Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
CNS Drugs
Published in: CNS Drugs 6/2018

Open Access 01-06-2018 | Original Research Article

Polypharmacy Among Headache Patients: A Cross-Sectional Study

Authors: Anna Ferrari, Carlo Baraldi, Manuela Licata, Cecilia Rustichelli

Published in: CNS Drugs | Issue 6/2018

Login to get access

Abstract

Background

Polypharmacy can appropriately treat multiple chronic conditions, but it can also increase potential harm. Polypharmacy information for primary headaches is minimal, despite drugs being the main tools to manage headaches.

Objective

The aim was to evaluate the prevalence, characteristics and risk factors of polypharmacy in patients with primary headaches and examine whether these variables differ between episodic and chronic headache patients.

Methods

We analysed polypharmacy (simultaneous use of five or more medications), medication type, comorbidity, and risk factors in 300 patients (mean age 42.81 ± 13.21 years) with primary headaches, divided into episodic and chronic, afferent to a headache centre.

Results

Patients took an average of 4.37 medications. Polypharmacy was common in 40.7% of patients, and among chronic patients, it reached 58.8%. Most patients used medications (mainly nonsteroidal anti-inflammatory drugs; 73.5%) to treat acute headaches, and 30.4% of episodic and 64.7% of chronic sufferers underwent prophylactic treatment (P < 0.0001), mostly using antidepressants (77.3%). Up to 76.7% of the cohort was taking other medications, primarily for acid-related disorders (21.7%). Comorbidities were present in 59.7% of the cohort. Variables significantly associated with polypharmacy were comorbidities, prophylactic treatment, and triptans (P < 0.001).

Conclusions

Patients with primary headaches, mainly young adults, are exposed to high polypharmacy, comparable to that of the elderly. Because increased numbers of drugs increase the risk of adverse reactions, the many medications concomitantly taken by primary headache sufferers should be frequently reviewed.
Appendix
Available only for authorised users
Literature
1.
2.
Calderón-Larrañaga A, Gimeno-Feliu LA, González-Rubio F, Poblador-Plou B, Lairla-San José M, Abad-Díez JM, Poncel-Falcó A, Prados-Torres A. Polypharmacy patterns: unravelling systematic associations between prescribed medications. PLoS ONE. 2013;8(12):e84967.CrossRefPubMedPubMedCentral
3.
Dwyer LL, Han B, Woodwell DA, Rechtsteiner EA. Polypharmacy in nursing home residents in the United States: results of the 2004 National Nursing Home Survey. Am J Geriatr Pharmacother. 2010;8(1):63–72.CrossRefPubMed
4.
Veehof LJ, Stewart RE, Meyboom-de Jong B, Haaijer-Ruskamp FM. Adverse drug reactions and polypharmacy in the elderly in general practice. Eur J Clin Pharmacol. 1999;55(7):533–6.CrossRefPubMed
5.
Berndt S, Maier C, Schütz HW. Polymedication and medication compliance in patients with chronic non-malignant pain. Pain. 1993;52(3):331–9.CrossRefPubMed
6.
Wauters M, Elseviers M, Vaes B, Degryse J, Dalleur O, Vander Stichele R, Van Bortel L, Azermai M. Polypharmacy in a Belgian cohort of community-dwelling oldest old (80 +). Acta Clin Belg. 2016;71(3):158–66.CrossRefPubMed
7.
Aparasu RR, Mort JR, Brandt H. Polypharmacy trends in office visits by the elderly in the United States, 1990 and 2000. Res Soc Adm Pharm. 2005;1(3):446–59.CrossRef
8.
Jokanovic N, Tan EC, Dooley MJ, Kirkpatrick CM, Elliott RA, Bell JS. Why is polypharmacy increasing in aged care facilities? The views of Australian health care professionals. J Eval Clin Pract. 2016;22(5):677–82.CrossRefPubMed
9.
Menzies V, Thacker LR 2nd, Mayer SD, Young AM, Evans S, Barstow L. Polypharmacy, opioid use, and fibromyalgia: a secondary analysis of clinical trial data. Biol Res Nurs. 2017;19(1):97–105.CrossRefPubMed
10.
Giummarra MJ, Gibson SJ, Allen AR, Pichler AS, Arnold CA. Polypharmacy and chronic pain: harm exposure is not all about the opioids. Pain Med. 2015;16(3):472–9.CrossRefPubMed
11.
Oates LN, Scholz MJ, Hoffert MJ. Polypharmacy in a headache centre population. Headache. 1993;33(8):436–8.CrossRefPubMed
12.
Putnam GP, O’Quinn S, Bolden-Watson CP, Davis RL, Gutterman DL, Fox AW. Migraine polypharmacy and the tolerability of sumatriptan: a large-scale, prospective study. Cephalalgia. 1999;19(7):668–75.CrossRefPubMed
13.
14.
Linde M, Gustavsson A, Stovner LJ, Steiner TJ, Barré J, Katsarava Z, Lainez JM, Lampl C, Lantéri-Minet M, Rastenyte D, Ruiz de la Torre E, Tassorelli C, Andrée C. The cost of headache disorders in Europe: the Eurolight project. Eur J Neurol. 2012;19:703–11.CrossRefPubMed
15.
Buse DC, Manack A, Serrano D, Turkel C, Lipton RB. Sociodemographic and comorbidity profiles of chronic migraine and episodic migraine sufferers. J Neurol Neurosurg Psychiatry. 2010;81:428–32.CrossRefPubMed
16.
Sarchielli P, Granella F, Prudenzano MP, Pini LA, Guidetti V, Bono G, Pinessi L, Alessandri M, Antonaci F, Fanciullacci M, Ferrari A, Guazzelli M, Nappi G, Sances G, Sandrini G, Savi L, Tassorelli C, Zanchin G. Italian guidelines for primary headaches: 2012 revised version. J Headache Pain. 2012;13(2):S31–70.CrossRefPubMed
17.
18.
Ferrari A, Baraldi C, Licata M, Vandelli D, Marchesi F, Palazzoli F, Verri P, Rustichelli C, Giuliani E, Silingardi E. Hair analysis for detection of triptans occasionally used or overused by migraine patients-a pilot study. Eur J Clin Pharmacol. 2016;72(9):1075–81.CrossRefPubMedPubMedCentral
19.
Licata M, Rustichelli C, Palazzoli F, Ferrari A, Baraldi C, Vandelli D, Verri P, Marchesi F, Silingardi E. Hair testing in clinical setting: simultaneous determination of 50 psychoactive drugs and metabolites in headache patients by LC tandem MS. J Pharm Biomed Anal. 2016;126:14–25.CrossRefPubMed
20.
Vandelli D, Palazzoli F, Verri P, Rustichelli C, Marchesi F, Ferrari A, Baraldi C, Giuliani E, Licata M, Silingardi E. Development and validation of a liquid chromatography-tandem mass spectrometric assay for quantitative analyses of triptans in hair. J Chromatogr B Analyt Technol Biomed Life Sci. 2016;1017–1018:136–44.CrossRefPubMed
21.
Ferrari A, Licata M, Rustichelli C, Baraldi C, Vandelli D, Marchesi F, Palazzoli F, Verri P, Silingardi E. Monitoring of adherence to headache treatments by means of hair analysis. Eur J Clin Pharmacol. 2017;73(2):197–203.CrossRefPubMed
22.
Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629–808.
23.
Vincent A, Whipple MO, McAllister SJ, Aleman KM, St Sauver JL. A cross-sectional assessment of the prevalence of multiple chronic conditions and medication use in a sample of community-dwelling adults with fibromyalgia in Olmsted County, Minnesota. BMJ Open. 2015;5(3):e006681.CrossRefPubMedPubMedCentral
24.
Kotlinska-Lemieszek A, Paulsen O, Kaasa S, Klepstad P. Polypharmacy in patients with advanced cancer and pain: a European cross-sectional study of 2282 patients. J Pain Symptom Manage. 2014;48(6):1145–59.CrossRefPubMed
25.
Ferrari A, Pinetti D, Bertolini A, Coccia C, Sternieri E. Interindividual variability of oral sumatriptan pharmacokinetics and of clinical response in migraine patients. Eur J Clin Pharmacol. 2008;64(5):489–95.CrossRefPubMed
26.
Bigal ME, Krymchantowski AV, Rapoport AM. New developments in migraine prophylaxis. Expert Opin Pharmacother. 2003;4(4):433–43.CrossRefPubMed
27.
Mehuys E, Paemeleire K, Crombez G, Adriaens E, Van Hees T, Demarche S, Christiaens T, Van Bortel L, Van Tongelen I, Remon JP, Boussery K. The heterogeneity of headache patients who self-medicate: a cluster analysis approach. Pain. 2016;157(79):1464–71.CrossRefPubMed
28.
Katsarava Z, Mania M, Lampl C, Herberhold J, Steiner TJ. Poor medical care for people with migraine in Europe—evidence from the Eurolight study. J Headache Pain. 2018;19(1):10.CrossRefPubMedPubMedCentral
29.
Steiner TJ, Stovner LJ, Vos T, Jensen R, Katsarava Z. Migraine is first cause of disability in under 50 s: will health politicians now take notice? J Headache Pain. 2018;19(1):17.CrossRefPubMedPubMedCentral
30.
Bingefors K, Isacson D. Epidemiology, co-morbidity, and impact on health-related quality of life of self-reported headache and musculoskeletal pain—a gender perspective. Eur J Pain. 2004;8(5):435–50.CrossRefPubMed
31.
Fishbain DA. Polypharmacy treatment approaches to the psychiatric and somatic comorbidities found in patients with chronic pain. Am J Phys Med Rehabil. 2005;84(3 Suppl):S56–63.PubMed
32.
Olivieri A, Di Cosmo C, De Angelis S, Da Cas R, Stacchini P, Pastorelli A, Vitti P. Regional observatories for goiter prevention. The way forward in Italy for iodine. Minerva Med. 2017;108(2):159–68.PubMed
33.
Uhlig BL, Engstrøm M, Ødegård SS, Hagen KK, Sand T. Headache and insomnia in population-based epidemiological studies. Cephalalgia. 2014;34(10):745–51.CrossRefPubMed
34.
35.
Baftiu A, Feet SA, Larsson PG, Burns ML, Henning O, Sætre E, Molden E, Granas AG, Johannessen SI, Landmark CJ. Utilisation and polypharmacy aspects of antiepileptic drugs in elderly versus younger patients with epilepsy: a pharmacoepidemiological study of CNS-active drugs in Norway, 2004-2015. Epilepsy Res. 2018;139:35–42.CrossRefPubMed
36.
Hooper L, Brown TJ, Elliott R, Payne K, Roberts C, Symmons D. The effectiveness of five strategies for the prevention of gastrointestinal toxicity induced by non-steroidal anti-inflammatory drugs: systematic review. BMJ. 2004;329(7472):948.CrossRefPubMedPubMedCentral
37.
38.
Ferrari A. Headache: one of the most common and troublesome adverse reactions to drugs. Curr Drug Saf. 2006;1(1):43–58.CrossRefPubMed
39.
Sternieri E, Coccia CP, Pinetti D, Ferrari A. Pharmacokinetics and interactions of headache medications, part I: introduction, pharmacokinetics, metabolism and acute treatments. Expert Opin Drug Metab Toxicol. 2006;2(6):961–79.CrossRefPubMed
40.
Lionetto L, Borro M, Curto M, Capi M, Negro A, Cipolla F, Gentile G, Martelletti P. Choosing the safest acute therapy during chronic migraine prophylactic treatment: pharmacokinetic and pharmacodynamic considerations. Expert Opin Drug Metab Toxicol. 2016;12(4):399–406.CrossRefPubMed
41.
De Andrés F, Lionetto L, Curto M, Capi M, Cipolla F, Negro A, Martelletti P. Acute, transitional and long-term cluster headache treatment: pharmacokinetic issues. Expert Opin Drug Metab Toxicol. 2016;12(9):1011–20.CrossRefPubMed
42.
43.
Martelletti P. The journey from genetic predisposition to medication overuse headache to its acquisition as sequela of chronic migraine. J Headache Pain. 2018;19(1):2.CrossRefPubMedPubMedCentral
44.
45.
Lebedeva ER, Kobzeva NR, Gilev DV, Olesen J. Factors associated with primary headache according to diagnosis, sex, and social group. Headache. 2016;56(2):341–56.CrossRefPubMed
46.
Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, McLachlan AJ, Cumming RG, Handelsman DJ, Le Couteur DG. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65(9):989–95.CrossRefPubMed
47.
Turner JP, Jamsen KM, Shakib S, Singhal N, Prowse R, Bell JS. Polypharmacy cut-points in older people with cancer: how many medications are too many? Support Care Cancer. 2016;24(4):1831–40.CrossRefPubMed
48.
Ailabouni NJ, Nishtala PS, Mangin D, Tordoff JM. Challenges and enablers of deprescribing: a general practitioner perspective. PLoS ONE. 2016;11(4):e0151066.CrossRefPubMedPubMedCentral
49.
Saper JR, Da Silva AN. Medication overuse headache: history, features, prevention and management strategies. CNS Drugs. 2013;27(11):867–77.CrossRefPubMed
50.
51.
Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5(4):345–51.CrossRefPubMed
52.
O’Dwyer M, Peklar J, McCallion P, McCarron M, Henman MC. Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. BMJ Open. 2016;6(4):e010505.CrossRefPubMedPubMedCentral
Metadata
Title
Polypharmacy Among Headache Patients: A Cross-Sectional Study
Authors
Anna Ferrari
Carlo Baraldi
Manuela Licata
Cecilia Rustichelli
Publication date
01-06-2018
Publisher
Springer International Publishing
Published in
CNS Drugs / Issue 6/2018
Print ISSN: 1172-7047
Electronic ISSN: 1179-1934
DOI
https://doi.org/10.1007/s40263-018-0522-8

Other articles of this Issue 6/2018

CNS Drugs 6/2018 Go to the issue

Correction

Correction to: Long-Acting Injectable Second-Generation Antipsychotics: An Update and Comparison Between Agents

Original Research Article

Activation of the Cannabinoid Type 2 Receptor by a Novel Indazole Derivative Normalizes the Survival Pattern of Lymphoblasts from Patients with Late-Onset Alzheimer’s Disease

Review Article

Systemic Therapy of Lung Cancer CNS Metastases Using Molecularly Targeted Agents and Immune Checkpoint Inhibitors

Review Article

Disability Outcome Measures in Phase III Clinical Trials in Multiple Sclerosis

Original Research Article

Prescription of Zolpidem and the Risk of Fatal Motor Vehicle Collisions: A Population-Based, Case-Crossover Study from South Korea

Commentary

Tailoring Treatment in Polymorbid Migraine Patients through Personalized Medicine