Showing papers by "Miguel J. A. Láinez published in 2019"

Non-invasive vagus nerve stimulation (nVNS) for the preventive treatment of episodic migraine: The multicentre, double-blind, randomised, sham-controlled PREMIUM trial

Abstract: IntroductionNon-invasive vagus nerve stimulation (nVNS; gammaCore®) has the potential to prevent migraine days in patients with migraine on the basis of mechanistic rationale and pilot clinical dat...

Economic benefits of treating medication-overuse headache – results from the multicenter COMOESTAS project:

Abstract: BackgroundMedication-overuse headache is a costly disease for individuals and society.ObjectiveTo estimate the impact of medication-overuse headache treatment on direct and indirect headache-relate...

Psychological, clinical, and therapeutic predictors of the outcome of detoxification in a large clinical population of medication-overuse headache: A six-month follow-up of the COMOESTAS Project.

Abstract: AimTo identify factors that may be predictors of the outcome of a detoxification treatment in medication-overuse headache.MethodsConsecutive patients entering a detoxification program in six centre...

Clinical Subtypes of Medication Overuse Headache - Findings From a Large Cohort

Abstract: BACKGROUND The International Classification of Headache Disorders lists different subtypes of medication overuse headache (MOH), according to the medication overused. The aim of this study is to evaluate whether the different subtypes correspond to clinically distinguishable phenotypes in a large population. METHOD This descriptive cross-sectional observational study included 660 patients with MOH referred to headache centers in Europe and Latin America as a part of the COMOESTAS project. Information about clinical features was collected with structured patient interviews and with self-administered questionnaires for measuring disability, anxiety, and depression. RESULTS Female/male ratio, body mass index, marital status, and level of education were similar among in subjects enrolled in the 5 centers. The mean age was higher among subjects overusing triptans (T-MOH) with respect to subjects overusing simple analgesic (A-MOH). Duration of headache before chronification was longer in T-MOH (19.2 ± 11.9 years) and in subjects overusing ergotamines (E-MOH, 17.8 ± 11.7 years) with respect to the A-MOH group (13.1 ± 10.9; P < .001 and P = .017, respectively) and in T-MOH with respect multiple drug classes (M-MOH, 14.9 ± 11.7; P = .030). Migraine Disability Assessment (MIDAS) score was significantly lower in E-MOH group (33.6 ± 41.6), while T-MOH group (56.8 ± 40.6) had a significant lower MIDAS score with respect to M-MOH (67.2 ± 62.5; P = .016 and P = .037, respectively). Prevalence of depression and anxiety was lower in patients overusing T with respect to other groups of patients (χ2 = 10.953, P = .027 and χ2 = 25.725, P < .001, respectively). CONCLUSION In this study on a large and very well characterized population of MOH, we describe the distinctive clinical characteristics of MOH subtypes. These findings contribute to more clearly define the clinical picture of a poorly delineated headache disorder. They also provide some insights in the possible trajectories leading to this highly disabling chronic headache, that is classified as a secondary form, but whose occurrence is entirely dependent on an underlying primary headache.

Pharmacologic Approaches to CDH: Evidence and Outcomes

Abstract: Chronic daily headache (CDH) is a highly prevalent condition that severely affects patient’s lives Most patients with CDH experience chronic migraine (CM) The management of these patients is complex and includes acute and preventive pharmacological treatment In CDH, the use of acute medication should be restricted to avoid the risk of medication-overuse headache However, the use of preventive medication should be considered in all patients with CDH There are few studies investigating the role of preventives in CDH, and the majority have CM Topiramate and onabotulinumtoxinA are the only two drugs with proved scientific evidence in the prevention of CM There are other neuromodulators, beta-blockers, calcium channel blockers, or antidepressants useful in the management of this population of patients We will present evidence for the efficacy of each drug and for recommended use