De la cefalea crónica diaria a la migraña crónica: historia, epidemiología y tratamiento

Introduction Triptans are the most specific symptomatic treatment for migraine available in Spain. All patients with chronic migraine should receive them. However, not all patients use them. Chronic migraine is included in the term chronic daily headache, which has been progressively replaced. Some...

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Autor: Martínez Pías, Enrique
Tipo de recurso: tesis doctoral
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Universidad de Valladolid
Repositorio:UVaDOC. Repositorio Documental de la Universidad de Valladolid
OAI Identifier:oai:uvadoc.uva.es:10324/61066
Acceso en línea:https://doi.org/10.35376/10324/61066
https://uvadoc.uva.es/handle/10324/61066
Access Level:acceso abierto
Palabra clave:Cefalea
Chronic migraine
Migraña crónica
Daily headache
Cefalea diaria
32 Ciencias Médicas
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oai_identifier_str oai:uvadoc.uva.es:10324/61066
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network_name_str España
repository_id_str
dc.title.none.fl_str_mv De la cefalea crónica diaria a la migraña crónica: historia, epidemiología y tratamiento
title De la cefalea crónica diaria a la migraña crónica: historia, epidemiología y tratamiento
spellingShingle De la cefalea crónica diaria a la migraña crónica: historia, epidemiología y tratamiento
Martínez Pías, Enrique
Cefalea
Chronic migraine
Migraña crónica
Daily headache
Cefalea diaria
32 Ciencias Médicas
title_short De la cefalea crónica diaria a la migraña crónica: historia, epidemiología y tratamiento
title_full De la cefalea crónica diaria a la migraña crónica: historia, epidemiología y tratamiento
title_fullStr De la cefalea crónica diaria a la migraña crónica: historia, epidemiología y tratamiento
title_full_unstemmed De la cefalea crónica diaria a la migraña crónica: historia, epidemiología y tratamiento
title_sort De la cefalea crónica diaria a la migraña crónica: historia, epidemiología y tratamiento
dc.creator.none.fl_str_mv Martínez Pías, Enrique
author Martínez Pías, Enrique
author_facet Martínez Pías, Enrique
author_role author
dc.contributor.none.fl_str_mv Guerrero Peral, Angel Luis
García Azorín, David
Universidad de Valladolid. Escuela de Doctorado
dc.subject.none.fl_str_mv Cefalea
Chronic migraine
Migraña crónica
Daily headache
Cefalea diaria
32 Ciencias Médicas
topic Cefalea
Chronic migraine
Migraña crónica
Daily headache
Cefalea diaria
32 Ciencias Médicas
description Introduction Triptans are the most specific symptomatic treatment for migraine available in Spain. All patients with chronic migraine should receive them. However, not all patients use them. Chronic migraine is included in the term chronic daily headache, which has been progressively replaced. Some patients with chronic migraine have daily headache. These individuals are frequently excluded from clinical trials and there are hardly any studies evaluating these patients. OnabotulinumtoxinA is one of the approved preventive treatments for chronic migraine. OnabotulinumtoxinA is one of the few treatments studied in patients with chronic migraine and daily headache. Objectives We will analyze the frequency of triptans use in chronic migraine patients. We will evaluate the triptans contraindications, and the possible causes and consequences of the non-use of triptans We will review the concept of chronic daily headache, the evolution and the differences with chronic migraine with daily headache. We will evaluate the response to treatment with OnabotulinumtoxinA in patients with chronic migraine and daily headache. We will evaluate the possible response factors to OnabotulinumtoxinA treatment in this group of patients. Material and methods We conducted two descriptive observational studies with a case series design. In these studies, we evaluated the use of triptans in patients with chronic migraine and the response to OnabotulinumtoxinA in patients with chronic migraine and daily headache. In a third study, we made a literature review of chronic migraine with daily headache. The studies were conducted in a third-level hospital and were approved by the Ethics Review Boards. The study population included patients diagnosed with chronic migraine by a neurologist expert in headaches. We excluded patients who had conditions that made it difficult to assess their clinical status. We also excluded patients with another headache disorder. Results Only 24% of patients with chronic migraine used triptans upon arrival at the Headache Unit. Only 3.2% of the patients who didn´t use triptan before, had contraindications. Only 12% of patients discontinued triptans due to bad tolerance. Frequency of vascular risk factors, contraceptive drugs or age did not differ between the groups. Up to 78% of patients with chronic daily headache have a migraine phenotype. Despite its name, the term chronic daily headache does not correspond to patients who suffer from headache all the days of the month. Currently, for patients suffering from chronic migraine headache and daily headache, the term chronic migraine with daily headache is used. Up to 33.3% of patients with chronic migraine experience daily headache. These patients could have a different response to treatment than patients without daily headache. Conclusions Three-quarters of chronic migraine patients did not use triptans. Non-use of triptans was not justified by intolerability, frequency of contraindications or frequency of vascular risk factors. We hypothesize that there is a triptanophobia. Triptanophobia could be defined as the excessive and inadequately justified concern of health professionals about the potential risks of triptans. One in three patients with chronic migraine suffers daily headache. These patients have been systematically excluded from clinical trials. We must study this group of patients and consider whether they should continue to be excluded. Patients with chronic migraine and daily headache did not respond worse than patients without daily headache after three treatment sessions with OnabotulinumtoxinA. The presence of daily headache was associated with a higher response to OnabotulinumtoxinA.
publishDate 2023
dc.date.none.fl_str_mv 2023
dc.type.none.fl_str_mv info:eu-repo/semantics/doctoralThesis
info:eu-repo/semantics/publishedVersion
format doctoralThesis
status_str publishedVersion
dc.identifier.none.fl_str_mv https://doi.org/10.35376/10324/61066
https://uvadoc.uva.es/handle/10324/61066
url https://doi.org/10.35376/10324/61066
https://uvadoc.uva.es/handle/10324/61066
dc.language.none.fl_str_mv Español
language_invalid_str_mv Español
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
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dc.source.none.fl_str_mv reponame:UVaDOC. Repositorio Documental de la Universidad de Valladolid
instname:Universidad de Valladolid
instname_str Universidad de Valladolid
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spelling De la cefalea crónica diaria a la migraña crónica: historia, epidemiología y tratamientoMartínez Pías, EnriqueCefaleaChronic migraineMigraña crónicaDaily headacheCefalea diaria32 Ciencias MédicasIntroduction Triptans are the most specific symptomatic treatment for migraine available in Spain. All patients with chronic migraine should receive them. However, not all patients use them. Chronic migraine is included in the term chronic daily headache, which has been progressively replaced. Some patients with chronic migraine have daily headache. These individuals are frequently excluded from clinical trials and there are hardly any studies evaluating these patients. OnabotulinumtoxinA is one of the approved preventive treatments for chronic migraine. OnabotulinumtoxinA is one of the few treatments studied in patients with chronic migraine and daily headache. Objectives We will analyze the frequency of triptans use in chronic migraine patients. We will evaluate the triptans contraindications, and the possible causes and consequences of the non-use of triptans We will review the concept of chronic daily headache, the evolution and the differences with chronic migraine with daily headache. We will evaluate the response to treatment with OnabotulinumtoxinA in patients with chronic migraine and daily headache. We will evaluate the possible response factors to OnabotulinumtoxinA treatment in this group of patients. Material and methods We conducted two descriptive observational studies with a case series design. In these studies, we evaluated the use of triptans in patients with chronic migraine and the response to OnabotulinumtoxinA in patients with chronic migraine and daily headache. In a third study, we made a literature review of chronic migraine with daily headache. The studies were conducted in a third-level hospital and were approved by the Ethics Review Boards. The study population included patients diagnosed with chronic migraine by a neurologist expert in headaches. We excluded patients who had conditions that made it difficult to assess their clinical status. We also excluded patients with another headache disorder. Results Only 24% of patients with chronic migraine used triptans upon arrival at the Headache Unit. Only 3.2% of the patients who didn´t use triptan before, had contraindications. Only 12% of patients discontinued triptans due to bad tolerance. Frequency of vascular risk factors, contraceptive drugs or age did not differ between the groups. Up to 78% of patients with chronic daily headache have a migraine phenotype. Despite its name, the term chronic daily headache does not correspond to patients who suffer from headache all the days of the month. Currently, for patients suffering from chronic migraine headache and daily headache, the term chronic migraine with daily headache is used. Up to 33.3% of patients with chronic migraine experience daily headache. These patients could have a different response to treatment than patients without daily headache. Conclusions Three-quarters of chronic migraine patients did not use triptans. Non-use of triptans was not justified by intolerability, frequency of contraindications or frequency of vascular risk factors. We hypothesize that there is a triptanophobia. Triptanophobia could be defined as the excessive and inadequately justified concern of health professionals about the potential risks of triptans. One in three patients with chronic migraine suffers daily headache. These patients have been systematically excluded from clinical trials. We must study this group of patients and consider whether they should continue to be excluded. Patients with chronic migraine and daily headache did not respond worse than patients without daily headache after three treatment sessions with OnabotulinumtoxinA. The presence of daily headache was associated with a higher response to OnabotulinumtoxinA.Introducción Los triptanes constituyen el tratamiento sintomático más específico para migraña disponible en España, y todos los pacientes con migraña crónica deben recibirlos. Sin embargo, no todos los pacientes los utilizan. La cefalea crónica diaria engloba varias entidades entre las que se encuentra la migraña crónica y que progresivamente han ido sustituyendo a este término clásico. Algunos pacientes con migraña crónica presentan cefalea todos los días del mes. Estos individuos son frecuentemente excluidos de los ensayos clínicos de tratamiento y apenas existen estudios que evalúen a estos pacientes. La OnabotulinumtoxinA es uno de los tratamientos preventivos aprobados para migraña crónica. Es una de las pocas opciones terapéuticas estudiadas en pacientes con migraña crónica y cefalea diaria, con discrepancias entre los resultados. Objetivos Se analizará la frecuencia del uso de triptanes en los pacientes con migraña crónica. Se evaluarán las contraindicaciones para su uso, así como las posibles causas y consecuencias de su no utilización. Se realizará una revisión del concepto de cefalea crónica diaria, su evolución y sus diferencias con la migraña crónica con cefalea diaria. Evaluaremos la respuesta al tratamiento con la OnabotulinumtoxinA en pacientes con migraña crónica y cefalea diaria y los posibles factores predictores. Material y métodos Se realizaron dos estudios observacionales descriptivos con diseño de serie de casos. En estos trabajos se evaluó el uso de triptanes en pacientes con migraña crónica y la respuesta a la OnabotulinumtoxinA en pacientes con migraña crónica y cefalea diaria. En un tercer estudio se realizó una revisión bibliográfica de la migraña crónica con cefalea diaria. Los estudios se realizaron en un hospital académico de tercer nivel y fueron aprobados por las Juntas de Revisión Ética de dicho centro. La población de estudio incluyó pacientes diagnosticados de migraña crónica por un neurólogo experto en cefaleas. Los pacientes fueron excluidos si existían condiciones que pudieran dificultar la evaluación de la situación clínica del paciente o si padecían otro trastorno de dolor de cabeza. Resultados Únicamente un 24% de los pacientes con migraña crónica utilizaban triptanes a su llegada a la Unidad de Cefaleas. Sólo un 3,2% de los pacientes que no los habían utilizado presentaban contraindicaciones para su uso y únicamente un 12% los habían tenido que suspender por mala tolerancia. No se evidenciaron diferencias en los factores de riesgo vascular, uso de anticonceptivos ni edad entre los usuarios y no usuarios de triptanes que justificaran su infrautilización. Hasta un 78% de los pacientes con cefalea crónica diaria presentan fenotipo migrañoso. A pesar de su nombre, el término cefalea crónica diaria no se corresponde con pacientes que sufren cefalea todos los días del mes. Actualmente, para los pacientes que sufren cefalea crónica de fenotipo migrañoso y cefalea diaria se utiliza el término migraña crónica con cefalea diaria. Hasta un 33,3% de los pacientes con migraña crónica sufren cefalea diaria. Estos pacientes podrían presentar diferente respuesta al tratamiento a los pacientes sin cefalea diaria. Conclusiones Tres de cada cuatro pacientes con migraña crónica no utilizaban triptanes, lo que no se justificó por la presencia de contraindicaciones, factores de riesgo vascular ni efectos adversos. Hipotetizamos que existe una triptanofobia, excesiva y no justificada preocupación sobre los potenciales riesgos de los triptanes que provocaría su infrautilización. Uno cada tres pacientes con migraña crónica presenta cefalea diaria, y estos pacientes han sido excluidos sistemáticamente de los ensayos clínicos de tratamiento. Debemos profundizar en el estudio de esta entidad y replantearnos si se les debe seguir excluyendo. Los pacientes con migraña crónica y cefalea diaria no respondieron peor que los pacientes sin cefalea diaria tras tres sesiones de tratamiento con la OnabotulinumtoxinA. La presencia de cefalea diaria se asoció a una mayor respuesta a la OnabotulinumtoxinA.Escuela de DoctoradoDoctorado en Investigación en Ciencias de la SaludGuerrero Peral, Angel LuisGarcía Azorín, DavidUniversidad de Valladolid. Escuela de Doctorado2023info:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://doi.org/10.35376/10324/61066https://uvadoc.uva.es/handle/10324/61066reponame:UVaDOC. Repositorio Documental de la Universidad de Valladolidinstname:Universidad de ValladolidEspañolinfo:eu-repo/semantics/openAccesshttp://creativecommons.org/licenses/by-nc-nd/4.0/oai:uvadoc.uva.es:10324/610662026-06-13T12:44:47Z
score 15,300719

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