Medication adherence in patients with cluster headache and migraine: an online survey.

To examine factors for adherent and non-adherent behavior in patients with cluster headache and migraine. Adults with cluster headache or migraine were included in this anonymous online survey using a questionnaire accessed via homepages of headache support groups. Medication adherence in preventive treatment was measured with the Medication Adherence Report Scale (MARS-D). Factors for non-adherent behavior were examined (subjective socioeconomic status, psychological comorbidities, self-efficacy, coping, side effects, expectations of treatment, information on medical treatment, and trust in the physician/treatment concept). 200 participants (n = 58 with cluster headache, n = 142 with migraine) were included. The rate of medication adherence in preventive treatment was 32.8% for participants with cluster headache and 20.4% for migraine. The most common reasons for low adherence in participants with cluster headache were altering the prescribed medication dose (34%) or taking less than instructed (14%), which was mostly due to insufficient benefit from the medication or side effects. Positive expectations of medical treatment (p ≤ 0.05) correlated significantly with adherent behavior in cluster headache. Furthermore, the adherence-promoting factors coping and self-efficacy were more pronounced in patients with cluster headache than in those with migraine (p < 0.05). This study is the first to comprehensively investigate medication adherence and factors influencing adherent/non-adherent behavior in patients with cluster headache. Patients with cluster headache had similar adherence levels to patients with migraine, but had higher resources of adherence-promoting factors.

Decision making of individuals with heroin addiction receiving opioid maintenance treatment compared to early abstinent users.

BACKGROUND AND AIMS: Individuals with heroin addiction are prone to dysfunctional decision-making. They frequently choose the short-term rewarding option of drug intake despite experiencing long-term negative consequences. Opioid maintenance treatment (OMT) is the most common treatment of heroin addiction. METHODS: In this study, 38 individuals in an early stage of abstinence from heroin addiction (ESA-HA individuals) at the end of inpatient detoxification treatment and 41 individuals in long-term OMT were examined. Decision-making was assessed by (I) a modified version of the Iowa Gambling Task (IGT) with drug-related stimuli focusing on decision-making under ambiguity and (II) the Game of Dice Task (GDT) assessing decision-making under objective risk. RESULTS: OMT-individuals showed significantly better performance in the IGT than the ESA-HA-individuals. They also showed significantly less craving under exposure of drug-related pictures. In the GDT, OMT-individuals showed significantly less risky decision-making than ESA-HA-individuals. CONCLUSION: The results suggest that patients receiving OMT show better functional decision-making and lower craving reactions. It could be assumed that the effectiveness of OMT in preventing relapse is linked to better decision-making and lower craving among these patients.

The use of complementary and alternative medicine in patients with multiple sclerosis: a longitudinal study.

BACKGROUND: Complementary and alternative medicine (CAM) in chronic progressive diseases, like multiple sclerosis (MS), is highly prevalent. Up to now there are no satisfying longitudinal analysis about changes in using of CAM accompanied by influencing parameters like disease duration, stage of impairment or socioeconomic factors. This study captured the using of CAM of MS patients in combination with disease progression. METHODS: 119 Patients with MS were asked about CAM utilization, sociodemographic and disease factors within the context of a semistructured interview at an interval of seven years. The depressive status was ascertained with the Beck's Depression Inventory (BDI). Differences of users and non-users were checked with diverse statistical tests. RESULTS: Comparing both isolated measurements at second point less patients used CAM accompanied by worse socioeconomic situation and progression of the disease. Patients use CAM in a stage of illness, characterized by the Established Disability Status Scale (EDSS) between 3.5 and 4.0 points, signifying a transition from moderate to severe impairment, and a shorter duration of illness in comparison to non-users. Types of used CAM have been changed over seven years. Relaxation techniques and traditional Chinese medicine (TCM) are the favorite therapies at second measurement. DISCUSSION: As the key result of the study patients use CAM in an early stage of the disease. Their EDSS lies between 3.5 and 4.0 points and they suffer medial two years shorter from MS than non-users. CAM could be an important appliance to cope with the disease.