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Göbel CH, Heinze A, Cirkel A, Göbel H. Rizatriptan as an Over-the-Counter Triptan in the Treatment of Migraine Attacks. Pain Ther 2024; 13:813-827. [PMID: 38886287 PMCID: PMC11255172 DOI: 10.1007/s40122-024-00625-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Abstract
Around 91% of migraine patients use over-the-counter medicines to treat attacks, often without further treatment or medical consultation. This therapeutic principle is established in most countries, regardless of how the healthcare system is otherwise structured or financed. Using Germany as an example, the basis for an expansion of attack therapy with rizatriptan as an over-the-counter triptan is described. To achieve the best possible tolerability and safety in the context of self-medication, the lowest possible dose should be selected to provide the most favourable tolerability and safety profile in the context of self-medication through low dosages. The lowest approved dose of rizatriptan is 5 mg. This was investigated in three randomized controlled trials with 752 patients. The results show that rizatriptan at a dose of 5 mg is more effective than the triptans naratriptan 2.5 mg, almotriptan 12.5 mg and sumatriptan 50 mg, which were previously available for self-medication in Germany. There was no significant difference in the frequency of adverse events with rizatriptan 5 mg compared to placebo. Rizatriptan 5 mg does not have a higher side effect potential than sumatriptan 50 mg, which is already exempt from the prescription requirement. The reasons given show that rizatriptan in a dose of 5 mg for the treatment of acute migraine attacks fulfils the requirements for a transfer from prescription to pharmacy-only status at least as well as sumatriptan 50 mg, naratriptan 2.5 mg and almotriptan 12.5 mg. From a clinical care perspective, it is desirable for affected patients to have other options available for self-medication. Non-responders to other substances also have a further treatment option with rizatriptan 5 mg, with the same or even better risk-benefit profile, to treat migraine attacks safely, effectively and in a tolerable manner as part of self-medication.
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Affiliation(s)
- Carl H Göbel
- Kiel Migraine and Headache Centre, Heikendorfer Weg 9-27, 24149, Kiel, Germany.
| | - Axel Heinze
- Kiel Migraine and Headache Centre, Heikendorfer Weg 9-27, 24149, Kiel, Germany
| | - Anna Cirkel
- Kiel Migraine and Headache Centre, Heikendorfer Weg 9-27, 24149, Kiel, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Hartmut Göbel
- Kiel Migraine and Headache Centre, Heikendorfer Weg 9-27, 24149, Kiel, Germany
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Zaranek L, Sobe H, Richter M, Hübler A, Berner R, von der Hagen M, Koch T, Sabatowski R, Klimova A, Goßrau G. [Gender-specific results of the Dresden children and adolescents headache program DreKiP]. Schmerz 2024; 38:107-117. [PMID: 37737282 PMCID: PMC10959813 DOI: 10.1007/s00482-023-00756-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Girls and women are more frequently affected by headache than boys and men. The influence of gender on the effectiveness of headache therapies has so far been hardly investigated. We examined gender differences in the outpatient multimodal Dresden Child and Adolescent Headache Program DreKiP. METHODS We treated 140 patients with primary headache in a 15-hour structured group program. At baseline (T0) and six (T1) and twelve months (T2) after the end of the program, data on headache-related limitation of daily activities (PedMIDAS) as well as headache frequency, intensity, and pain-related disability (P-PDI) were collected. Retrospectively, these data were analyzed separately for girls and boys. RESULTS For 91 patients (9-19 years, median = 15; 71.4 % female) data were available for at least two measurement time points. Girls showed significantly higher headache frequency than boys at all time points (median headache days/last three months at T0: ♀ 43, ♂ 20; T1: ♀ 32, ♂ 12; T2: ♀ 28, ♂ 9) as well as numerically higher headache-related limitation of daily life. There were significant effects over time with a decrease in headache frequency (F (2.88) = 5.862; p = 0.004) and improvement in daily functioning (F (2.92) = 5.340; p = 0.006). There was no gender-specific treatment response. DISCUSSION The DreKiP therapy shows effects in girls and boys with primary headache. Higher headache frequencies and everyday life restrictions in girls may have hormonal but also psychosocial causes and should be addressed in educational measures.
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Affiliation(s)
- Laura Zaranek
- Klinik für Kinder- und Jugendmedizin, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
| | - Hanna Sobe
- UniversitätsSchmerzCentrum, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Matthias Richter
- Klinik für Kinder- und Jugendmedizin, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
- UniversitätsSchmerzCentrum, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Anke Hübler
- UniversitätsSchmerzCentrum, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
- Klinik für Anästhesiologie und Intensivtherapie, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
| | - Reinhard Berner
- Klinik für Kinder- und Jugendmedizin, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
| | - Maja von der Hagen
- Klinik für Kinder- und Jugendmedizin, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
- Abteilung Neuropädiatrie, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
| | - Thea Koch
- Klinik für Anästhesiologie und Intensivtherapie, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
| | - Rainer Sabatowski
- UniversitätsSchmerzCentrum, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
- Klinik für Anästhesiologie und Intensivtherapie, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
| | - Anna Klimova
- NCT Partner Site Dresden, Institut für Medizinische Informatik und Biometrie, Medizinische Fakultät "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
| | - Gudrun Goßrau
- UniversitätsSchmerzCentrum, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
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Gaul C, Förderreuther S, Lehmacher W, Weiser T. Correlation of effectiveness and tolerability assessments from a pharmacy-based observational study investigating the fixed-dose combination of 400 mg ibuprofen plus 100 mg caffeine for the treatment of acute headache. Front Neurol 2023; 14:1273846. [PMID: 37941578 PMCID: PMC10628638 DOI: 10.3389/fneur.2023.1273846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/28/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Observational studies are valuable for investigating correlations between patient-reported treatment outcomes. In this study, we report a secondary analysis of a published pharmacy-based observational (patient-centered "real-world" outcomes) study on experiences reported by patients who treated their headache with an over-the-counter analgesic. Methods A pharmacy-based exploratory survey was conducted in German community pharmacies. Patients buying a fixed-dose analgesic combination product (400 mg ibuprofen + 100 mg caffeine; IbuCaff) to treat their headache were offered a questionnaire that contained-among others-questions about time to onset of pain relief (OPR), assessment of time to onset of pain relief (AOPR), assessment of efficacy and tolerability, and pain intensity 2 h after intake. A correlation analysis of the data was performed. Moreover, perceived treatment effects compared to other acute headache medications used in the past were collected. Results The correlation between OPR and AOPR was high (Spearman rank correlation r = 0.594, p < 0.0001). Headache patients assessed the onset of analgesic action within 15 min as "very fast" and within 30 min as "fast". The other readouts were correlated as well [assessment of efficacy and % pain intensity difference (%PID) at 2 h: r = 0.487; OPR/AOPR and %PID at 2 h: r = 0.295/0.318; OPR/AOPR and assessment of tolerability: r = 0.206/0.397; OPR/AOPR and assessment of efficacy: r = 0.406/0.594; assessment of efficacy and assessment of tolerability: r = 0.608; p < 0.0001 for all correlations]. Compared to previous treatments, most patients (>89%) assessed the speed of analgesic action, efficacy, and tolerability of IbuCaff as equal to or better than for the previous treatment. Discussion Headache patients assessed the onset of analgesia within 15 min as "very fast" and within 30 min as "fast". Efficacy assessments for acute headache medication appear to be highly correlated.
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Affiliation(s)
- Charly Gaul
- Headache Center Frankfurt, Frankfurt, Germany
| | | | - Walter Lehmacher
- Emeritus, Institute for Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - Thomas Weiser
- Medical Consumer Healthcare, Sanofi, Frankfurt, Germany
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Klan T, Diezemann-Prößdorf A, Guth AL, Gaul C, Witthöft M. [Fear of migraine attacks: diagnosis and treatment]. Schmerz 2023:10.1007/s00482-023-00711-y. [PMID: 37072537 PMCID: PMC10112828 DOI: 10.1007/s00482-023-00711-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 04/20/2023]
Abstract
In the field of headache disorders, the term "fear of attacks" refers to the fear of a headache attack occurring. Excessive fear of attacks may worsen the course of a migraine and lead to an increase in migraine activity. In the assessment of attack-related fear, a categorical (fear of attacks as a specific phobia) and a dimensional approach (measuring the extent of fear using a questionnaire) are available. The 29-item Fear of Attacks in Migraine Inventory (FAMI) is an economic self-report questionnaire for the assessment of attack-related fear, and it has good psychometric properties. The treatment of attack-related fear includes behavioral interventions as well as pharmacological therapy. Behavioral interventions have few side effects and are based on the treatment of common anxiety disorders (e.g., agoraphobia). Although the evidence of existing treatments is sparse, attack-related fear should be considered in routine care.
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Affiliation(s)
- Timo Klan
- Psychologisches Institut, Johannes Gutenberg-Universität Mainz, Wallstr. 3, 55099, Mainz, Deutschland.
| | | | | | - Charly Gaul
- Kopfschmerzzentrum Frankfurt, Frankfurt, Deutschland
| | - Michael Witthöft
- Psychologisches Institut, Johannes Gutenberg-Universität Mainz, Wallstr. 3, 55099, Mainz, Deutschland
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Greenbaum T, Emodi-Perlman A. Headache and orofacial pain: A traffic-light prognosis-based management approach for the musculoskeletal practice. Front Neurol 2023; 14:1146427. [PMID: 36895899 PMCID: PMC9990418 DOI: 10.3389/fneur.2023.1146427] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/26/2023] [Indexed: 02/22/2023] Open
Abstract
Introduction Headache (HA) is one of the most prevalent disabling conditions worldwide and is classified as either primary or secondary. Orofacial pain (OFP) is a frequent pain perceived in the face and/or the oral cavity and is generally distinct from a headache, according to anatomical definitions. Based on the up-to-date classification of the International Headache Society, out of more than 300 specific types of HA only two are directly attributed to the musculoskeletal system: The cervicogenic HA and HA attributed to temporomandibular disorders. Because patients with HA and/or OFP frequently seek help in the musculoskeletal practice, a clear and tailored prognosis-based classification system is required to achieve better clinical outcomes. Purpose The aim of perspective article is to suggest a practical traffic-light prognosis-based classification system to improve the management of patients with HA and/or OFP in the musculoskeletal practice. This classification system is based on the best available scientific knowledge based on the unique set-up and clinical reasoning process of musculoskeletal practitioners. Implications Implementation of this traffic-light classification system will improve clinical outcomes by helping practitioners invest their time in treating patients with significant involvement of the musculoskeletal system in their clinical presentation and avoid treating patients that are not likely to respond to a musculoskeletal based intervention. Furthermore, this framework incorporates medical screening for dangerous medical conditions, and profiling the psychosocial aspects of each patient; thus follows the biopsychosocial rehabilitation paradigm.
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Affiliation(s)
- Tzvika Greenbaum
- Department of Physical Therapy, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alona Emodi-Perlman
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gaul C, Gräter H, Weiser T, Michel MC, Lampert A, Plomer M, Förderreuther S. Impact of the Neck and/or Shoulder Pain on Self-reported Headache Treatment Responses – Results From a Pharmacy-Based Patient Survey. Front Neurol 2022; 13:902020. [PMID: 35923833 PMCID: PMC9339896 DOI: 10.3389/fneur.2022.902020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/21/2022] [Indexed: 01/10/2023] Open
Abstract
Neck and/or shoulder pain (NSP) frequently occurs together with headache. Therefore, we explored how patients with and without concomitant NSP differ in their baseline characteristics and in perceived treatment responses to an analgesic. An anonymous survey was performed among 895 patients with headache (735 self-reported tension-type headache [TTH]) who used an analgesic fixed-dose combination containing 400 mg ibuprofen and 100 mg caffeine as a non-prescription treatment. NSP was abundant among patients in our survey (60%) and was associated with >1 additional day of headache per month. Patients with NSP reported predominantly sedentary work more frequently than those without (40 vs. 29%); they also reported physical tension/poor posture as a perceived trigger factor more frequently (70 vs. 16%). The reported pain reduction was comparable in those with and without concomitant NSP regardless of whether assessed as mean pain rating (from about 6 to 1.5 on a 10-point rating scale), patients experiencing a ≥50% in pain reduction (89.6 vs. 88.8%) or becoming pain-free within 2 h (57 vs. 64%). However, recurrence of pain and use of another dose within the same day were more frequent with than without NSP. We conclude that concomitant NSP is frequent in patients with headache but does not substantially alter responses to a non-prescription medication.
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Affiliation(s)
- Charly Gaul
- Headache Center Frankfurt, Frankfurt am Main, Germany
| | - Heidemarie Gräter
- Medical Consumer Healthcare, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Thomas Weiser
- Medical Consumer Healthcare, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Martin C. Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany
- *Correspondence: Martin C. Michel
| | - Anette Lampert
- Medical Consumer Healthcare, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Manuel Plomer
- Medical Consumer Healthcare, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
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A Digital Health Application Allowing a Personalized Low-Glycemic Nutrition for the Prophylaxis of Migraine: Proof-of-Concept Data from a Retrospective Cohort Study. J Clin Med 2022; 11:jcm11041117. [PMID: 35207390 PMCID: PMC8878080 DOI: 10.3390/jcm11041117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Migraine is a headache disorder with the highest socioeconomic burden. The aim of this study was to deliver the first proof-of-concept data of the potential role of an individual low-glycemic diet provided by a novel digital health application in the prophylaxis of migraine. Methods: We analyzed data from a retrospective survey of individuals who participated in a digital nutrition program that provides dietary recommendations based on the individual analysis of continuous glucose measurement from an up to 14-day test phase. A total of 84 individuals completed the retrospective digital survey. The endpoints were changes in the number of migraine days, average duration of attacks, average pain severity, frequency of intake of pain medication, absenteeism, and presenteeism before and after program participation. Results: The intraindividual comparisons of the endpoints before and after program participation revealed decreases in migraine frequency and other patient-relevant migraine parameters. Moreover, patients with a baseline migraine frequency of two and more migraine days per month and adherence to the dietary recommendations (n = 40) showed a mean reduction in migraine days by 33% with a 50%-responder rate of 38%. Conclusions: The data provides emerging evidence that an individualized low-glycemic diet based on continuous glucose measurement could be a promising approach for a diet-based, non-pharmacological migraine prophylaxis. However, future research is required to confirm the implied effectiveness.
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von der Lippe E, Krause L, Porst M, Wengler A, Leddin J, Müller A, Zeisler ML, Anton A, Rommel A. Prevalence of back and neck pain in Germany. Results from the BURDEN 2020 Burden of Disease Study. JOURNAL OF HEALTH MONITORING 2021; 6:2-14. [PMID: 35586774 PMCID: PMC8832370 DOI: 10.25646/7855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/18/2021] [Indexed: 11/20/2022]
Abstract
Back and neck pain are widespread and can significantly reduce quality of life. A cross-sectional telephone survey (N=5,009) was carried out between October 2019 and March 2020 to gain a valid estimate of the prevalence of back and neck pain among adults in Germany. In addition to the frequency and intensity of back and neck pain, the study collected information about quality of life and comorbidity. The findings showed that 61.3% of respondents reported back pain in the last twelve months. Lower back pain was reported about twice as often as upper back pain, with 15.5% of respondents stating that they experienced chronic back pain. 45.7% reported neck pain, and 15.6% of respondents have experienced lower and upper back pain in addition to neck pain in the past year. Women are affected by all types of pain more often than men. About half of the respondents categorise their back or neck pain as moderate; older respondents report significantly more pain episodes per month than younger respondents. The results described here provide a comprehensive picture of the population-related limitations associated with back and neck pain and are used within the framework of the BURDEN 2020 study to quantify key indicators of burden of disease calculation.
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Affiliation(s)
- Elena von der Lippe
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Laura Krause
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Michael Porst
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Annelene Wengler
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Janko Leddin
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Anja Müller
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Marie-Luise Zeisler
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Aline Anton
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Alexander Rommel
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
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