well as their subjective response were registered. Patients with transformed migraine or tension-type headache more than 2 days per week were excluded. RESULTS: Analgesics, non-steroidal anti-inflammatory drugs, ergotics and sumatriptan had been taken by 99, 69, 54 and 40% of the 305 interviewed patients, respectively. A subjective good response was refered to by 9% of patients who had taken analgesics, 23% of patients who had taken non-steroidal anti-inflammatory drugs, 39% of those who had taken ergotics and 63% of patients with sumatriptan. The current symptomatic treatment was: analgesics 34% of cases, non-steroidal anti-inflamatory drugs 26%, ergotics 13% and sumatriptan 63%. Regarding preventive treatments, 108 patients (35%) had been treated with calcium-antagonists, 87 (29%) with beta-blockers, 55 (18%) with amitriptyline and only 7 (2.2%) with valproic acid. The percentages of good responses to these drugs were: 55% for beta-blockers, 42% for calcium-antagonists and 31% for amitriptyline. CONCLUSIONS: Our data confirm that analgesics are not efficacious in the majority of migraine patients and that the advent of sumatriptan has clearly improved the quality of migrane symptomatic treatment, even though about one-third of migraine patients do not respond to this drug. This study confirm that calcium-antagonists are the antimigraine preventive treatment most frequently prescribed in our country, even though their subjective efficacy is lower than that of beta-blockers.

Pascual J, Leira R, Láinez JM. · Service of Neurology, Department of Medicine (UC), University Hospital 'Marqués de Valdecilla', Santander, Spain. · Cephalalgia. · Pubmed #14984228 No free full text.

Abstract: The aim was to explore whether combining a beta-blocker and sodium valproate could lead to an advantage in efficacy in patients with migraine previously resistant to the two medications in monotherapy. Fifty-two patients (43 women) with a history of episodic migraine with or without aura, and previously unresponsive to beta-blockers and sodium valproate in monotherapy, were treated with a combination of propranolol or nadolol and sodium valproate in an open-label fashion. Eight patients (15%) discontinued due to adverse events. Fifteen (29%) did not respond. The remaining 29 cases (56%) showed response (> 50% reduction in migraine days). The response was excellent in nine (17%). From this open trial, combination therapy with a beta-blocker and sodium valproate appears to be a good migraine preventative in some previously resistant migraine cases. Controlled trials are now necessary to determine the true advantage in efficacy of this combination in difficult to treat migraineurs.

Pascual J, Sánchez del Rio M, Mateos V, Láinez JM, Hernández-Gallego J, Leira R, Jiménez MD. · University Hospital Marqués de Valdecilla (UC), Santander. · Neurologia. · Pubmed #14505244 links to  free full text

Abstract: INTRODUCTION: The efficacy of current preventive migraine treatments is limited. In addition, tolerability problems are not infrequent. OBJECTIVES: To check our experience with topiramate in the treatment of patients with refractory migraine. PATIENTS AND METHODS: We offered treatment with topiramate to patients with the diagnosis of International Headache Society (IHS) migraine who had not responded to or tolerated beta-blockers, amitriptyline, flunarizine and/or valproate. This series is made up of 115 patients (88 women), between 16 and 81 years. Most of them (n=79) fulfilled the Silberstein et al. criteria for transformed migraine. The parameters analyzed were "response" (reduction in migraine frequency>50%), excellent response (>75%) and tolerability. RESULTS: After 3 months, the maintenance doses of topiramate ranged from 25 to 400 mg, though most patients took 100 mg. Twenty-four (21%) patients withdrew due to adverse events, mostly cognitive difficulties, that had already occurred with doses as low as 25-50 mg, while 26 (23%) found topiramate ineffective. The remaining 65 (56%) patients responded, 34 with excellent response. Sixteen patients (10 obese) lost weight (3-13 kg). CONCLUSIONS: Topiramate seems to be a good therapeutic option for about half of the patients with refractory migraine. In these patients response is usually excellent. Intolerance due to adverse events appears in one-fifth of the cases early and at low doses.

Pascual J, Láinez JM, Leira R, Titus F, Mateos V, Galván J, Anonymous00116. · Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, Santander, España. · Neurologia. · Pubmed #12590376 links to  free full text

Abstract: BACKGROUND: Almotriptan, the most recent drug of the triptan family, has shown good efficacy and tolerability profile in clinical trials. OBJECTIVE: To assess almotriptan's tolerability and effectiveness in the setting of routine clinical practice. PATIENTS AND METHODS: 1,643 patients diagnosed of migraine according to IHS criteria were recruited by 317 neurologists in the TEA 2000 study. Patients were instructed to report data on migraine attacks in a diary for a three months follow-up period. Data from 4,253 migraine attacks were obtained. RESULTS: The incidence of adverse events was 0.02 per migraine attack (3,9 % of patients). Subjective clinical improvement after 30 minutes (33.2 y 37.1 %), pain improvement after 2 hours (65.5 % and 70.2 %), pain free response after 2 hours (26.6 % and 29.2 %), recurrence between 2 and 24 hours (21.2 % and 17 %) and a complete response by 24 hours (18.6 % and 22.9 %) were found. These results were obtained in both "intention to treat" and "per protocol" analyses, being even much better when only low pain intensity attacks were considered. CONCLUSIONS: The TEA 2000 study results demonstrate good effectiveness and excellent tolerability profile of almotriptan 12.5 mg in the daily clinical neurological practice. The results of this study confirm those obtained in clinical trials carried out before almotriptan was introduced into the market and that it is a good therapeutic choice for the symptomatic treatment for migraine attacks.