[Organisation of headache units from a multidisciplinary point of view]. / Organizacion de las unidades de cefalea desde un punto de vista multidisciplinar.

Headache units have come into being to respond to the need to address the treatment of patients with complex headaches in a multidisciplinary manner. Although headaches are one of the most prevalent medical pathologies, it is surprising how little is being done to foster the development of such units. Within the multidisciplinary organisation, the role of the neurologist with adequate training in this field is essential. He or she is the person responsible for receiving, directing, supervising and coordinating the treatment, together with other medical specialties. The basic core of the team should consist of a psychiatrist, psychologist and physiotherapist. Their joint coordinated action generates an objective improvement in the pain over and beyond that achieved with each isolated treatment.

TITLE: Organizacion de las unidades de cefalea desde un punto de vista multidisciplinar.Las unidades de cefaleas surgen ante la necesidad de abordar de forma multidisciplinar el tratamiento de pacientes con dolores de cabeza complejos. A pesar de que las cefaleas son una de las patologias medicas mas prevalentes, es llamativa la poca promocion que existe para su desarrollo. Dentro de la organizacion multidisciplinar, el papel del neurologo debidamente formado en este campo es crucial. Es la persona encargada de recibir, dirigir, supervisar y coordinar el tratamiento, junto con otras especialidades medicas. Se debe contar con la participacion del psiquiatra, del psicologo y del fisioterapeuta como nucleo basico. Su actuacion conjunta y coordinada genera de forma objetiva una mejoria del dolor frente a cada tratamiento de forma aislada.

[Triptans in clinical practice: effectiveness, tolerance and patient's satisfaction with medication (TRIPRACLI study)]. / Los triptanes en la practica clinica: eficacia, tolerancia y satisfaccion del paciente con los farmacos (estudio TRIPRACLI).

INTRODUCTION AND AIMS: This study was aimed determining the effectiveness, tolerance and satisfaction of patients with migraine as regards different triptans, according to the characteristics of their attacks. At the same time it sought to establish a predictive model that can be used to recommend one or another, depending on those characteristics. PATIENTS AND METHODS: Retrospective observation-based study conducted in headache units in a number of different centres. Patients included in the study were those with migraine who used the same triptan to treat their attacks. Data concerning preference, effectiveness, speed and tolerance were analysed. RESULTS: The analysis included 160 patients (88 females), with a mean age of 42.92 years. The most commonly used triptans were eletriptan, almotriptan and rizatriptan. Both patients and doctors reported a high degree of satisfaction (88% and 65%) with the triptan that was used. In the surveys on preference, patients preferred their current triptan to the previous one (83%) or to non-specific drugs. The overall score on a visual analogue scale was above 7 for all the triptans, without any differences from one to another. On analysing the use of a particular triptan depending on the characteristics of the attacks, no statistically significant differences were found. CONCLUSIONS: In this selected group of patients, triptans are a treatment that patients claim to be very satisfied with. Although there are no overall differences in the scores among different triptans, the fact that certain triptans are used more by patients after previous experiences with others suggests that they are more effective. We did not find any parameter that predicts the use of a particular triptan.

Migraña como factor de riesgo cerebrovascular / Migraine as a cerebrovascular risk factor

Introducción: En los últimos años ha cobrado relevancia la migraña como factor de riesgo vascular así como la presencia de lesiones inespecíficas de sustancia blanca y lesiones isquémicas clínicamente silentes. Se ha intentado relacionar la presencia de estos hallazgos en la neuroimagen con la cronificación de la migraña. A esto hay que añadir la detección de un peor perfil metabólico en pacientes migrañosos. Con el fin de aclarar la relación entre la migraña y las alteraciones vasculares cerebrales, se ha realizado una exhaustiva revisión de la literatura. Desarrollo: Múltiples estudios han demostrado una asociación significativa entre la migraña, especialmente la migraña con aura (MCA), y el riesgo de infarto cerebral, sobre todo en mujeres < 45 años. El riesgo de ictus aumenta en presencia de otros factores asociados: más de 3 veces con hábito tabáquico y más de 4 veces con el consumo de anticonceptivos orales (ACO). La migraña puede causar directamente un infarto isquémico, aunque es infrecuente. La MCA tiene un riesgo 12 veces superior de infartos subclínicos en fosa posterior. Conclusiones: Como la migraña es un factor de riesgo vascular independiente, se presupone que un mejor control de la misma, así como de otros factores de riesgo vascular asociados, disminuirán la incidencia de ictus. Se aconseja un abandono del hábito tabáquico y suprimir el uso de ACO, sobre todo en mujeres con MCA. A pesar de todo, el riesgo absoluto de infarto es bajo y se traduce aproximadamente en 3,8 casos adicionales por cada 100.000 mujeres al año (AU)

Introduction: Migraine has become an important vascular risk factor during the past few years, along with the presence of white matter and clinically silent ischaemic lesions. Whether these findings contribute to the migraine becoming chronic has been a source of debate. People with chronic migraine also have a less favourable metabolic profile. An exhaustive review of the literature has been made in order to try to clarify the relationship between migraine and vascular risk factors.Development: Migraine, particularly with aura and in women < 45 years-old, is associated with an increased risk of cerebral infarction. This risk increases if the patient smokes or uses oral contraceptives. Migraine can also be a direct cause of a stroke, although it is an infrequent complication. Migraine with aura is associated with a risk factor of 12 of having subclinical infarctions in posterior foss circulation.Conclusions: Since migraine is an independent vascular risk factor, a better control of migraine attacks, as well as other possible concomitant vascular risk factors, should decrease the likelihood of a stroke. Overall, the real risk of infarction is low, with 3.8 new cases per 100,000 women and year (AU)

[Migraine as a cerebrovascular risk factor]. / Migraña como factor de riesgo cerebrovascular.

INTRODUCTION: Migraine has become an important vascular risk factor during the past few years, along with the presence of white matter and clinically silent ischaemic lesions. Whether these findings contribute to the migraine becoming chronic has been a source of debate. People with chronic migraine also have a less favourable metabolic profile. An exhaustive review of the literature has been made in order to try to clarify the relationship between migraine and vascular risk factors. DEVELOPMENT: Migraine, particularly with aura and in women < 45 years-old, is associated with an increased risk of cerebral infarction. This risk increases if the patient smokes or uses oral contraceptives. Migraine can also be a direct cause of a stroke, although it is an infrequent complication. Migraine with aura is associated with a risk factor of 12 of having subclinical infarctions in posterior fossa circulation. CONCLUSIONS: Since migraine is an independent vascular risk factor, a better control of migraine attacks, as well as other possible concomitant vascular risk factors, should decrease the likelihood of a stroke. Overall, the real risk of infarction is low, with 3.8 new cases per 100,000 women and year.