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Communicating the Right Therapy for the Right Patient at the Right Time: Acute Therapy

Published online by Cambridge University Press:  02 December 2014

Fred D. Sheftell
Fred D. Sheftell*
Affiliation:
New England Centre for Headache, Stamford, CT06902 USA
*
FD Sheftell, 778 Long Ridge Road, Stamford, CT06902 USA
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Abstract

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Objective:

Review of problems arising from communication difficulties in headache practice.

Methods:

Literature review and assessment of practice experience.

Background:

Advances in understanding of the pathophysiology of migraine and the availability of specific acute therapies have given migraine sufferers access to effective treatment and physicians a wide array of therapeutic alternatives. There remains uncertainty about the best drug group for any given patient and about which triptan to use when and in which formulation; about patient preference and satisfaction; about interpretations of pivotal trials and meta-analyses; and about the relevance of large group efficacy and safety data to the individual patient. The clinician may be daunted by the array of triptans with choices of dosage and multiple formulations and will likely learn how to use two or three of them at most, as in depression and hypertension. In the context of the wide array of choices and the complexities of assessing responses and patient preferences, this paper attempts to provide a framework for incorporating the evidence with clinical experience and for communicating these concepts effectively.

Benefits, Harms and Costs:

None.

Results and Conclusion:

Even when an appropriate recommendation is determined, therapy may fail unless the doctor patient relationship permits open communication, time for questions and answers and time for instruction on how to use a given medication, and its probable effects. Translating evidence into patient-friendly language is a skill as necessary as that of making the clinical decision itself. Tools are available that can support this effort and aid in creating an environment of “partnership”.

Résumé:

RÉSUMÉ:Objectif:

Revoir les problèmes résultant de difficultés de communication dans la pratique auprès de patients souffrant de céphalée.

Méthodes:

Revue de la littérature et évaluation de l'expérience en pratique. Contexte: Les progrès dans la compréhension de la physiopathologie de la migraine et la disponibilité de traitements aigus spécifiques ont fourni aux migraineux un accès à un traitement efficace et aux médecins un vaste choix de thérapies. L'incertitude persiste quant au meilleur groupe de médicaments à prescrire pour un patient donné et quel triptan utiliser, quand et sous quelle forme; à la préférence et la satisfaction des patients; à l'interprétation d'essais cliniques clés et de méta-analyses; et à la pertinence pour un patient des données d'efficacité et de sécurité provenant de groupes importants de patients. La panoplie de triptans à multiples dosages et formulations peut rebuter le clinicien. Il apprendra probablement à se servir de deux ou trois médicaments tout au plus, comme c'est le cas dans la dépression et l'hypertension. Dans le contexte d'un vaste choix et de la complexité de l'évaluation de la réponse et des préférences du patient, cet article tente de fournir un modèle pour l'intégration des données et de l'expérience clinique, et pour la communication efficace de ces concepts.

Bénéfices, risques et coûts: Aucun. Résultats et Conclusion:

Même quand une recommandation appropriée est faite, le traitement peut échouer si la relation médecin-patient ne permet pas la communication ouverte et n'inclut pas un temps pour les questions et les réponses, pour enseigner la façon d'utiliser un médicament et aviser le patient des effets secondaires probables. Vulgariser l'information dans un langage accessible au patient est une habileté aussi nécessaire que celle de prendre la décision clinique ellemême. Des outils sont disponibles pour supporter cette initiative et aider à créer un environnement de partenariat.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue S2: A Peer-Reviewed Supplement to the Canadian Journal of Neurological Sciences , 2002 , pp. S33 - S39
Copyright
Copyright © The Canadian Journal of Neurological 2002

References

1. Tepper, SJ, Rapoport, AM. The triptans: a summary. CNS Drugs 1999;12(5):403–417.Google Scholar
2. Physician’s Desk Reference. 54th ed. Montvale (NJ): Medical Economics Company. 2000.Google Scholar
3. Tfelt-Hansen, P, Bousser, M-G, Solomon, S, et al. Guidelines for controlled trials of drugs in migraine. In: International Headache Society Members Handbook. International Headache Society Committee on Clinical Trials in Migraine: Oslo, Norway: Scandanavian University Press; 1998/99: 111–120.Google Scholar
4. Sackett, DL, Richardson, WS, Rosenberg, W, Haynes, BR. Evidence-based Medicine. How to Practice & Teach EBM. Edinburgh, London, New York, Philadelphia, Sydney, Toronto: Churchill Livingstone. 1999.Google Scholar
5. Silberstein, SD, for the US Headache Consortium. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000;55:754–762.CrossRefGoogle Scholar
6. Silberstein, SD. Migraine symptoms: results of a survey of self-reported migraineurs. Headache 1995;35:387–396.Google Scholar
7. Hall, JA, Doman, MC. Meta-analysis of satisfaction with medical care: description of research domain and analysis of overall satisfaction levels. Soc Sci Med 1988;27:637–644.Google Scholar
8. Sheftell, FD, Tepper, ST. New paradigms in the recognition and treatment of migraine. Headache 2002 (in press).Google Scholar
9. Lucas, SL, Tepper, SJ, Sheftell, FD. Therapeutic gain and the triptans. In: Rapoport, AM, Sheftell, FD, (Eds). Seminars in Headache Management. Hamilton, Ontario. Decker Periodicals 1998;3:13–14.Google Scholar
10. US Physician Desk Reference. Sumatriptan, zolmitriptan, naratriptan, rizatriptan. 2000.Google Scholar
11. Sheftell, FD, Fox, AW, Weeks, RE, Tepper, SJ. Differentiating the efficacy of 5HT agonists. Headache 2001;41:257–263.Google Scholar
12. Goadsby, P. A triptan too far? J Neurol Neurosurg Psychiat 1998; 64:143–147.Google Scholar
13. Sheftell, FD, Fox, AW. Acute migraine treatment: a clinician’s view. Cephalalgia 2000;20(Suppl 2):14–24.Google Scholar
14. Cady, RK, Sheftell, F, Lipton, RB, et al. Effect of early intervention with sumatriptan on migraine pain: retrospective analyses of data from three clinical trials. Clin Ther 2000;22:1035–1047.Google Scholar
15. Cady, R, Lipton, RB, Hall, C, et al. Treatment of mild headache in disabled migraine sufferers: results of the Spectrum Study. Headache 2000;40:792–797.Google Scholar
16. Sheftell, F, O’Quinn, S, Watson, C, Pait, D, Winter, P. Low migraine headache recurrence with naratriptan: clinical parameters related to recurrence. Headache 2000;40:103–110.Google Scholar
17. Tepper, SJ, Donnan, GA, Dowson, AJ, et al. A long-term study to maximise migraine relief with zolmitriptan. Cur Med Res Opin 1999;15:254–271.Google Scholar
18. Lipton, RB, Stewart, WF, Stone, AM, et al. Stratified care vs step care strategies for migraine. The Disability in Strategies of Care (DISC) Study. JAMA2000, 284:2599–2605.Google Scholar
19. Primary Care Network. Patient-Centered Strategies for the Effective Management of Migraine. Springfield, MO; PCN Publishing. 2000.Google Scholar
20. Blau, JN. Migraine. London, England. Chapman and Hall. 1987.Google ScholarPubMed
21. Sheftell, FD, Weeks, RE, Rapoport, AM, et al. Subcutaneous sumatriptan in a clinical setting: the first 100 consecutive patients with acute migraine in a tertiary care center. Headache 1994; 34:67–72.Google Scholar
22. Graham, JR. The headache patient and the doctor. In: Adler, CS, Adler, SM, Packard, RC, (Eds). Psychiatric Aspects of Headache. Baltimore, MD: Williams and Wilkins;1987:34–55.Google Scholar
23. Edmeads, J, Findlay, H, Tugwell, P, et al. Impact of migraine and tension-type headache on life-style, consulting behavior, and medication use: a Canadian Population survey. Can J Neurol Sci 1993; 20:131–137.Google Scholar
24. Roter, DL, Hall, JA. Models of the doctor-patient relationship. In: Roter, DL, Jall, JA (Eds). Doctors Talking With Patients/Patients Talking With Doctors: Improving Communication in Medical Visits. Wesport, CT: Auburn House;1992:21–37.Google Scholar
25. Lipton, RB, Stewart, WF. Acute migraine therapy: do doctors understand what migraine patients want from therapy. Headache 1999;39 (Suppl 2):S20–S26.Google Scholar
26. Roter, DL, Hall, JA, Katz, NR. Consequences of talk: the relationship of talk to patient outcomes. In: Roter, DL, Jall JA(Eds). Doctors Talking With Patients/Patients Talking With Doctors: Improving Communication in Medical Visits. Wesport, CT: Auburn House;1992:131–150.Google Scholar
27. Lipton, RB, Goadsby, PJ, Sawyer, JPC, et al. Migraine: diagnosis and assessment of disability. Rev Contemp Pharmacother 2000;11:63–73.Google Scholar
28. Ware, JE, Bjorner, JB, Kosinski, MA. Practical implications of item response theory and computerized adaptive testing, a brief summary of ongoing studies of widely used headache impact scales. Med Care 2000;38(suppl 2):11–73.Google Scholar
29. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988;8(suppl7):1–96.Google Scholar