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- Dahlöf, Carl, 1947, et al.
(författare)
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[Is migraine a progressive cerebral disease?]
- 2005
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Ingår i: Neurologia. ; 20:7, s. 356-65
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Tidskriftsartikel (refereegranskat)abstract
- Migraine is a primary neurovascular headache which affects approximately 12% of the adult population. Migraine particularly affects women of working age and is associated with significant disability and reduced quality of life. During migraine attacks, the capacity to engage in daily activities such as child care, work, and social activities is reduced, and relationships with family members and friends become strained. In this respect, migraine places a heavy economic burden on both the individual and society. It is also known migraine is a risk factor for ischemic stroke in young women with migraine with aura. Recently, it was reported that some individuals that experience migraine with and without aura may be at an increased risk for subclinical lesions in certain areas of the brain. Cerebral white matter lesions (WMLs) are a common finding on cerebral MRI scans. Although, it appears that cerebral WMLs are more common in migraineurs than in the general population, the nature, association and the clinical significance of cerebral WMLs in migraineurs are not yet conclusive. Furthermore, there is no good evidence to support the notion that cerebral WMLs in migraineurs can predict subclinical or clinical stroke in these individuals. Needless to say, the need for more longitudinal and prospective migraine research is immense. The aim of the future migraine research should be to obtain more information about the natural course of migraine as well as evaluate the association between migraine and cerebral WMLs and their consequences. In addition, continuing genetic identification of key proteins involved in migraine will improve our understanding of this common and sometimes most debilitating disorder, which can strike during the most productive years of a person's life.
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| 2. |
- Bigal, Marcelo, et al.
(författare)
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Satisfaction with current migraine therapy: experience from 3 centers in US and Sweden
- 2007
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Ingår i: Headache. ; 47:4, s. 475-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess the level of satisfaction and determinants of satisfaction or dissatisfaction of patients presenting in tertiary care, in regard to their usual care (UC) for the acute treatment of migraine. DESIGN/METHODS: Patients seen in 3 headache centers were assessed by means of 21 attributes related to their UC. Questions covered satisfaction with efficacy (including onset of relief, degree of relief, consistency of action, ease of use), tolerability (lack of side effects overall, CNS side effects, other side effects), and willingness to continue using the same medication and to change to another medication. All questions were answered on a 5-point scale (where 1 was strongly agree, 2 was agree, 3 was neutral, 4 was disagree, and 5 was strongly disagree). RESULTS: We assessed 183 subjects (74.8% women, mean age = 39.3 years). UC consisted, as a single drug or combination, of: triptan conventional tablets--62%; triptan disintegrating tablets--8%; sumatriptan nasal spray 9%; sumatriptan injection, 9%; nontriptans--19.6%. Most (54%) had no benefit within the first hour of treatment. The maximum benefit took more than 1 hour to be reached in 69%, and more than 2 hours in 36%. After the maximum benefit had been reached, pain worsened in 61%. Although 58% were satisfied with the degree of relief, 37% were dissatisfied with the speed of effect, 50% with the recurrence of pain, and 42% with the need for a second dose. Most were satisfied with the tolerability (56%). Finally, most (79.7%) said they were willing to try another acute medication. CONCLUSIONS: An important subset of patients, including a large subgroup of patients using triptans, is dissatisfied with their UC. Clinical trials assessing patients' preference should be conducted to complement the information from clinical trials.
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| 3. |
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| 4. |
- Dahlöf, Carl, 1947
(författare)
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[Can migraine cause subclinical brain lesions? A Dutch study shows a connection--but more research is required]
- 2004
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Ingår i: Läkartidningen. ; 101:47
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Tidskriftsartikel (refereegranskat)abstract
- There is general agreement that migraine a primary disease of the central nervous system with secondary vascular effects. In a recent study by Kruit and co-authors (JAMA 2004;291(4):427-34) it is reported that some individuals that experience migraine with and without aura may be at an increased risk for subclinical lesions in certain areas of the brain. The results are very interesting but have to be interpreted with caution. Needless to say, it is imperative that in the absence of scientific evidence, we do not further burden individuals with migraine with frightening information on the potentially poor prognosis of their disease. At the same time, it is equally important that we do not miss the opportunity to avoid possible risks for brain lesions by means of optimized symptomatic treatment of migraine attacks as well as preventive therapies. Accordingly, the need for more longitudinal and prospective migraine research is immense. The aim of the future migraine research should be to obtain more information about the natural course of migraine as well as evaluate the association between migraine and cerebral WMLs and their consequences. The results generated in future studies may prove very important, not least with respect to future allocation of health care resources. Future studies will hopefully provide correct answers to most questions about migraine and constitute a basis for improved care of migraine sufferers with optimal use of the different treatment options as well as offer promising treatment strategies to prevent disease progression, including risk factor modification, optimized symptomatic treatment of migraine attacks and preventive therapies.
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| 5. |
- Dahlöf, Carl, 1947
(författare)
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Cutaneous allodynia and migraine: another view.
- 2006
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Ingår i: Current pain and headache reports. - 1531-3433. ; 10:3, s. 231-8
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Tidskriftsartikel (refereegranskat)abstract
- The paradigm of early treatment of the migraine attack at mild pain intensity has become one alternative to circumventing the problem of compromised oral absorption of symptomatic drugs due to migraine-induced gastrointestinal dysmotility. Early treatment also has been proposed to be advantageous because most migraineurs could be less responsive to delayed treatment, owing to the development of central sensitization of the trigeminal pain transmission. Ranking the underlying principles, it seems that the improved response to an oral triptan formulation at mild migraine symptom intensity has more to do with less impaired gastrointestinal absorption in the early stage of the attack than decreasing the time and preventing chances for central sensitization and development of cutaneous allodynia. Furthermore, parenteral administration of a triptan is always more likely to provide relief of symptoms than conventional tablets, even when it is used later in the course of the migraine attack. Individually tailored use of the available triptan formulations will increase, without any doubt, the within-migraineur consistency of response. It also will reduce the overall proportion of migraine attacks or migraineurs not responding to triptan treatment. Notwithstanding, the recommendation of early treatment during the migraine attack when the pain is mild remains valid.
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| 6. |
- Dahlöf, Carl, 1947, et al.
(författare)
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Efficacy, speed of action and tolerability of almotriptan in the acute treatment of migraine: pooled individual patient data from four randomized, double-blind, placebo-controlled clinical trials
- 2006
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Ingår i: Cephalalgia. ; 26:4, s. 400-8
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Tidskriftsartikel (refereegranskat)abstract
- A meta-analysis of pooled individual patient data from four randomized, placebo-controlled, double-blind trials comparing several doses of almotriptan (n = 1,908) with placebo (n = 386) was used to investigate the efficacy, speed of onset and tolerability of almotriptan in the acute treatment of migraine. As early as 30 min after dosing, almotriptan 12.5 mg was significantly more effective than placebo for pain relief (14.9% vs. 8.2%; P < 0.05) and pain free (2.5% vs. 0.7%; P < 0.05). At 2 h, pain-relief rates were 56.0%, 63.7% and 66.0% for almotriptan 6.25, 12.5 and 25 mg, respectively, compared with 35% for placebo; 2-h pain-free rates were 26.7%, 36.4% and 43.4% compared with 13.9% for placebo. All almotriptan dosages were significantly more effective than placebo in eliminating migraine-associated symptoms (P < 0.05) and in achieving sustained pain relief up to 24 h (P < 0.05). The incidence of adverse events after almotriptan 6.25 mg and 12.5 mg was not significantly different from that of placebo. This meta-analysis confirms the findings of individual clinical trials, while demonstrating for the first time, significant pain-free efficacy at 30 min compared with placebo.
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| 7. |
- Dahlöf, Carl, 1947, et al.
(författare)
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Huvudvärk : Fakta, frågor och svar
- 2005
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Boken beskriver hur man diagnostiserar och behandlar huvudvärk samt vad de olika tillstånden kan bero på. Dessutom redovisas kända alternativa behandlingsformer, allt från akupunktur till huskurer. Under de senaste åren har närmare 100 brev med frågor, intressanta funderingar och tips kommit in till författarna från personer runt om i Sverige med olika sorters huvudvärk. Dessa brev redovisas, besvaras och kommenteras i respektive kapitel. Boken är avsedd för vårdpersonal och patienter.
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| 8. |
- Dahlöf, Carl, 1947, et al.
(författare)
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Huvudvärk - teori och klinik
- 2006
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Under senare år har större uppmärksamhet riktats mot neurologiska sjukdomars betydelse för folkhälsan eftersom det står klart att många stora hälsoproblem är orsakade av sjukdomar i hjärnan och dess nervsystem. Huvudvärk påverkar nästan alla någon gång och utgör ett problem för cirka 40 procent av befolkningen. Huvudvärk är en av de mest vanliga orsakerna till läkarbesök såväl inom primärvården som på neurologisk mottagning och representerar en stor socioekonomisk börda för såväl individ som samhälle. Huvudvärk är ett framträdande folkhälsoproblem i alla länder och dränerar produktiviteten, sjukvårdssystemet, samhället, individen och familjen på resurser. De socioekonomiska kostnaderna för huvudvärk är mycket höga, de uppskattades härom året till 10 miljarder ECU per år. Migrän och andra huvudvärksformer rankas på tredje plats efter slaganfall och demens och står för en tredjedel av den totala kostnaden för alla neurologiska sjukdomar i Europa. Författarnas ambition med föreliggande bok har varit att ge en balanserad och skäligt omfattande beskrivning av huvudvärk, nervsmärtor i hjärnan och ansiktssmärtor hos barn och vuxna med avseende på patofysiologi, diagnostik och behandling. Vi hoppas att denna lärobok ska vara till nytta för alla de inom sjukvården som behandlar huvudvärkspatienter och vill öka sina kunskaper inom denna högst intressanta del inom neurologin.
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| 9. |
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| 10. |
- Dahlöf, Carl, 1947
(författare)
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Infrequent or non-response to oral sumatriptan does not predict response to other triptans--review of four trials
- 2006
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Ingår i: Cephalalgia. ; 26:2, s. 98-106
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Tidskriftsartikel (refereegranskat)abstract
- A migraineur can claim to be an infrequent responder ('non-responder') to an oral triptan independent of which triptan he or she is presently using. Four trials of an alternative triptan (zolmitriptan/rizatriptan; eletriptan; naratriptan; almotriptan) in patients with a history of infrequent response to oral sumatriptan were compared and contrasted in terms of study design, patient characteristics, and efficacy and tolerability of the triptan under investigation. Unfortunately, none of the reported studies used an appropriate parallel design, which would have had the non-responding triptan (oral sumatriptan) in one arm and without encapsulation. While the four trials differed in terms of study design (open-label vs. placebo-controlled), definition of sumatriptan 'non-responder' (retrospective vs. prospective) and pain intensity at baseline (30% severe to 70% severe), all four demonstrated that lack of response to sumatriptan did not predict lack of response to an alternative triptan. Changing triptans resulted in 2-h pain-relief rates of 25-81% in patients with a history of poor response to sumatriptan. It can be concluded that migraine patients who respond infrequently to sumatriptan should be switched to a different triptan, as lack of response to one triptan does not predict likelihood of responsiveness to another. A review of the available evidence suggests that almotriptan may be one of the most appropriate choices for an alternative triptan.
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