Vera Osipova

The prevalence of primary headache disorders in Russia: A countrywide survey

Objective: To estimate the 1-year prevalences of primary headache disorders and identify their principal risk factors in the general population of Russia. Methods: A countrywide population-based random sample of 2725 biologically unrelated adults in 35 cities and nine rural areas were interviewed in a door-to-door survey using a previously validated diagnostic questionnaire. Results: Of the 2725 eligible adults contacted, 2025 (74.3%) responded (females 52.6%, mean age 39.5 ± 13.4 years). Of these, 1273 (62.9%) reported headache ‘not related to flu, hangover, cold, head injury’ occurring at least once in the previous year. The gender- and age-standardized 1-year prevalence of migraine was 20.8%. Female gender (odds ratio (OR) = 3.8; 95% confidence interval (CI) 2.8–5.1) and obesity (OR = 1.5; 1.1–2.1) were positively associated with this type of headache. The gender- and age-standardized 1-year prevalence of tension-type headache (TTH) was 30.8%. TTH was more prevalent in urban than in rural areas (OR = 1.6; 1.3–2.0). Headache on ≥15 days/month was reported by 213 (10.5%) respondents (gender- and age-standardized prevalence 10.4%), and associated with low socioeconomic status (OR = 3.4; 2.4–4.9), obesity (OR = 3.0; 2.1–4.3), female gender (OR = 2.9; 2.1–4.1) and age over 40 years (OR = 2.6; 1.9–3.6). The majority of these respondents (68.1%) overused acute headache medications. Conclusion: The study demonstrated a high prevalence of migraine and a very high prevalence of headache on  ≥15 days/month, and revealed unmet health-care needs of people with headache in Russia.

A basic diagnostic headache diary (BDHD) is well accepted and useful in the diagnosis of headache. a multicentre European and Latin American study.

Aims: We tested the usability and usefulness of the basic diagnostic headache diary (BDHD) for the diagnosis of migraine, tension-type headache and medication-overuse headache in European and Latin American countries. Methods: Patients were subdivided into two groups according to a 1:1 randomization list. Those in group 1 were sent the BDHD before their first visit to the headache centre and asked to complete it for at least 1 month. Those in group 2 made their first visit to the headache centre without receiving the BDHD. Results: A total of 626 patients from nine countries and 16 centres completed the study. The BDHD entries were complete in 97.5% of cases. BDHD information and clinical interview were, when taken together, considered complete for diagnosis in 97.7% of cases in group 1 whereas the information obtained by clinical interview alone in group 2 was considered complete in only 86.8% of cases (p < 0.001). The median number of diagnoses per patient in group 1 was significantly higher than in group 2 (p = 0.04). The BDHD was very well accepted by both patients and doctors. Conclusions: It is concluded that the BDHD is a useful tool in the diagnostic assessment of the most frequent and disabling forms of primary headache and in headache management.

The burden of headache in Russia: validation of the diagnostic questionnaire in a population-based sample.

Background:  We report validation of the Russian‐language version of the Lifting The Burden headache screening and diagnostic questionnaire in a population‐based sample of 501 individuals in four cities (Smolensk, Tchelyabinsk, Nishny Novgorod and Tver) and three rural areas (Tula, Tver and Gornyi) of Russia.

Headache‐attributed burden and its impact on productivity and quality of life in Russia: structured healthcare for headache is urgently needed

The study evaluated headache‐attributed burden and its impact on productivity and quality of life (QoL) in Russia. Its purpose was to support recommendations for change.

ARISE: A Phase 3 randomized trial of erenumab for episodic migraine:

Background Calcitonin gene-related peptide plays an important role in migraine pathophysiology. Erenumab, a human monoclonal antibody that inhibits the calcitonin gene-related peptide receptor, is being evaluated for migraine prevention. Methods In this randomized, double-blind, placebo-controlled, phase 3 study, 577 adults with episodic migraine were randomized to placebo or 70 mg erenumab; 570 patients were included in efficacy analyses. Primary endpoint was change in monthly migraine days. Secondary endpoints were ≥50% reduction in monthly migraine days, change in acute migraine-specific medication treatment days, and ≥5-point reduction in Physical Impairment and Impact on Everyday Activities domain scores measured by the Migraine Physical Function Impact Diary. All endpoints assessed change from baseline at month 3. Results Patients receiving erenumab experienced −2.9 days change in monthly migraine days, compared with −1.8 days for placebo, least-squares mean (95% CI) treatment difference of −1.0 (−1.6, −0.5) (p < 0.001). A ≥ 50% reduction in monthly migraine days was achieved by 39.7% (erenumab) and 29.5% (placebo) of patients (OR:1.59 (95% CI: 1.12, 2.27) (p = 0.010). Migraine-specific medication treatment days were reduced by −1.2 (erenumab) and −0.6 (placebo) days, a treatment difference of −0.6 (−1.0, −0.2) (p = 0.002). The ≥5-point reduction rates in Migraine Physical Function Impact Diary – Physical Impairment were 33.0% and 27.1% (OR:1.33 (0.92, 1.90) (p = 0.13) and in Migraine Physical Function Impact Diary – Everyday Activities were 40.4% and 35.8% (OR:1.22 (0.87, 1.71) (p = 0.26). Safety and adverse event profiles of erenumab were similar to placebo. Most frequent adverse events were upper respiratory tract infection, injection site pain, and nasopharyngitis. Conclusions As a preventive treatment of episodic migraine, erenumab at a dosage of 70 mg monthly significantly reduced migraine frequency and acute migraine-specific medication use. (Funded by Amgen). Trial registration ClinicalTrials.gov, NCT02483585.

The Yekaterinburg headache initiative: an interventional project, within the Global Campaign against Headache, to reduce the burden of headache in Russia

BackgroundAs major causes of global public ill-health and disability, headache disorders are paradoxically ignored in health policy and in planning, resourcing and implementing health services. This is true worldwide. Russia, where the prevalence of headache disorders and levels of attributed disability are well in excess of the global and European averages, is no exception, while arcane diagnoses and treatment preferences are an aggravating factor. Urgent remedial action, with political support, is called for.MethodsYekaterinburg, in Sverdlovsk Oblast, is the chosen centre for a demonstrational interventional project in Russia, undertaken within the Global Campaign against Headache. The initiative proposes three actions: 1) raise awareness of need for improvement; 2) design and implement a three-tier model (from primary care to a single highly specialized centre with academic affiliation) for efficient and equitable delivery of headache-related health care; 3) develop a range of educational initiatives aimed at primary-care physicians, non-specialist neurologists, pharmacists and the general public to support the second action.Results and conclusionWe set these proposals in a context of a health-care needs assessment, and as a model for all Russia. We present and discuss early progress of the initiative, justify the investment of resources required for implementation and call for the political support that full implementation requires. The more that the Yekaterinburg headache initiative can achieve, the more likely it is that this support will be forthcoming.

Headache service quality: evaluation of quality indicators in 14 specialist-care centres

BackgroundThe study was a collaboration between Lifting The Burden (LTB) and the European Headache Federation (EHF). Its aim was to evaluate the implementation of quality indicators for headache care Europe-wide in specialist headache centres (level-3 according to the EHF/LTB standard).MethodsEmploying previously-developed instruments in 14 such centres, we made enquiries, in each, of health-care providers (doctors, nurses, psychologists, physiotherapists) and 50 patients, and analysed the medical records of 50 other patients. Enquiries were in 9 domains: diagnostic accuracy, individualized management, referral pathways, patient’s education and reassurance, convenience and comfort, patient’s satisfaction, equity and efficiency of the headache care, outcome assessment and safety.ResultsOur study showed that highly experienced headache centres treated their patients in general very well. The centres were content with their work and their patients were content with their treatment. Including disability and quality-of-life evaluations in clinical assessments, and protocols regarding safety, proved problematic: better standards for these are needed. Some centres had problems with follow-up: many specialised centres operated in one-touch systems, without possibility of controlling long-term management or the success of treatments dependent on this.ConclusionsThis first Europe-wide quality study showed that the quality indicators were workable in specialist care. They demonstrated common trends, producing evidence of what is majority practice. They also uncovered deficits that might be remedied in order to improve quality. They offer the means of setting benchmarks against which service quality may be judged. The next step is to take the evaluation process into non-specialist care (EHF/LTB levels 1 and 2).

Framing education on headache disorders into the Global Burden of Disease Study 2010. The European Headache Federation stands ready

Framing education on headache disorders into the Global Burden of Disease Study 2010. The European Headache Federation stands ready.

Migraine in the Elderly

Despite in the majority of patients migraine completely stops after the age of 50, in some subjects migraine persists with more or less typical symptoms. This chapter illustrates two migraine outcomes in the late age: severe persistence and “headless’ migraine – late-life migrainous accompaniment. It is stressed that migraine after the age of 50 is often misdiagnosed and mistreated. Migraine outcomes in the elder age are summarized. Differential diagnosis in the elderly migraineurs, clinical predictors of migraine evolution in the elderly as well as key factors leading to migraine persistence after 50 are being discussed.

Chronic migraine classification: one more attempt of optimization and criteria revision

First of all we would like to thank Manzoni et al. for the deep and thoughtful discussion on chronic migraine (CM) classification [1]. All of us who deal with CM patients feel sharp need in universal and complete classification of this complicated and ambiguous disorder, especially taking into account the problem of medication overuse [2, 3]. Below, we present our opinion on the latest revision of the ICHD-2 for migraine suggested by the Italian team and propose new revision of CM diagnostic criteria for ICHD-3.