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Huang J, Wang X, Jin Y, Lou G, Yu Z. Trends and prescribing patterns of antimigraine medicines in nine major cities in China from 2018 to 2022: a retrospective prescription analysis. J Headache Pain 2024; 25:62. [PMID: 38654177 PMCID: PMC11036710 DOI: 10.1186/s10194-024-01775-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The objective of this study was to investigate the trends and prescribing patterns of antimigraine medicines in China. METHODS The prescription data of outpatients diagnosed with migraine between 2018 and 2022 were extracted from the Hospital Prescription Analysis Cooperative Project of China. The demographic characteristics of migraine patients, prescription trends, and corresponding expenditures on antimigraine medicines were analyzed. We also investigated prescribing patterns of combination therapy and medicine overuse. RESULTS A total of 32,246 outpatients who were diagnosed with migraine at 103 hospitals were included in this study. There were no significant trend changes in total outpatient visits, migraine prescriptions, or corresponding expenditures during the study period. Of the patients who were prescribed therapeutic medicines, 70.23% received analgesics, and 26.41% received migraine-specific agents. Nonsteroidal anti-inflammatory drugs (NSAIDs; 28.03%), caffeine-containing agents (22.15%), and opioids (16.00%) were the most commonly prescribed analgesics, with corresponding cost proportions of 11.35%, 4.08%, and 19.61%, respectively. Oral triptans (26.12%) were the most commonly prescribed migraine-specific agents and accounted for 62.21% of the total therapeutic expenditures. The proportion of patients receiving analgesic prescriptions increased from 65.25% in 2018 to 75.68% in 2022, and the proportion of patients receiving concomitant triptans decreased from 29.54% in 2018 to 21.55% in 2022 (both P < 0.001). The most frequently prescribed preventive medication classes were calcium channel blockers (CCBs; 51.59%), followed by antidepressants (20.59%) and anticonvulsants (15.82%), which accounted for 21.90%, 34.18%, and 24.15%, respectively, of the total preventive expenditures. Flunarizine (51.41%) was the most commonly prescribed preventive drug. Flupentixol/melitracen (7.53%) was the most commonly prescribed antidepressant. The most commonly prescribed anticonvulsant was topiramate (9.33%), which increased from 6.26% to 12.75% (both P < 0.001). A total of 3.88% of the patients received combined therapy for acute migraine treatment, and 18.63% received combined therapy for prevention. The prescriptions for 69.21% of opioids, 38.53% of caffeine-containing agents, 26.61% of NSAIDs, 13.97% of acetaminophen, and 6.03% of triptans were considered written medicine overuse. CONCLUSIONS Migraine treatment gradually converges toward evidence-based and guideline-recommended treatment. Attention should be given to opioid prescribing, weak evidence-based antidepressant use, and medication overuse in migraine treatment.
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Affiliation(s)
- Jing Huang
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, China
| | - Xinwei Wang
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, China
| | - Yiyi Jin
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, China
| | - Guodong Lou
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3rd East Qingchun Road, Hangzhou, Zhejiang Province, China
| | - Zhenwei Yu
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3rd East Qingchun Road, Hangzhou, Zhejiang Province, China.
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Comparan HDM, Khaliq A, Frota LM, Pomar-Forero D, Ahmad B, Marnet E, Teixeira FJP, Thomas A, Patel P, Brunkal H, Singireddy S, Lucke-Wold B, Maciel CB, Busl KM. Efficacy of Cyclooxygenase-2 Inhibitors for Headache in Acute Brain Injury: A Systematic Review. Res Sq 2024:rs.3.rs-4232407. [PMID: 38659820 PMCID: PMC11042422 DOI: 10.21203/rs.3.rs-4232407/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background Headache management after acute brain injury (ABI) is challenging. While opioids are commonly used, selective cyclooxygenase-2 inhibitors (COXIBs) may be promising alternatives. However, concerns about cardiovascular effects and bleeding risk have limited their use. We aimed at summarizing available data on efficacy of COXIBs for headache management following ABI. Methods A systematic review was conducted through MEDLINE and Embase for articles published through 09/2023 (PROSPERO CRD42022320453). No language filters were applied to the initial searches. Interventional or observational studies and systematic reviews assessing efficacy of COXIBs for headache in adults with ABI were eligible. Article selection was performed by two independent reviewers using Distiller SR®. Descriptive statistics were used for data analysis, while meta-analysis was unfeasible due to study heterogeneity. Results Of 3190 articles identified, six studies met inclusion criteria: four randomized controlled trials and two retrospective cohort studies, all conducted in neurosurgical patients (total n=738) between 2006-2022. Five studies used COXIBs in the intervention group only. Of the six studies, four found a reduction in overall pain scores in the intervention group, while one showed improvement only at 6 hours postoperative, and one did not find significant differences. Pain scores decreased between 4-15%, the largest shift being from moderate to mild severity. Three studies found an overall opioid use reduction throughout hospitalization in the intervention group, while one reported a reduction at 12 hours postoperative only. Opioid consumption decreased between 9-90%. Two studies found a decrease in hospital-length-of-stay by ~1 day in the intervention group. The one study reporting postoperative hemorrhage found a statistically non-significant 3% reduction in the intervention group. Conclusions In adults with ABI, COXIBs may serve as opioid-sparing adjunctive analgesics for headache control, with limited but pointed data to indicate efficacy in the post-neurosurgical setting. However, further safety data remains to be elucidated.
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Affiliation(s)
- Hector David Meza Comparan
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Anum Khaliq
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Luciola Martins Frota
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Daniela Pomar-Forero
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Bakhtawar Ahmad
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Erica Marnet
- Department of Medicine, Bridgeport Hospital, Bridgeport, CT, USA 06610
| | - Fernanda J P Teixeira
- Department of Neurology, University of Miami/Jackson Memorial Hospital, FL, USA, 33130
| | - Anita Thomas
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Priyank Patel
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Haley Brunkal
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Saanvi Singireddy
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, FL 32611, USA
| | - Carolina B Maciel
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA; Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, FL 32611, USA; Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA; Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA
| | - Katharina M Busl
- Department of Neurology, Division of Neurocritical Care, University of Florida, College of Medicine, Gainesville, FL 32611, USA; Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, FL 32611, USA
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Wijeratne T, Jenkins B, Stark RJ, Sun-Edelstein C. Assessing and managing medication overuse headache in Australian clinical practice. BMJ Neurol Open 2023; 5:e000418. [PMID: 37304309 PMCID: PMC10255228 DOI: 10.1136/bmjno-2023-000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/30/2023] [Indexed: 06/13/2023] Open
Abstract
More than 3 million Australians are estimated to have migraine disorders, and over a quarter of a million Australians are estimated to have medication overuse headache (MOH). The personal, societal and economic burden of MOH is high. MOH impacts an individual's ability to work or study, care for family or themselves, culminating in poor quality of life. Accurate and timely diagnosis and treatment of MOH are imperative. Withdrawal failures and relapse rates are high in MOH. Treatment of MOH is aimed at ceasing medication overuse and reducing monthly migraine days with the aim of achieving a pattern of well-controlled episodic migraine. Current treatment approaches in routine practice include withdrawal with preventive treatment, withdrawal with optional preventive treatment in the subsequent weeks and preventive treatment without withdrawal. This viewpoint article provides an overview of managing MOH in Australian clinical practice, with a focus on the importance of patient education and the role of preventive treatment in supporting patients as they withdraw from acute migraine medication(s).
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Affiliation(s)
- Tissa Wijeratne
- Department of Neurology, Sunshine Hospital, St Albans, Victoria, Australia
- Department of Medicine, Sunshine Hospital, St Albans, Victoria, Australia
- The Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
- Department of Psychology, RMIT University, Melbourne, Victoria, Australia
| | - Bronwyn Jenkins
- Department of Neurology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Richard J Stark
- Department of Neurology and Neurosciences, Alfred Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, Monash University, Clayton, Victoria, Australia
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Orsi S, Melhado EM, Zambelli BAK, Paternost BA, Farina JHF, Ferreira SG, Albuquerque TVC. Knowledge of the medical resident about diagnosis and treatment of patients with headache. Headache Med 2022. [DOI: 10.48208/headachemed.2022.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction
Considering the high prevalence of headache, it is necessary a study about the effectiveness of the care of patients with headache by medical resident in Emergency Care Units (EDU) and medical outpatient clinics.
Objective
The objective of this study was to analyze the effectiveness of care in EDUs, outpatient clinics and medical wards and the management of patients with headache complaints.
Method
The study was observational descriptive (cross-sectional cohort) through the application of an online questionnaire answered by the medical residents.
Results
There were 115 residents who answered the survey. In the group of residents who see patients with headache (n=95) the number of visits was 4.87 per week. The resident's idea is that headaches are symptoms of an underlying disease in 49.5% of them. On the question about feeling able to differentiate primary from secondary headaches, 50% of the residents said yes. On the question, "Is Migraine the same as Headache?" 6.1% answered yes. On the question, "Would you use morphine derivatives to treat headache?" 19.1% of the residents answered that they would. On the question about having knowledge about the harms of using morphine derivatives in headache, 60% answered that they did not have in-depth knowledge or that they have no knowledge. In this sample of residents, 74/115 (65%) suffer from headache. Only 36/115 (31%) of the residents sought care because of the headache. Of the residents, 3/115 (2.6%) have chronic daily headache. In the question about knowing what is "chronic daily headache" and from medication overuse, about 35% do not know or did not delve into the concept.
Conclusion
We conclude that there is a lack of teaching about types of headaches, criteria for diagnosis and treatment. Urgent modifications should be made in the medical course to enable newly graduated doctors to diagnose and treat patients with headache.
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