RT info:eu-repo/semantics/doctoralThesis
T1 De la cefalea crónica diaria a la migraña crónica: historia, epidemiología y tratamiento
A1 Martínez Pías, Enrique
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Cefalea
K1 Chronic migraine
K1 Migraña crónica
K1 Daily headache
K1 Cefalea diaria
K1 32 Ciencias Médicas
AB IntroductionTriptans are the most specific symptomatic treatment for migraine available in Spain. All patients with chronic migraine should receive them. However, not all patients use them.Chronic migraine is included in the term chronic daily headache, which has been progressively replaced. Some patients with chronic migraine have daily headache. These individuals are frequently excluded from clinical trials and there are hardly any studies evaluating these patients.OnabotulinumtoxinA is one of the approved preventive treatments for chronic migraine. OnabotulinumtoxinA is one of the few treatments studied in patients with chronic migraine and daily headache.ObjectivesWe will analyze the frequency of triptans use in chronic migraine patients. We will evaluate the triptans contraindications, and the possible causes and consequences of the non-use of triptansWe will review the concept of chronic daily headache, the evolution and the differences with chronic migraine with daily headache. We will evaluate the response to treatment with OnabotulinumtoxinA in patients with chronic migraine and daily headache. We will evaluate the possible response factors to OnabotulinumtoxinA treatment in this group of patients.Material and methodsWe conducted two descriptive observational studies with a case series design. In these studies, we evaluated the use of triptans in patients with chronic migraine and the response to OnabotulinumtoxinA in patients with chronic migraine and daily headache. In a third study, we made a literature review of chronic migraine with daily headache.The studies were conducted in a third-level hospital and were approved by the Ethics Review Boards. The study population included patients diagnosed with chronic migraine by a neurologist expert in headaches. We excluded patients who had conditions that made it difficult to assess their clinical status. We also excluded patients with another headache disorder.ResultsOnly 24% of patients with chronic migraine used triptans upon arrival at the Headache Unit. Only 3.2% of the patients who didn´t use triptan before, had contraindications. Only 12% of patients discontinued triptans due to bad tolerance. Frequency of vascular risk factors, contraceptive drugs or age did not differ between the groups.Up to 78% of patients with chronic daily headache have a migraine phenotype. Despite its name, the term chronic daily headache does not correspond to patients who suffer from headache all the days of the month. Currently, for patients suffering from chronic migraine headache and daily headache, the term chronic migraine with daily headache is used. Up to 33.3% of patients with chronic migraine experience daily headache. These patients could have a different response to treatment than patients without daily headache.ConclusionsThree-quarters of chronic migraine patients did not use triptans. Non-use of triptans was not justified by intolerability, frequency of contraindications or frequency of vascular risk factors. We hypothesize that there is a triptanophobia. Triptanophobia could be defined as the excessive and inadequately justified concern of health professionals about the potential risks of triptans.One in three patients with chronic migraine suffers daily headache. These patients have been systematically excluded from clinical trials. We must study this group of patients and consider whether they should continue to be excluded.Patients with chronic migraine and daily headache did not respond worse than patients without daily headache after three treatment sessions with OnabotulinumtoxinA. The presence of daily headache was associated with a higher response to OnabotulinumtoxinA.
YR 2021
FD 2021
LK https://uvadoc.uva.es/handle/10324/61066
UL https://uvadoc.uva.es/handle/10324/61066
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 11-jul-2024