[Headaches in general medical practice].

The bulk of patients with primary headaches HA (cephalalgias) are observed in primary care. The optimal diagnostic algorithm implies the exclusion of potentially dangerous causes of HA and secondary cephalalgias requiring specific treatment. Verification of the form of primary HA is carried out clinically, does not require additional diagnostic methods and is based on the use of the criteria of the International Classification of Headache Disorders. Among all cephalalgias in general clinical practice, the vast majority of cases are represented by four forms: migraine, tension type headache, cluster headache, and medication overuse headache. The complex application of modern methods of pharmacological and non-pharmacological treatment with the use of preventive strategies ensures high efficiency in the management of patients with HA.

[A role of cognitive and emotional factors in formation of pain]. / Rol' kognitivnykh i emotsional'nykh faktorov v formirovanii boli.

Pain is influenced by multiple emotional and cognitive factors. This paper provides an overview of the most important emotional and cognitive factors affecting pain, which has been confirmed in experimental and clinical studies. Emotional factors that increase pain perception include anxiety, depression, and other negative emotions. Positive emotions lead to a decrease in pain. Cognitive factors such as attention, expectation anxiety, and pain assessment can both increase and decrease pain sensations, depending on their specific focus. It becomes clear that pain is not just a reflection of nociceptive irritation, but also a feeling formed by psychological factors that can be individual in each case.

[Headache and cerebrovascular diseases]. / Golovnaya bol' i tserebrovaskulyarnye zabolevaniya.

Headache is a common symptom of acute and chronic cerebrovascular diseases. Headache can be symptomatic in patients with various forms of vascular pathology of the brain but primary headaches are much more common. Secondary headaches in acute cerebrovascular accidents may be the first symptom, and in some cases, a risk factor or complication of stroke. In chronic cerebrovascular diseases, headache may be the predominant symptom in the early stages and resolve in the later stages of the disease. At the same time, the severity, nature and course of headache cannot be considered as reliable signs of cerebrovascular disease. Meanwhile, the verification of the headache form is important from the point of view of determining the priorities of diagnosis and therapy.

[Migraine in the real-life clinical practice: results of the observational study of diagnosis and treatment patterns in the urban population of the Russian Federation]. / Migren' v real'noi klinicheskoi praktike: rezul'taty nablyudatel'nogo issledovaniya patternov diagnostiki i lecheniya sredi gorodskogo naseleniya Rossiiskoi Federatsii.

OBJECTIVE: Analysis of real-life clinical practice data regarding the patterns of diagnosis and treatment of migraine in the Russian Federation. MATERIAL AND METHODS: An observational real-world cohort study was conducted from January 2013 to December 2018 (over a 5-year period) to analyze the electronic database of 5 large private clinic chains in Moscow and St. Petersburg. RESULTS: Among 1.15 million people who sought medical care, «G43 Migraine¼ diagnosis was established in 6.650 people, which accounted for 0.6%. A total of 54% of patients were diagnosed by a neurologist, while 35% by a GP. In roughly half the cases, to diagnose migraine, the doctors had to resort to additional methods of examination. While 53% of patients had indications for preventive treatment, it was prescribed only to 12% of those. Of these, the treatment strategy chosen for 29% of patients was changed: either the intragroup/intergroup switching of the medicinal product took place, or the combined treatment was prescribed. CONCLUSION: In the real-life outpatient clinical practice, the level of diagnosis of migraine is extremely low. Additional methods of examination are excessively used for the diagnosis of migraine. The insufficient use of preventive medication and common use of therapies with unsubstantiated efficacy in migraine result in frequent changes in the treatment strategy.

[Migraine burden and clinical inertia: what can we do?] / Migren' i klinicheskaia inertsiia: chto my mozhem sdelat'?

AIM: To study the compliance of neurologists and headache specialists to chronic headache and chronic migraine (CM) diagnosis and treatment guidelines. MATERIAL AND METHODS: The survey included 634 neurologists from all regions of the Russian Federation. Mean age of respondents was 40.7±8.5 years, mean years of experience 14.2±7.8 years. RESULTS: Most doctors work in outpatient or hospital settings (49% and 24%, respectively), 7% were headache specialists. Tension-type headache (TTH) was diagnosed in 30% and CM in 17% of patients while 44% of patients were presumed to have a mixed headache disorder (TTH+CM). Only 10% of physicians do not use instrumental diagnostic methods in chronic headache. This study has shown sufficient attention to comorbid conditions and frequent prescription of headache preventative treatment. Botox prescription data is equivocal: 35% of physicians recommend such treatment, 27% do not, while other doctors prescribe it for off-label indications. CONCLUSION: To overcome clinical inertia, further education in chronic headaches and their optimal treatment is warranted.

[Mild cognitive impairment: what's next?] / Umerennye kognitivnye rasstroistva: chto dal'she?

The concept of mild cognitive impairment is one of the promising directions for studying the predementia stages of different diseases. The feasibility of studying this phenomenon is due not only to a high risk of dementia, but also the potential reversibility of cognitive decline in old age. Long-term follow-up of patients shows different trajectories of cognitive decline in aging. The study of risk factors for the progression of moderate cognitive impairment provided an opportunity to highlight new horizons of prevention of dementia of various etiologies. Despite the insufficient effectiveness of drug therapy in patients with moderate cognitive impairment, exploring the opportunities for possible treatment of their subtypes seems promising from the point of view of improving clinical symptoms and a possible reduction in the rate of disease progression.

[Neurocognitive aging and cognitive disorders]. / Neirokognitivnoe starenie i kognitivnye rasstroistva.

Aging is the leading risk factor of the most common cognitive disorders, primarily Alzheimer's disease and vascular dementia. These diseases have a progressive course and pathological underlying processes develop long before the onset of clinical signs of cognitive impairment. In the context of current trends in population aging and the steady increase in the number of patients with dementia, the search for factors contributing to the acceleration of neurocognitive aging processes, as well as factors with a modifying effect on these processes, is a key element in the effective management of elderly patients.

[The efficacy and safety of naproxen in the treatment of nonspecific lumbalgia: the results of an open multi-center study (NEST)]. / Éffektivnost' i bezopasnost' naproksena v lechenii nespetsificheskoi liumbalgii: rezul'taty otkrytogo mnogotsentrovogo issledovaniia (NEST).

AIM: To assess the efficacy and safety of naproxen in patients with nonspecific low back pain. MATERIAL AND METHODS: Ninety patients with nonspecific low back pain were enrolled in the study. Patients took 550 mg of naproxen twice a day. All patients were assessed with VAS, the Oswestry questionnaire, Schober's test and clinical global impression scale. The treatment lasted from 7 to 14 days depending on the pain relief (VAS ≤10 mm). RESULTS: The pain syndrome relief was observed in 77 patients (88.5%) during the first week of the treatment and in 81 (93.1%) by the end of the study. The average value of VAS was reduced by 6.2 times (by 52.9 mm) in comparison to the baseline. According to the Oswestry questionnaire the influence of pain syndrome on the life quality was reduced by 4,78 times in comparison to the baseline. Schober's test revealed an increase in the amplitude of movements during therapy by 27% in comparison to the baseline. Only 5 (5.7%) drug-related adverse reactions were observed during the whole study, 80% of those were mild. CONCLUSION: Naproxen in the dose of 550 mg twice a day demonstrates the high efficacy and safety in patients with non-specific pain in lumbosacral spine.

[Neurostimulation of the supraorbital nerve with the Cefaly device - a new method for the treatment of migraine]. / Neirostimuliatsiia supraorbital'nogo nerva s pomoshch'iu ustroistva Cefaly - novyi metod lecheniia migreni.

Treatment of migraine mainly includes pharmacological approaches aimed at breaking migraine attacks and preventive treatment to reduce their frequency. Despite the wide range of pharmacological agents, frequent side effects and pharmacotherapy resistance in patients with migraine determine the urgency of finding new alternative treatment strategies. The introduction of new non-invasive methods for percutaneous stimulation has fundamentally expanded the therapeutic opportunities for many patients with migraine, irrespective of the severity of the disease and responsiveness to pharmacotherapy. Stimulation of the supraorbital nerve with the percutaneous Cefaly device ('Cefaly Technology sprl', Seraing, Belgium) in clinical randomized, controlled studies has demonstrated efficacy in significantly reducing both the frequency of migraine attacks and the total number of days with headache. Cefaly is the first FDA approved migraine prevention medical device.

[The efficacy of the second generation triptan migrepam in the treatment of migraine attacks: results of the comparative study]. / Éffektivnost' triptana vtorogo pokoleniia migrepama v kupirovanii pristupov migreni: rezul'taty sravnitel'nogo issledovaniia.

AIM: To evaluate the efficacy and safety of migrepam in the treatment of migraine attacks. MATERIAL AND METHODS: Sixty patients with episodic migraine with and without aura, aged between 18 and 65 years, were included in the randomized prospective, open, comparative study. Patients of group I (n=30) received migrepam (zolmitriptan) in a dose of 2.5 mg, group II (n=30) received sumatriptan, 50 mg. The following parameters were assessed: intensity of headache, photo-, phonophobia, frequency, severity of the associated symptoms, indicators of the degree of impact of the headache on general condition and quality of life, headache-related disability, functional activity, as well as patient satisfaction with the therapy. RESULTS AND CONCLUSION: A comparison of the initial indicators of the groups did not reveal any significant differences between them both in demographic characteristics and main parameters analyzed. As a result of therapy, a similar pattern of influence of the studied drugs on the intensity of pain and accompanying symptoms is shown. The more significant effect of migrepam on the characteristics of daily functioning, which is accompanied by a higher subjective assessment of the effectiveness of the relief of migraine attacks by the patients, is noted.

[Evaluation of nutrition, body composition and features of dietetic counseling for patients with functional hypothalamic amenorrhea].

The assessment of nutrition status, anthropometry, eating disorders, fat tissue and leptin levels in 48 patients with functional hypothalamic amenorrhea (FHA) was conducted. The study of nutrition status revealed a discrepancy between the caloric intake and energy expenditure in 50% of patients, inadequate daily intake of carbohydrates in 91.7%, increased protein intake in 70.8% of patients. The recommended ratio of proteins, fats, carbohydrates in patients of the study group was not observed (1:1:0.3). It was noted that the deficit of adipose tissue and the decrease in serum leptin concentration were observed not only in patients with low body mass index), but also in 70% of women with normal values. Using the questionnaire Eating Disorder Inventory 2 (EDI-2) revealed that 54.2% of patients had drive for thinness and 22.9% of patients had body dissatisfaction. The results indicate the need for an integrated approach to the management of patients with FHA, which provides consultation of a gynecologist, psychotherapist and nutritionist.

[Mixed dementia: the role of cerebrovascular pathology]. / Smeshannaia dementsiia: rol' tserebrovaskuliarnoi patologii.

Alzheimer's disease and vascular dementia are two most common causes of dementia in late life. The combination of Alzheimer's type dementia and vascular dementia is the third most common form of dementia, especially in the elderly. Most clinical forms of dementia are characterized by the presence of 'overlap' symptoms of both neurodegenerative and vascular pathology, which makes it expedient to consider mixed dementia as a separate entity characterized by clinical presentations, course and the rate of progression of cognitive decline. Despite the lack of clinical guidelines for management of patients with mixed dementia, it seems appropriate to use strategies that have shown their effectiveness in various types of cognitive impairment.

[Ways of optimizing the management of patients with migraine in Russia (resolution of the council of experts)]. / Puti optimizatsii vedeniia patsientov s migren'iu v Rossii (rezoliutsiia soveta ékspertov).

Migraine is the third most common disease in the world. The overall prevalence of migraine in the Russian Federation is estimated at 20% with an estimated global prevalence of 14.7%. Migraine affects mostly people of working age and has a significant negative impact on the quality of life, the level of adaptation, ability to work, social functioning. Migraine represents a significant social and economic burden for patients and society as a whole. A team of national experts on migraine offers a program to prioritize quality of management of patients with headache.

[Migraine and sleep]. / Migren' i son.

This review discusses the epidemiological, clinical and pathophysiological aspects of the comorbidity of migraine and various forms of sleep disorders, the role of disturbances in the sleep and wake cycle in the processes of transformation of headaches, and possible strategies for modifying therapeutic approaches in this comorbidity.

[Diagnosis and treatment of migraine: Recommendations of the Russian experts]. / Diagnostika i lechenie migreni: rekomendatsii rossiiskikh ékspertov.

These recommendations on the diagnosis and treatment of migraine were elaborated by Russian headache experts in accordance with the evidence-based practice. Together with the latest classification, diagnostic principles and criteria of different clinical sub-forms the consensus contains basic data on migraine epidemiology, pathophysiological mechanisms, differential diagnosis and most effective and evidence based approaches to pharmacological and non-pharmacological management of migraine patients.

[The optimization of management of chronic daily headache patients]. / Optimizatsiya vedeniya patsientov s khronicheskoi ezhednevnoi golovnoi bol'yu.

AIM: To optimize the management of chronic daily headache (CDH) using cognitive-behavioral therapy (CBT). MATERIAL AND METHODS: The study included 90 patients (76 women and 14 men), aged from 23 to 78 years (mean age 46.71±11.99) with primary forms of CDH. The patients were followed-up by the neurologist during 12 months, psychological characteristics were studied together with the psychiatrist. Patients received combined treatment, including optimized pharmacotherapy, educational program, relaxation training, CBT and exercise therapy. RESULTS: The diagnosis of CDH has not been previously established in 86.7% of the patients. All patients received unnecessary additional diagnostic examinations, ineffective treatment (86.7%) that resulted in the formation of wrong conceptions about their state (90%). Three months after combined treatment, a significant positive effect has been achieved in 62.2% of the patients and after 12 months in 72.2%. CONCLUSION: The combined treatment program that included CBT can relatively rapidly help patients with CDH and exerts a stable positive effect during 12 months of the follow-up.

[Possibilities of preventive therapy in frequent episodic tension-type headache].

OBJECTIVE: To study the efficacy and safety of tenoten in the preventive treatment of frequent episodic tension-type headache (FETHA) compared to patients treated with pain relievers. MATERIAL AND METHODS: A study included 60 patients with FETHA. Patients of the main group (n=30) received tenoten in addition to standard treatment. The study comprised 3 visits: beginning of treatment, after one month and after three months. All patients underwent physical and clinical/neurological examinations. In each visit, treatment efficacy was assessed according the following parameters: VAS scores (0-10) for assessment of pain and tension in pericranial muscles in 6 standard points, mean frequency and duration of the headache episode, quality of life indices, Beck depression scores, Spilberger trait and state anxiety, autonomic symptom severity, parameters of sleep disorders, frequency of adverse effects, CGI scores (0-7). RESULTS AND CONCLUSION: Tenoten as a preventive medication reduced the frequency of headache episodes that allowed to diagnose patients with rare episodic tension-type headache in the end of treatment. At the same time, there was a significant reduction in headache intensity during the episode and decrease in amount of analgesics used by the patients.

[Low back pain: possibilities of pathogenetic treatment].

Intervertebral disc (IVD) degeneration is one of the major causes of low back pain (LBP). Due to the complexity of spinal pain syndromes, it is often difficult to determine the extent of the IVD's contribution to the genesis of spinal pain. Inflammatory response to IVD' injury has been acknowledged to be important in the process of disc degeneration and may play an important role in pain generation. In this article, the inflammatory mechanisms of LBP will be discussed with special focus on interactions between inflammatory mediators and IVD biomechanics. Tumor necrosis factor-α (TNF-α) is a key mediator of inflammatory reactions in the pathogenesis of degenerative disk disease. The role of TNF-α inhibitors as a potential target of therapeutic interventions in prevention of neuronal damage and neuroprotection in LBP is discussed.

[Tenoxicam (texamen) in the treatment of acute cervicalgia: results of an open comparative trial].

OBJECTIVE: Acute cervical pain is one of the most common reasons for a visit to a doctor and temporal disability. We studied efficacy and safety of the nonsteroid anti-inflammatory drug tenoxicam (texamen) in the treatment of acute cervical pain in myofascial syndrome. MATERIAL AND METHODS: A trial included 50 people (42 women and 8 men, mean age 42,2±6,8 years) with acute cephalgia. A main group (30 patients) received tenoxicam in dose 20 mg daily in the morning during 7 days with simultaneous therapeutic exercises with elements of postisometric relaxation of cervical muscles. A control group (20 patients) received myorelaxants and massage of a cervical-collar zone. RESULTS: The analgesic effect was more rapid in patients treated with texamen compared to controls. Statistically significant differences were seen in 1-3 days of treatment. In the main group, the analgesic effect long, only 16,6% of patients reported the aggravation of pain in the evening hours during the first day of treatment and 10% in the 2nd day; 23,3% patients of the main group used an additional dose of texamen, another nonsteroid anti-inflammatory drug (ibuprofen) or triptan to stop pain. CONCLUSION: The introduction of nonsteroid anti-inflammatory drugs, in particular texamen, in the complex treatment of acute cephalgia can significantly reduce pain syndrome.

Headache-attributed burden and its impact on productivity and quality of life in Russia: structured healthcare for headache is urgently needed.

BACKGROUND AND PURPOSE: The study evaluated headache-attributed burden and its impact on productivity and quality of life (QoL) in Russia. Its purpose was to support recommendations for change. METHODS: A countrywide population-based random sample of 2725 biologically unrelated adults (aged 18-65 years) in 35 cities and nine rural areas of Russia were interviewed in a door-to-door survey. The structured questionnaire enquired into symptom burden, functional disability, lost productive time and QoL (applying the WHOQoL-8 question set), as well as willingness to pay (WTP) for adequate headache treatment, if it were available. RESULTS: Mean lost paid-work days due to headache in the previous 3 months were 1.9 ± 4.2, and mean lost household work days were 3.4 ± 5.7. The estimated annual indirect cost of primary headache disorders was USD 22.8 billion, accounting for 1.75% of gross domestic product. QoL was reduced by all types of primary headaches. According to WHOQoL-8, it was significantly lower in those with headache on ≥15 days/month than in those with episodic headache (24.7 ± 4.6 vs. 28.1 ± 5.0; P < 0.05) and lower in those with migraine than in those with tension-type headache (TTH) (27.1 ± 4.9 vs. 28.8 ± 5.0; P < 0.05). Average WTP for adequate headache treatment was RUB 455 ± 494 per month (median RUB 300), a sum sufficient in most cases, and correlated with illness severity (higher for headache on ≥15 days/month than for migraine, and for migraine than for TTH). CONCLUSIONS: Headache is common, burdensome and costly in Russia and, manifestly, poorly mitigated by existing healthcare. Structured healthcare services for headache need to be urgently put in place.