Principles of migraine treatment

Abstract

Introduction. Migraine is a recurrent headache disorder affecting ∼15% of the population during the most productive periods of their lives, between the ages of 22 and 55 years. Chronic migraine is no longer considered a complication of migraine and is recognized in individuals that had at least five attacks fulfilling criteria for migraine with/or without aura. This disorder affects 1,4-2,2% of the population and is associated with a higher headache impact in comparison with the episodic migraine. Medication overuse of acute analgesics often occurs with chronic migraine. In patients with migraine frequent intake of acute headache medication can increase the frequency and intensity of headache, causing a vicious circle of further intake of medication and increased attack frequency. Here is how the treatment can become the cause of another separate condition, known as medication-overuse headache.Aim of the study. To determine medication overuse of acute treatment in patients with chronic migraine and its impact to the severity of the disease. Materials and methods. In this study were included 36 patients with confirmed clinical diagnosis of chronic migraine who requested a consultation of a neurologist at the Institute of Neurology and Neurosurgery in Chisinau. The study was based on survey: self-report questionnaire with references to the medicamentous migraine treatment and Migraine patient assessment questionnaire from the National Clinical Protocol. A clinical analysis of the disease and medication intake were performed. The patients were separated in two groups: with and without medication overuse of acute treatment (medication overuse is diagnosed if a limit medication days per month is exceeded for ergotamines, triptans, opioids and combination drugs ≥10 days per month, and for simple analgesics ≥15 days per month, both for longer than 3 months), based on the results of two questionnaires. Student-T test was chosen as statistical criteria for this research. Results. We found that patients with medication overuse of acute treatment have a significantly more severe clinical signs of the disease. We compared the following clinical outcomes: number of days with headache per month and intensity of headache. In case of medication abuse we found higher values on two parameters: frequency (p<0.0001) and intensity (p=0.0016) of headache per month. Conclusions. On conclusion, the analysis of our data support the concept that medication overuse is the reason for the development of more severe clinical signs in patients with existing primary headache disorder. Patients who managed correctly their migraine attacks have moderated clinical signs.