Sudden hemichorea and frontal lobe syndrome: a rare presentation of unbalanced polycythaemia vera.

Polycythaemia vera (PV) is an haematological neoplasm that frequently presents neurological symptoms. However, chorea is a rare complication of this disease, occurring in less than 5% of the patients. Cognitive impairment related to PV unbalanced is also a rare complication, and it can improve with proper treatment. We present a 96-year-old-man with acute-onset hemichorea and frontal lobe syndrome with no vascular pathology in the basal ganglia or frontal region. A clear relationship was observed between the onset of involuntary movements and the cognitive impairment and worsening of haematological parameters in the patient. After causal and symptomatic treatment, the patient's clinical status improved. In the elderly, PV must be considered as a cause of acute chorea and sudden cognitive impairment, as early diagnosis leads to effective treatment and prevention of complications.

IFN beta 1a as Glucocorticoids-Sparing Therapy in a Patient with CLIPPERS.

BACKGROUND: Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a recently described inflammatory disease of the central nervous system, distinguished by brainstem- and spinal cord-centered lesions with a characteristic contrast enhancement on MRI, a lymphocytic perivascular infiltrate on pathological exam, and a dramatic response to and dependence on steroids therapy. Since its initial description in 2010, different glucocorticoid-sparing agents, mostly immunosuppressant drugs, have been used to minimize the dosage, but these therapies also carry the risk of important secondary effects. We present the first reported case of CLIPPERS treated with interferon beta 1a as add-on therapy. CASE REPORT: A previously healthy 31-year-old man presented with gait ataxia and dysarthria. MRI showed pons-centered hyperintense patchy lesions on T2-weighted images. Additional tests ruled out other possible diagnoses and symptoms reversed with intravenous methylprednisolone. Over the years the patient presented with several episodes of deterioration each year, which were partly reversed with glucocorticoid therapy, but leaving him with growing sequelae. Four years after the initial event, treatment with interferon-beta-1a was initiated, achieving reduced frequency of the relapses to 1 every 4 years, which were no longer associated to increasing disability. This allowed reducing glucocorticoids to 30 mg of Deflazacort every other day. CONCLUSIONS: Interferon beta-1a could be an alternative to corticosteroid-combined therapy in CLIPPERS and its more benign profile of secondary effects compared to immunosuppressants could make it an attractive choice.

Factors associated with the differences in migraine prevalence rates between Spanish regions.

We have analyzed the relation of prevalence rates in Spanish regions with a series of human, environmental, and ecological factors. We find that the variability in migraine rates found between Spanish regions may be explained by interregional differences in the percentage of daily smokers, percentage of alcohol consumers, percentage of population presenting physical and/or psychological life-limiting conditions, percentage of population engaging in physical exercise, minimum absolute temperatures per year, number of days under 0 °C per year, and altitude.

Compresión medular: aproximación multidisciplinar a una auténtica urgencia neurooncológica. Réplica / Spinal cord compression: a multidisciplinary approach to an authentic neuro-oncological emergency

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[Spinal cord compression: a multidisciplinary approach to a real neuro-oncological emergency. Reply]. / Compresion medular: aproximacion multidisciplinar a una autentica urgencia neurooncologica. Replica.

TITLE: Compresion medular: aproximacion multidisciplinar a una autentica urgencia neurooncologica. Replica.

Compresión medular: aproximación multidisciplinar a una auténtica urgencia neurooncológica / Spinal cord compression: a multidisciplinary approach to a real neuro-oncological emergency

La compresión medular debe ser considerada una urgencia neurooncológica de primera magnitud. Bajo este planteamiento, la aproximación multidisciplinar y la rapidez en la instauración de las medidas terapéuticas que procedan son cruciales para optimizar el pronóstico funcional (y quizás vital) de los pacientes afectos. Las actitudes nihilistas hasta ahora imperantes en algunos sectores profesionales, posiblemente derivadas de una percepción de mal pronóstico a corto plazo, deben ser completamente desterradas. La mejora de la supervivencia global de los pacientes oncológicos en su conjunto, la disponibilidad de nuevas técnicas neuroquirúrgicas accesibles a una gran mayoría de nuestros hospitales, y las mejoras evidentes en los equipos y técnicas de radioterapia permiten abordar esta patología con mejores perspectivas de éxito, no sólo en lo que al control de la progresión tumoral propiamente dicha se refiere, sino también en el control del dolor, el mantenimiento de la funcionalidad de la médula espinal y la supervivencia global del paciente. En este contexto, consideramos obligado que todos los hospitales dispongan de protocolos de actuación específicos para la compresión medular aguda. La puesta en marcha en el Centro Médico de Asturias de un protocolo de estas características ha animado a realizar una revisión y actualización sobre el tema, con especial énfasis en las evidencias disponibles para cada una de las modalidades terapéuticas comentadas

Spinal cord compression must be considered a top-priority neuro-oncological emergency. Hence, a multidisciplinary approach and swiftness in establishing appropriate therapeutic measures are crucial to optimise the functional (and perhaps vital) prognosis of these patients. The nihilistic attitudes that have prevailed up until now in some professional sectors, possibly stemming from the perception of a poor short-term prognosis, must be completely eradicated. The overall improvement in survival rates among cancer patients in general, the availability of new neurosurgical techniques in the vast majority of our hospitals and the obvious improvements in radiotherapy equipment and techniques all this pathology to be addressed with greater chances of success. This greater likelihood of accomplishing a better outcome refers not only to the control of the development of the tumour itself, but also to pain control, maintenance of the functioning of the spinal cord and the overall survival of the patient. In this context, we consider it essential for all hospitals to have specific protocols on how to proceed in cases of acute spinal cord compression. The fact that this kind of protocol has been introduced in the Centro Médico de Asturias has prompted us to conduct a review of the current state-of-the-art in this field, with special emphasis on the evidence available for each of the modes of therapy that are discussed

[Spinal cord compression: a multidisciplinary approach to a real neuro-oncological emergency]. / Compresion medular: aproximacion multidisciplinar a una autentica urgencia neurooncologica.

Spinal cord compression must be considered a top-priority neuro-oncological emergency. Hence, a multi-disciplinary approach and swiftness in establishing appropriate therapeutic measures are crucial to optimise the functional (and perhaps vital) prognosis of these patients. The nihilistic attitudes that have prevailed up until now in some professional sectors, possibly stemming from the perception of a poor short-term prognosis, must be completely eradicated. The overall improvement in survival rates among cancer patients in general, the availability of new neurosurgical techniques in the vast majority of our hospitals and the obvious improvements in radiotherapy equipment and techniques all this pathology to be addressed with greater chances of success. This greater likelihood of accomplishing a better outcome refers not only to the control of the development of the tumour itself, but also to pain control, maintenance of the functioning of the spinal cord and the overall survival of the patient. In this context, we consider it essential for all hospitals to have specific protocols on how to proceed in cases of acute spinal cord compression. The fact that this kind of protocol has been introduced in the Centro Medico de Asturias has prompted us to conduct a review of the current state-of-the-art in this field, with special emphasis on the evidence available for each of the modes of therapy that are discussed.

Situación de partida y abordaje asistencial de la migraña en las consultas de neurología de España. Estudio PRIMERA / Initial situation and approach to the care of migraine in neurology services in Spain. The PRIMERA study

Introducción. A pesar de la alta discapacidad que conlleva, muchos pacientes con migraña nunca han consultado por este motivo. El estudio de quienes acuden por primera vez a consulta es obligado como paso previo a plantear medidas de intervención específicas para este colectivo de pacientes. Objetivo. Conocer el perfil de los pacientes con migraña que acuden por primera vez a una consulta de neurología, así como las actitudes diagnósticas y terapéuticas adoptadas por los neurólogos con respecto a ellos. Pacientes y métodos. Estudio transversal y multicéntrico, realizado en consultas de neurología de todo el territorio nacional. Participaron 168 neurólogos que reclutaron un total de 851 pacientes (74,6% mujeres; edad media: 34,0 ± 10,7 años). La discapacidad se evaluó mediante el cuestionario específico para migraña (Headache Impact Test) y el cuestionario de discapacidad genérico (Sheehan Disability Scale). Resultados. El 66,5% de los pacientes consultó por consejo médico, el 33,5% restante lo hizo por iniciativa propia. Sólo el 55,9% tenía un diagnóstico previo de migraña. Los principales motivos de consulta fueron la ineficacia del tratamiento sintomático (25%) y el incremento en la frecuencia o intensidad de las crisis (23,4%). Aunque el 70,3% de los pacientes puntuaba alta discapacidad en el Headache Impact Test, sólo el 17,4% utilizaba tratamiento específico y únicamente el 13,3% tratamiento preventivo. Conclusiones. El estudio PRIMERA ratifica, una vez más, que la migraña es una entidad infradiagnosticada e infratratada en nuestro medio, por lo que siguen siendo precisas intervenciones de tipo educativo y formativo específicas para esta patología (AU)

Introduction. Despite the high degree of disability it entails, many patients with migraine have never visited their doctor for this reason. It is necessary to conduct a study to examine the characteristics of first-time visits as a step that must be carried out prior to establishing specific intervention measures for this group of patients. Aim. To determine the profile of the patients with migraine who visit a neurology service for the first time, together with the diagnostic and therapeutic attitudes that neurologists display towards them. Patients and methods. We conducted a cross-sectional, multi-centre study of neurology services across the country. The research included 168 neurologists who recruited 851 patients (74.6% females; mean age: 34.0 ± 10.7 years). Disability was assessed by means of the specific migraine questionnaire (Headache Impact Test) and the generic disability questionnaire (Sheehan Disability Scale). Results. A third (66.5%) of the patients went for consultation following their doctor’s advice, while the remaining 33.5% went on their own accord. Only 55.9% had been previously diagnosed with migraine. The main reasons for visiting were ineffective symptomatic treatment (25%) and an increase in the frequency or intensity of the attacks (23.4%). Although 70.3% of the patients had high disability scores on the Headache Impact Test, only 17.4% used specific treatment and only13.3% were on preventive treatment. Conclusions. The PRIMERA study confirms, once again, that migraine is an under-diagnosed and under-treated condition in our setting, which means that specific educational interventions and training are still required for this pathology (AU)

Factores precipitantes de crisis de migraña en pacientes atendidos en consultas de neurología. Estudio FACTOR / Precipitating factors of migraine attacks in patients attended in neurology services. The FACTOR study

Introducción. Los pacientes con migraña refieren con frecuencia factores o circunstancias que precipitan o desencadenansus crisis. A pesar de ello, son muy escasos los estudios realizados al efecto. Objetivo. Explorar los factores precipitantes de crisis de migraña en nuestro medio, así como su posible relación con laintensidad de las crisis o la repercusión global de la migraña. Pacientes y métodos. Estudio epidemiológico, transversal y multicéntrico realizado en consultas de neurología. Se recogierondatos sociodemográficos y clínicos, así como los factores precipitantes identificados de un listado cerrado. Se utilizaron el cuestionario de discapacidad específico para migraña -Headache Impact Test (HIT-6)- y la medida del número de días equivalentes a días de trabajo perdidos. Resultados. Se reclutaron 817 pacientes (72,5% mujeres; edad media: 34,6 ± 10,3 años). El 70,5% de los pacientes tenía un grado de discapacidad grave según el HIT-6. La media mensual de días equivalentes a días de trabajo perdidos fue de 2,1 ± 2,5. Un 96,6% de los pacientes identificó algún factor precipitante de crisis, siendo los más frecuentemente comunicadoslos hormonales (75,2%), el estrés (70,9%) y los relacionados con las alteraciones en el patrón de sueño (68,4%). Conclusiones. El estudio FACTOR confirma que la mayoría de pacientes con migraña identifica alguna circunstancia precipitantede sus crisis. El control o evitación de estos factores, en los casos en que sea posible, debe formar parte del programa de educación del paciente con migraña (AU)

Introduction. Patients with migraine often report factors or circumstances that precipitate or trigger their attacks. Yet fewstudies have been conducted to examine this matter. Aim. To explore the factors that precipitate migraine in our setting, as well is their possible relation with the intensity ofthe attacks or the overall repercussion of migraine.Patients and methods. An epidemiological, cross-sectional, multi-centre study was conducted in neurology consultation services. Sociodemographic and clinical data were collected and the precipitating factors were identified from a closed list. The specific migraine disability questionnaire -Headache Impact Test (HIT-6)- and the measurement of the number of lost workday equivalents were used in the study.Results. Altogether 817 patients were recruited (72.5% females, mean age: 34.6 ± 10.3 years). A total of 70.5% of the patients had severe disability according to the HIT-6. The mean monthly number of lost workday equivalents was 2.1 ± 2.5. A total of 96.6% of the patients identified some precipitating factor for the attacks, the most commonly reported being hormonal (75.2%), stress (70.9%) and those related with disorders affecting sleep patterns (68.4%). Conclusions. The FACTOR study confirms that most patients with migraine identify some circumstance that precipitatestheir attacks. Controlling or avoiding these factors, whenever possible, must be part of the programme of education received by patients suffering from migraine (AU)

[Precipitating factors of migraine attacks in patients attended in neurology services. The FACTOR study]. / Factores precipitantes de crisis de migraña en pacientes atendidos en consultas de neurología. Estudio FACTOR.

INTRODUCTION: Patients with migraine often report factors or circumstances that precipitate or trigger their attacks. Yet few studies have been conducted to examine this matter. AIM: To explore the factors that precipitate migraine in our setting, as well is their possible relation with the intensity of the attacks or the overall repercussion of migraine. PATIENTS AND METHODS: An epidemiological, cross-sectional, multi-centre study was conducted in neurology consultation services. Sociodemographic and clinical data were collected and the precipitating factors were identified from a closed list. The specific migraine disability questionnaire -Headache Impact Test (HIT-6)- and the measurement of the number of lost workday equivalents were used in the study. RESULTS: Altogether 817 patients were recruited (72.5% females, mean age: 34.6 ± 10.3 years). A total of 70.5% of the patients had severe disability according to the HIT-6. The mean monthly number of lost workday equivalents was 2.1 ± 2.5. A total of 96.6% of the patients identified some precipitating factor for the attacks, the most commonly reported being hormonal (75.2%), stress (70.9%) and those related with disorders affecting sleep patterns (68.4%). CONCLUSIONS: The FACTOR study confirms that most patients with migraine identify some circumstance that precipitates their attacks. Controlling or avoiding these factors, whenever possible, must be part of the programme of education received by patients suffering from migraine.

[Transorbital echography for assessment of optical nerve atrophy in demyelinating diseases: a pilot study]. / Utilidad del dúplex orbitario para la valoración de atrofia del nervio óptico en enfermedades desmielinizantes: estudio piloto.

INTRODUCTION. Demielinating diseases are a group of heterogenic diseases in whom mieline is attacked. The optic nerve (ON) is one of the most commonly affected. SUBJECTS AND METHODS. An observational prospective case-control study with ON orbital echography was developed. The case group was formed by 31 demielinating diseases patients and the control group was formed by 24 healthy people. Mean age of cases: 48.3 ± 11.8 years old, controls 48.7 ± 9.9 years old. 46% of controls and 35% of cases were males. RESULTS. We found statistical significance differences between cases and controls regarding the diameter of right (controls 3.64 ± 0.58 mm vs patients 2.84 ± 0.56 mm; p < 0.001) and left ON (controls 3.95 ± 0.84 mm vs patients 2.74 ± 0.54 mm; p < 0.001). We found no differences between maximum systolic and median velocities regarding ophthalmic arteries in both groups, neither for previous acute optical neuritis history or visual evocated potentials. CONCLUSIONS. ON evaluation with transorbital echography is an easy, feasible, non invasive, useful and costless technique for the evaluation of the ON atrophy. As for visual evocated potentials are abnormal in a huge number of patients without previous optical neuritis evidence, the diameter of ON measured by transorbital Doppler could be a consistent paraclinic marker of these diseases.

Cambio del patrón del dolor en un paciente migrañoso / Change in the pattern of pain in a patient with migraine

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Factores de personalidad, grado de discapacidad y abordaje terapéutico de los pacientes con migraña atendidos en primera consulta en neurología (estudio Psicomig) / Personality factors, degree of disability and therapeutic management of patients with migraine visiting a neurology unit for the first time (Psicomig study)

Introducción. La migraña se ha asociado recientemente a determinados perfiles de personalidad y estilos de afrontamiento. Objetivo. Explorar la asociación entre factores de personalidad, discapacidad y abordaje terapéutico en la migraña. Pacientes y métodos. Estudio epidemiológico, transversal y multicéntrico, con pacientes atendidos por primera vez en una consulta de neurología por migraña. Se recogieron datos sociodemográficos y clínicos de los pacientes. Para valorar factores de personalidad se utilizó el NEO-FFI (Neuroticism-Extroversion-Openness-Five Factor Inventory); se evaluó el grado de discapacidad mediante el Headache Impact Test (HIT-6) y la medida del número de días equivalentes a días de trabajo perdidos –lost workday equivalents (LWDE)–. Se realizaron análisis de regresión logística bivariantes. Resultados. Se reclutaron 736 pacientes, de los cuales fueron valorables para el análisis 700 (75,6% mujeres; edad media: 35,5 ± 11,5 años). Un 68,9% presentaba migraña sin aura, 1-4 crisis/mes (66,7%) y de intensidad moderada (58,1%). El 76,1% de pacientes tenía discapacidad grave según el HIT-6. De los 554 pacientes activos, la media de días equivalentesa días de trabajo perdidos en los últimos tres meses fue de 6,8 ± 8,2. Los pacientes mostraban una mayor inestabilidad emocional que la población general, y su puntuación fue menor en extraversión, apertura, amabilidad y responsabilidad. Todos los pacientes recibían tratamiento para su migraña: el 47,3%, mediante un tratamiento escalonado entre ataques; el 39,9%, intraataque, y estratificado, únicamente el 12,9%. Conclusiones. Este estudio confirma el impacto de la migraña en términos de discapacidad y en términos de pérdida de productividad laboral, así como su asociación a factores de personalidad (AU)

Introduction. Migraine has recently been associated to certain personality profiles and styles of coping. Aim. To explore the association between personality factors, disability and the therapeutic management of migraine. Patients and methods. We conducted an epidemiological, cross-sectional, multi-centre study with patients with migraine visiting a neurology unit for the first time. Socio-demographic and clinical data were collected about the patients. The NEO-FFI (Neuroticism-Extraversion-Openness Five-Factor Inventory) was used to evaluate personality factors; the degree of disability was evaluated using the Headache Impact Test (HIT-6) and the number of lost workday equivalents (LWDE) was measured. Bivariate logistic regression analyses were also performed. Results. A total of 736 patients were recruited, of whom 700 were suitable for inclusion in the analysis (75.6% females; mean age: 35.5 ± 11.5 years). In all, 68.9% presented migraine without aura, 1-4 seizures/month (66.7%) and of moderate intensity (58.1%). A total of 76.1% of patients had severe disability according to the HIT-6. Of the 554 active patients, the mean number of lost workday equivalents in the previous three months was 6.8 ± 8.2. Patients showed greater emotional instability than the general population and they scored lower on extraversion, openness, agreeableness and conscientiousness. All the patients were being treated for their migraine: 47.3% by means of stepped treatment between seizures; 39.9% intra-seizures, and stratified in only 12.9%. Conclusions. This study confirms the impact of migraine in terms of disability and in terms of loss of labour output, together with its association with personality factors (AU)

One-year prevalence of migraine in Spain: a nationwide population-based survey.

AIM: The purpose of the study was to estimate the one-year prevalence of migraine among a population-based sample of Spanish adults. METHOD: Men and women aged 18-65 years were selected at random according to quotas for age, sex, size of habitat (<10,000 inhabitants, 10,001-50,000 inhabitants, 50,001-200,000 inhabitants and >200,000 inhabitants) and residence proportional to the population size of the geographical location. A random-digit-dial, computer-assisted telephone interview (CATI) survey was conducted between April and July 2006. The 2004 International Headache Society operational diagnostic criteria were applied. RESULTS: From a total of 70,692 telephone calls and 26,255 (31.7%) valid contacts, 5,668 (21.6%) respondents completed the CATI survey. A total of 476 subjects (8.4%, 95% confidence interval [CI] 7.7-9.1%) with strict migraine and 236 with probable migraine (4.2%, 95% CI 3.7-4.7%) were recorded. The 1-year prevalence of total migraine (N = 712) was 12.6% (95% CI 11.6-13.6) (17.2% in females, 8.0% in males). The prevalence rates showed significant geographic variations, from 7.6% in Navarra to 18% in the Canary Islands. One-half of the subjects had migraine with aura. One-third of subjects were never diagnosed for migraine. CONCLUSIONS: The one-year prevalence of migraine in Spain is 12.6%, with a prevalence of migraine with and without aura of 8.4% and probable migraine of 4.2%. These findings add data to the current understanding of migraine.

[Chronic migraine as seen by neurologists and patients: results of the CIEN-mig project (III)]. / La migraña crónica vista por el neurologo y el paciente: resultados del proyecto CIEN-mig (III).

INTRODUCTION: Data on the reality of chronic migraine in our clinics are scarce. AIM. To know the frequency of consultation and attitude of the neurologist regarding chronic migraine, and the opinion of patients with this condition. SUBJECTS AND METHODS: A total of 145 neurologists consulted electronically two questionnaires. The first tested the impact of chronic migraine and their approach in the daily practice. The second was filled in by the consecutive patients. RESULTS: A total of 4.1% of patients consulted due to chronic migraine, mostly women in their forties. The average time for diagnosis was 28.7 months. All neurologists recommended preventive treatment from the beginning. More than a quarter kept this treatment for more than a year and used drug combinations. Only half thought that overuse was the reason for chronic migraine and the majority allowed non-steroidal anti-inflammatories and triptans at restricted doses. Only half of the patients knew they had chronic migraine. In their opinion, heredity and the absence of an early and serious treatment could contribute for chronic migraine development. CONCLUSIONS: Almost one patient per day consults due to chronic migraine, which gives an idea of its impact. A better feed-back with primary care level is necessary, if we consider that the delay in the diagnosis is longer than two years. The majority of neurologists follows the current recommendations of the Headache Group of the Spanish Society of Neurology.

[Satisfaction of the migraine patient attending neurology clinics: results of CIEN-mig project (II)]. / Satisfacción del paciente con migraña que acude a consultas de neurología: resultados del proyecto CIEN-mig (II).

INTRODUCTION: Migraine is the most common neurological consultation in our country. AIM. To analyse the satisfaction level of the patient with migraine attending our clinics. PATIENTS AND METHODS: A total of 160 neurologists asked 10 consecutive migraine patients to fill in a satisfaction questionnaire. RESULTS: The questionnaire was answered by 1330 patients. The most important factors they considered for their neurologists were professional experience and kindness. Patients thought neurologist should improve in time to explain treatment and accessibility. Almost 90% of patients considered that treatments for migraine had improved, but almost half of them were not satisfied with the management in primary care setting. Patients were more satisfied with symptomatic treatment (69.1%) than with preventatives (50.4%). More than half had a neuroimaging study due to their headaches. Only half thought that such an study would improve their satisfaction. CONCLUSIONS: The level of satisfaction of the migraine patient attending our clinics has improved in the last years. In patients' opinion the aspects which should be improved are the time to explain migraine and its treatment, accessibility and preventive treatment.

Satisfacción del paciente con migraña que acude a consultas de neurología: resultados del proyecto CIEN-mig (II) / Satisfaction of the migraine patient attending neurology clinics: results of CIEN-mig project (II)

Introducción. La migraña es el motivo neurológico más frecuente de consulta en nuestro país. Objetivo. Analizar el grado de satisfacción del paciente migrañoso que acude a consultas de neurología de nuestro país. Pacientes y métodos. Un total de 160 neurólogos españoles pasó un cuestionario de satisfacción a 10 pacientes consecutivos con migraña que acudieron a consulta. Resultados. Un total de 1.330 pacientes contestaron el cuestionario. Los factores que los pacientes consideraban más importantes por parte de neurólogo fueron la experiencia profesional y la amabilidad. Los pacientes pensaban que deberíamos mejorar sobre todo en el tiempo en explicar el tratamiento y en la facilidad de acceso a la consulta. Casi el 90% de los pacientes pensaba que los tratamientos frente a la migraña habían mejorado, pero casi la mitad de los pacientes no estaba satisfecha con la atención en la atención primaria. Los pacientes se mostraban más satisfechos con el tratamiento sintomático (69,1%) que con el tratamiento preventivo (50,4%). A algo más de la mitad de los pacientes se les había realizado un estudio de neuroimagen para analizar sus cefaleas. Sólo la mitad pensaba que llevar a cabo un estudio de neuroimagen mejoraría su satisfacción. Conclusiones. La satisfacción de los pacientes con migraña que acuden a consultas de neurología ha mejorado los últimos años. En su opinión, los aspectos susceptibles de mejora serían la explicación de esta afección y su tratamiento, la facilidad de acceso a la consulta y el tratamiento preventivo (AU)

Introduction. Migraine is the most common neurological consultation in our country. Aim. To analyse the satisfaction level of the patient with migraine attending our clinics. Patients and methods. A total of 160 neurologists asked 10 consecutive migraine patients to fill in a satisfaction questionnaire. Results. The questionnaire was answered by 1330 patients. The most important factors they considered for their neurologists were professional experience and kindness. Patients thought neurologist should improve in time to explain treatment and accessibility. Almost 90% of patients considered that treatments for migraine had improved, but almost half of them were not satisfied with the management in primary care setting. Patients were more satisfied with symptomatic treatment (69.1%) than with preventatives (50.4%). More than half had a neuroimaging study due to their headaches. Only half thought that such an study would improve their satisfaction. Conclusions. The level of satisfaction of the migraine patient attending our clinics has improved in the last years. In patients’ opinion the aspects which should be improved are the time to explain migraine and its treatment, accessibility and preventive treatment (AU)

La migraña crónica vista por el neurólogo y el paciente: resultados del proyecto CIEN-mig (III) / Chronic migraine as seen by neurologists and patients: results of the CIEN-mig project (III)

Introducción. Existen pocos datos acerca de la realidad de la migraña crónica en nuestras consultas. Objetivo. Conocer la carga asistencial y la actitud del neurólogo frente a la migraña crónica y la opinión del paciente con esta patología. Sujetos y métodos. Un total de 145 neurólogos contestaron por vía electrónica dos cuestionarios. El primero iba encaminado a caracterizar el impacto de la migraña crónica y su actitud en la práctica habitual. El segundo había de ser respondido por tres pacientes consecutivos. Resultados. Un 4,1% consultó por migraña crónica, mayoritariamente mujeres en la quinta década. El tiempo medio hasta el diagnóstico fue de 28,7 meses. Todos los neurólogos recomendaron tratamiento preventivo desde el inicio. Más de una cuarta parte lo mantenía más de un año y utilizaba combinaciones de fármacos. Sólo la mitad pensaba que el abuso de analgésicos era la causa de la migraña crónica y la mayoría se decantó por permitir antiinflamatorios no esteroideos y triptanes de forma restringida. Sólo la mitad de los pacientes sabía que tenía migraña crónica. En su opinión, la herencia y la ausencia de un tratamiento reglado y precoz podrían contribuir al desarrollo de migraña crónica. Conclusiones. Casi un paciente al día consulta por migraña crónica, lo que da idea de su impacto asistencial. La coordinación con atención primaria es necesaria, si tenemos en cuenta que el retraso en el diagnóstico es de más de dos años. La mayoría de los neurólogos sigue las recomendaciones de tratamiento del Grupo de Cefaleas de la Sociedad Española de Neurología (AU)

Introduction. Data on the reality of chronic migraine in our clinics are scarce. Aim. To know the frequency of consultation and attitude of the neurologist regarding chronic migraine, and the opinion of patients with this condition. Subjects and methods. A total of 145 neurologists consulted electronically two questionnaires. The first tested the impact of chronic migraine and their approach in the daily practice. The second was filled in by the consecutive patients. Results. A total of 4.1% of patients consulted due to chronic migraine, mostly women in their forties. The average time for diagnosis was 28.7 months. All neurologists recommended preventive treatment from the beginning. More than a quarter kept this treatment for more than a year and used drug combinations. Only half thought that overuse was the reason for chronic migraine and the majority allowed non-steroidal anti-inflammatories and triptans at restricted doses. Only half of the patients knew they had chronic migraine. In their opinion, heredity and the absence of an early and serious treatment could contribute for chronic migraine development. Conclusions. Almost one patient per day consults due to chronic migraine, which gives an idea of its impact. A better feedback with primary care level is necessary, if we consider that the delay in the diagnosis is longer than two years. The majority of neurologists follows the current recommendations of the Headache Group of the Spanish Society of Neurology (AU)