ABSTRACT
Background: Migraine headache is a common neurologicalepisodic condition originating from the central nervous systemthat can significantly impair the lives of otherwise normallyfunctioning people. Pharmacologic options for migraineprophylaxis include beta blockers, calcium channel blockers,antidepressants and anticonvulsants; all of which have varyingdegrees of adverse effects that may significantly limit their usein this disease.Objectives: To observe whether low dose Topiramate is moreeffective compared to Propranolol in migraine prophylaxis.Methods: This clinical trial was carried out in the Out PatientDepartment (OPD) & Headache Clinic, Department ofNeurology, Bangabandhu Sheikh Mujib Medical University,Dhaka. A total of 120 patients around the age range of 18 to 50years diagnosed as migraine (with aura or without aura)according to ICHD-3 criteria, were recruited as the studypopulation. By simple random sampling procedure, using odd& even number, 60 patients were administered by Tab.Topiramate 50 mg/ day named as group-I and rest 60 patientswere administered by Tab. Propranolol 80 mg /day named asgroup-II. Out of them in total 96 patients had completed thestudy due to drop out of 13 patients in group-I & 11 patients ingroup-II in different steps of follow up. Finally 47 patientsremain in group-I and 49 patients in group-II. During trial, threefollow up visits were taken for both group, 1st follow up after 4weeks of baseline information (Before starting prophylacticmedication), 2nd follow up after 4 weeks of treatment, 3rdfollow up after 8 weeks of treatment. Efficacy of treatment wasmeasured by headache frequency, duration and Severity ofheadache as measured by the VAS.Results: The mean (SD) age of group-I (topiramate) andgroup-II (propranolol) group were found 29.72 (9.58) yearsand 30.96 (10.11) years respectively. Female sex was foundpredominant in both groups. At final follow up, there wasstatistically significant difference in mean (SD) value offrequency of migraine attack between topiramate andpropranolol group [4.72 (2.80) vs. 3.48 (2.20); p=0.024].Propranolol appeared statistically significant than topiramate[TPM 5.53 (2.98) vs. PRO 4.36 (1.55); p=0.047]. RegardingSeverity of headache, better results also were observed in thepropranolol group than topiramate (p < 0.05). Both drugsappeared significant in efficacy measurement (p < 0.001).Patient drop out was more in the topiramate group than thepropranolol group (21.68 % vs. 18.34%). Furthermore, in thetopiramate group, patients complained of more adverse effectsthan propranolol group (23.4% vs. 14.3%), which wasstatistically significant.Conclusion: The present study suggests that low doseTopiramate and Propranolol are effective for migraineprophylaxis in reduction of frequency, Severity and duration ofmigraine headache individually and propranolol appears moreeffective compared to that of topiramate.
ABSTRACT
In this edge, medical tourism is not a new idea. Medical treatment is one of the essential demands of human beings and it requires high quality and intensive care. Beside western world, few developing countries are playing key roles as medical tourism destinations. India is one of the leading names among these countries. The purpose of the paper is to find the factors influencing the attractiveness of India as a health tourism destination. The study has found the major contributing factors and their relative importance in the attractiveness of the health tourism destination that is India from consumers' perspectives by conducting survey with an application of structural equation modelling approach. In Indian context, medical tourists consider service quality and cost mostly to select any medical destination. In addition they also give value to the destination competitiveness but tourist attitude is less important in comparison with other factors affecting their destination choice. Since the study has used structural equation modelling approach to test the hypothesis and figure out the relative importance of the factors, the fundamental indices such as Nottned Chi square [less than 3], RMSEA [less than 0.08] and CFI [more than 0.90] values show the overall model fit of the proposed model. In order to transform a country such as India as an attractive and competitive medical tourist destination in this time of globalization, a step should be taken to control cost ensuring the quality of services