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Stephen D Silberstein - One of the best experts on this subject based on the ideXlab platform.

  • Preventive Migraine Treatment.
    CONTINUUM: Lifelong Learning in Neurology, 2015
    Co-Authors: Stephen D Silberstein
    Abstract:

    Purpose of Review:This article reviews the evidence base for the preventive Treatment of Migraine.Recent Findings:Evidence-based guidelines for the preventive Treatment of Migraine have recently been published by the American Academy of Neurology (AAN) and the Canadian Headache Society (CHS), provid

  • Preventive Migraine Treatment
    Neurologic Clinics, 2009
    Co-Authors: Stephen D Silberstein
    Abstract:

    The pharmacologic Treatment of Migraine may be acute (abortive) or preventive (prophylactic), and patients with frequent severe headaches often require both approaches. Preventive therapy is used to try to reduce the frequency, duration, or severity of attacks. The preventive medications with the best-documented efficacy are amitriptyline, divalproex, topiramate, and the beta-blockers. Choice is made based on a drug's proven efficacy, the physician's informed belief about medications not yet evaluated in controlled trials, the drug's adverse events, the patient's preferences and headache profile, and the presence or absence of coexisting disorders. Because comorbid medical and psychologic illnesses are prevalent in patients who have Migraine, one must consider comorbidity when choosing preventive drugs. Drug therapy may be beneficial for both disorders; however, it is also a potential confounder of optimal Treatment of either.

  • removing barriers to appropriate Migraine Treatment formulary limitations and triptan package size
    Headache, 2005
    Co-Authors: Stephen D Silberstein, David W Dodick, Jim Kesslick
    Abstract:

    The main goals in the pharmacologic management of Migraine headache are to avert or relieve debilitating pain, prevent escalating acute medication use, and improve day-to-day functioning. This review will examine the evidence supporting the early use of acute medication, usually when pain is mild, to enhance patient outcomes. We will also discuss imposed quantity limits as a practical impediment to the implementation of this strategy in the managed care setting, and will identify strategies for overcoming this barrier to effective care. Quantity limits imposed on triptan therapy by health plans can hinder the optimal acute Treatment of Migraine. A standard triptan quantity limit sufficient to permit early Migraine Treatment and a movement by manufacturers to provide blister packs consistent with a standard quantity limit should reduce patients costs, permit brand mobility when appropriate, and bolster long-term cost effectiveness by removing an important impediment to the use of triptans when they are most effective, early in the Migraine attack when pain is often still mild.

Roger Yates - One of the best experts on this subject based on the ideXlab platform.

  • Zolmitriptan nasal spray: advances in Migraine Treatment.
    Neurology, 2003
    Co-Authors: Nick Syrett, Susan Abu-shakra, Roger Yates
    Abstract:

    Zolmitriptan nasal spray was developed specifically to achieve fast, high effectiveness and to overcome many of the limitations associated with oral and sc Migraine therapies. Pharmacokinetic studies have demonstrated a very rapid appearance of zolmitriptan in plasma as early as 5 minutes after intranasal dosing, with about 40% of peak plasma concentration (C(max)) being achieved within 10 to 15 minutes of dosing. Comparison of plasma concentration-time profiles of zolmitriptan and its active metabolite after oral and intranasal administration, together with PET scanning, clearly indicate direct absorption of zolmitriptan across the nasal mucosa after intranasal administration. The remainder of the dose is then swallowed and is absorbed through the gastrointestinal tract. In one blinded, randomized, placebo-controlled, multiple-attack study of zolmitriptan nasal spray, headache response was superior to placebo as early as 15 minutes after dosing (p < 0.05). In the zolmitriptan 5 mg Treatment group, the primary end point of 2-hour headache response was achieved in 70% (300/427) of attacks versus 31% of attacks (119/389 attacks) in the placebo group (p < 0.001). Patients achieved a 2-hour headache response, had no recurrence, and used no additional or escape medications for up to 24 hours in 49% of attacks versus 14% of attacks in the placebo group (p < 0.001). Zolmitriptan 5 mg nasal spray was well tolerated. These data and those from other similar studies demonstrate that zolmitriptan nasal spray combines early, sustained efficacy and good tolerability, making it an optimal acute Treatment for Migraine.

  • Zolmitriptan nasal spray: advances in Migraine Treatment.
    Neurology, 2003
    Co-Authors: Nick Syrett, Susan Abu-shakra, Roger Yates
    Abstract:

    Zolmitriptan nasal spray was developed specifically to achieve fast, high effectiveness and to overcome many of the limitations associated with oral and sc Migraine therapies. Pharmacokinetic studies have demonstrated a very rapid appearance of zolmitriptan in plasma as early as 5 minutes after intranasal dosing, with about 40% of peak plasma concentration (Cmax) being achieved within 10 to 15 minutes of dosing. Comparison of plasma concentration-time profiles of zolmitriptan and its active metabolite after oral and intranasal administration, together with PET scanning, clearly indicate direct absorption of zolmitriptan across the nasal mucosa after intranasal administration. The remainder of the dose is then swallowed and is absorbed through the gastrointestinal tract. In one blinded, randomized, placebo-controlled, multiple-attack study of zolmitriptan nasal spray, headache response was superior to placebo as early as 15 minutes after dosing (p

David M Biondi - One of the best experts on this subject based on the ideXlab platform.

Christian Lucas - One of the best experts on this subject based on the ideXlab platform.

  • Strategies to Improve Migraine Treatment Results
    Drugs, 2006
    Co-Authors: Christian Lucas
    Abstract:

    The purpose of this review is to describe strategies for optimizing the use of available agents for acute Migraine therapy. Patient satisfaction with Migraine therapy depends on obtaining rapid and complete resolution of pain and preventing headache recurrence, making 2-h pain free and sustained pain free more relevant endpoints than 2-h pain relief for assessing acute Migraine therapies. Many Treatment guidelines recommend a step-care approach to Migraine management, that is, starting with a simple analgesic, followed by various combination analgesics, allowing a Migraine-specific drug (e.g. a triptan) only after the patient has demonstrated an inadequate response to non-specific Treatments. This can result in prolonged morbidity and patients lapsing from care. In the stratified-care approach, the initial Treatment is selected according to the individual patient’s Migraine severity and associated disability, promoting the use of Migraine-specific Treatments as first-line agents for patients with disabling Migraines. Another strategy, triptan Treatment during mild headache pain, has been shown to improve Treatment success rates compared with Treatment delayed until pain is moderate to severe. Treatment before the development of central sensitization is thought to underlie the improvement in outcomes. In conclusion, Migraine Treatment strategies such as the stratified-care approach and the administration of medication while pain is mild will help increase Treatment success rates and substantially reduce patient suffering and disability.

G. Nocea - One of the best experts on this subject based on the ideXlab platform.

  • Comparison of Expected Outcomes between Patients and Neurologists Using Kano’s Methodology in Symptomatic Migraine Treatment
    The Patient - Patient-Centered Outcomes Research, 2012
    Co-Authors: Jorge Matías-guiu, M. T. Caloto, G. Nocea
    Abstract:

    Objectives Our objective was to evaluate the potential usefulness of the Kano conceptual model to assess expectations of patients and neurologists in Spain regarding symptomatic Migraine Treatment. Methods We performed a multicenter, cross-sectional study in adult Migraine patients with at least 1 year of disease evolution and at least one prescription of anti-Migraine drugs within the last year. Data collection was performed using questionnaires that included sociodemographic and Treatment expectations. Using Kano’s methodology, Treatment attributes were classified as the following: Must-be; One-dimensional; Attractive; Indifferent; Reverse; or Questionable. Results A total of 204 Migraine patients (mean age 39.2 years [SD 11.9]; 84.6% women) and 68 neurologists (mean age 44 years [SD 8.8]; 63.2% men) were surveyed. None of the Treatment attributes evaluated by the patients showed a dominant Must-be feature. Among patients and neurologists, the attributes that led to a greater dissatisfaction when absent and that were ranked as the three most important attributes were those related to Treatment safety (absence of long-term adverse effects), efficacy (pain relief achievement), and quality of life (possibility of resuming occupational or academic activities). Differences in attributes’ classification were noted among patients and neurologists. The attribute that was considered most important by the patients was achievement of total disappearance of pain, whereas for neurologists the most important attribute was absence of long-term adverse effects. Conclusions Kano’s methodology is a useful tool to analyze differences in Migraine Treatment expectations among patients and neurologists. The main difference between patients and neurologists related to basic priorities. Therefore, when selecting Treatment for Migraine, physicians should invite the patient to participate in the decision making of which Treatment is more appropriate.

  • Comparison of expected outcomes between patients and neurologists using Kano's methodology in symptomatic Migraine Treatment.
    The Patient: Patient-Centered Outcomes Research, 2012
    Co-Authors: Jorge Matías-guiu, M. T. Caloto, G. Nocea
    Abstract:

    Kano’s methodology is a useful tool to analyze differences in Migraine Treatment expectations among patients and neurologists. The main difference between patients and neurologists related to basic priorities. Therefore, when selecting Treatment for Migraine, physicians should invite the patient to participate in the decision making of which Treatment is more appropriate. Copyright Springer International Publishing AG 2012