Glen D. Solomon

Quality of life and well-being of headache patients : measurement by the medical outcomes study instrument

SYNOPSIS

Burden of migraine. A review of its socioeconomic impact.

According to population-based epidemiological studies using International Headache Society diagnostic criteria, the prevalence of migraine in developed countries ranges from 8 to 14%. These prevalence figures confirm the widespread nature of the disorder. Moreover, as migraine is a chronic episodic disorder that predominantly affects people during their working lives (between the ages of 25 and 55 years), indirect costs associated with reduced productivity represent a substantial proportion of the total cost of migraine.The results of health-related quality-of-Life studies demonstrate that migraine has a considerable impact on functional capacity, resulting in disrupted work and social activities. Many migraineurs, however, do not seek medical attention, have not been accurately diagnosed by a physician or do not use prescription medication. Therefore, the direct costs of treatment for migraine are relatively small compared with the indirect costs.Migraine is an important chronic illness that has a major impact on the working sector of a population. The overall cost attributable to migraine is unknown, but it is now established that the indirect costs of migraine outweigh the direct costs and therefore represent an obvious target for healthcare intervention aimed at reducing the impact of this chronic condition.

The burden of migraine to the individual suffer: a review

This review of the literature reveals that migraine is a common, chronic condition featuring episodic attacks which vary in severity and sympatomatology. Throbbing, unilateral headache, which is aggravated by activity, is the most prominent feature, although a high proportion of sufferers also experience phonophobia, photophobia, and nausea, which may lead to vomiting. Preceding aura is a less common feature of the attack. The frequency and duration of migraine attacks varies widely between individuals, though the median frequency is around 1 attack per month and median duration is roughly 24 h. Migraine attacks can have a profound effect on the day‐to‐day lives and well‐being of the sufferer. In the long term, migraine may cause profound emotional changes and result in coping strategies that interfere with working, social and family life and many normal daily activities. These effects are apparent in quality of life studies on migraine patients. Thus, the impact of migraine on many quality of life parameters is similar to that of other chronic conditions such as osteoarthritis, diabetes and depression. Reduction in the personal burden of migraine can be facilitated by encouraging migraine sufferers to consult their doctor, through accurate diagnosis of migraine headaches and assessment of the disability suffered by the migraineurs, and through improved and well‐executed treatment strategies.

Quality of Life Assessment Among Migraine Patients Treated With Sumatriptan

Purpose.‐Quality of life evaluations can enhance traditional measures of therapeutic efficacy. The purpose of our study was to evaluate the impact of sumatriptan on the quality of life of patients with migraine headaches.

Demographics of Headache in Elderly Patients

SYNOPSIS

Therapeutic advances in migraine.

Migraine is a common and debilitating disorder of uncertain pathogenesis. Recent research into the pathophysiology of migraine and serotonin receptors has revolutionized the approach to pharmacotherapy. New medications, such as sumatriptan, and new dosage forms of older medications, including dihydroergotamine, NSAIDs, and phenothiazines are available to treat acute attacks. New prophylactic approaches include the use of calcium‐channel blockers, NSAIDs, fluoxetine, and valproate. The addition of several new agents for the acute and prophylactic therapy of migraine has improved the outlook for this disabling disorder.

Quality-of-life assessment in patients with headache.

SummaryAlthough headache is the most common pain complaint secn by primary care physicians, the measurement of quality of life in patients with headache is in its earliest stages. Most of the research has been published within the past 2 years, much of it only in abstract form, Quality—of—life data derived from the Medica[ Outcomes SlUdy instrument (SF−20) demonst rate that chronic headache disorders are associated with significant limitations in all 6 health categori es of patient well—being and functioning. The outcomes profi le for each of the common benign headache disorders appear to be unique for the specific headache diagnosis. Migraine is primarily associated with an impairment in role (work) functioning. Chronic tension—type headache is associated with a marked impairment in mental health and a generalised impairment in functioning. Cluster headache is associated with the greatest amount of pain, but with little impairment in physical functioning.The economic toll of recurrent headache is considerable. Lost productivity in the US due to migraine is esti mated at

The Impact of Drug Therapy on Quality of Life in Headache and Migraine

US6.5 to 17.2 billion per year. Chronic headache disorders cause sign ifica ntly more morbidity, impairment of function. and economic loss than has previously been recognised.

The pharmacology of medications used in treating headache

SummaryAlthough headache is among the most common and costly disorders in primary care, our understanding of its direct impact on the quality of life of affected individuals is incomplete. While studies evaluating the role of headache on health-related quality of life and healthcare economics are starting to appear in the medical literature, the effect of pharmacotherapy in improving quality of life is only beginning to be studied.At present, studies evaluating health-related quality of life in patients with migraine who are undergoing treatment are limited to 3 agents: sumatriptan, flurbiprofen and diclofenac. Several studies have consistently indicated that these drugs benefit patients by improving key dimensions of health-related quality of life or patients’ sense of well-being to a significant extent.Given the magnitude of functional and emotional impairment associated with chronic headache disorders, assessing patients’ perceptions of their quality of life makes a useful contribution to the evaluation of therapeutic interventions and should supplement traditional clinical endpoints in determining the effectiveness of new drugs.

Hypersensitivity to substance P in the etiology of postlumbar puncture headache.

Migraine is a common and disabling disease of uncertain pathogenesis. Research on the trigeminovascular system, serotonin receptors, and substance P have provided clues to improving the pharmacotherapy of this disorder. Selective serotonin agonists, such as sumatriptan, dihydroergotamine, ergotamine tartrate, nonsteroidal anti-inflammatory drugs (NSAIDS), isometheptene mucate, and phenothiazines are useful to treat acute attacks. Prophylactic agents include beta-blockers, calcium channel blockers, NSAIDs, antidepressants, and valproate. The addition of several new agents for the acute and prophylactic therapy of migraine has improved the outlook for this debilitating disorder.