BACKGROUND

Polypharmacy in patients with chronic disease such as Migraine Headache poses potential harm in patients such that psychological distress may come in. In relation to psychological distress, Migraine Headache patients with multiple drug use are at increased risk of anxiety and depression.

OBJECTIVES

The main objective of the study is to determine the association between anxiety and depression to polypharmacy in migraine headache patients by using the data in the PNA One Headache Database.

METHODOLOGY

We utilized the data obtained from the Philippine Neurological Association One (PNA-1) Headache Database from 2021 to 2024 and determine the association between Anxiety and Depression to Polypharmacy in patients with Migraine.

RESULTS AND DISCUSSION

The number of medications taken by patients does not significantly differ across depression and anxiety levels, indicating that polypharmacy has no impact on patient’s depression and anxiety. However, the study found that patients with anxiety have more tendency to report more severe headache.

CONCLUSION

The study highlights that participants, primarily middle-aged women, experience chronic headaches with high pain severity, often lasting for hours. Educational attainment may influence headache management compliance with a large proportion having only elementary education. Headache onset typically begins in early adulthood, and medication effectiveness often diminishes over time suggesting potential tolerance issues. Anxiety is associated with reporting of increased headache severity while depression does not significantly impact headache characteristics or polypharmacy. The findings emphasize the need for targeted interventions and revised treatment strategies to improve headache management outcomes.

Human ; Anxiety ; Depression ; Headache ; Migraine Disorders ; Polypharmacy

INTRODUCTION: Neuropathic pain poses a therapeutic challenge since it is multifactorial. It is thought to be governed by multiple mechanisms and has various clinical manifestations Current treatments are palliative and require use of different kinds of drugs which include anticonvulsants, tricyclic anti-depressants, non-opiod analgesics and opiods. Neuropathic pain is often highly refractory to treatment, with maximum reductions in pain intensity of 30% to 40% as the norm (2). Lamotrigine inhibits the release of glutamate by stabilizing the neural membrane through blocking activation of voltage-sensitive sodium channels and by inhibiting the presynaptic release of glutamate (3) which acts on the postulated pathophysiologic process of neuropathic pain which is the influx of sodium into the nerves and release of excitatory amino acids particularly glutamate.

OBJECTIVE: To assess the evidence from randomized controlled trials the efficacy of lamotrigine in reducing painful diabetic neuropathy.

DESIGN: Meta-analysis of 3 randomized trials identified through Medline/Pubmed, Google and Cochrane Library (2001 up to present). All comparisons were performed according to intent to treat principle. The studies were analyzed using Review Manager Version 5. Heterogeneity of dichotomous outcome was assessed using the Q test. Data were overviewed with random effects model.

RESULTS: Total of 266 patients with diabetic neuropathy was included. Patients were randomized to receive lamotrigine and placebo. The main outcome measure was changed in the mean a pain intensity score based on the numerical pain scale. Overall assessment showed that lamotrigine is efficacious in reducing painful diabetic neuropathy with a combined mean difference for primary outcome of -0.79 with a 95% confidence interval.

CONCLUSION: Based on this meta-analysis, lamotrigine is an effective and well-tolerated treatment for painful diabetic neuropathy.

Human ; Humans ; Diabetic Neuropathies ; Lamotrigine ; Anticonvulsants ; Glutamic Acid ; Sodium ; Confidence Intervals ; Triazines ; Neuralgia ; Analgesics ; Medline ; Outcome Assessment (health Care) ; Sodium Channels

INTRODUCTION: Posterior Inferior Cerebellar Artery aneurysms are rare and constitute 0.5 to 2% of total aneurysms in the brain. The majority of cases involve aneurysms in the proximal area of the vertebral artery from which the PICA arise (1). Distal PICA aneurysms are even rarer and account for approximately 0.3% of all PICA aneurysms. In a study done by Park et al, only five cases of distal PICA aneurysms were reported among 386 brain aneurysms making it a rare entity. They present typical computed tomography (CT) scan findings, but it can easily be overlooked on initial diagnosis.

CASE PRESENTATION: A 56-year-old female presented with a subarachnoid hemorrhage in the basal cisterns and CP angles associated with compression of the pons and intraventricular extension of the hemorrhage. CT angiography showed saccular, lobulated aneurysm measuring 5.9 x 4.7 x 4.6 cm with a narrow 2mm neck along the right PICA medullary-cranial loop junction accompanied by minimal focal vasospasm of the proximal medullary segment. Patient underwent coiling of the aneurysm. achieving subtotal filing of the aneurysm and there was complete preservation of parent arteries. The patient recovered without neurological sequelae.

DISCUSSION: PICA aneurysms commonly occur in patients in their 5th and 6th decades without gender predilection. The age and sex distribution of PICA aneurysms are similar to those of general aneurysms (1). Our case was in the 5th decade. Symptoms of PICA aneurysms are similar to those of subarachnoid hemorrhage. These symptoms include sudden onset of severe headache, sensorial changes, syncope and meningeal irritation. As in our case, the patient presented with severe headache followed by unresponsiveness. Non-invasive vascular imaging techniques are useful in detecting presence of aneurysm like 3D CT angiography and Magnetic Resonance Angiography. As in our case, a CT angiography became very useful in finding out the exact cause of the subarachnoid hemorrhage and in discovering the exact location of the aneurysm. Outcome of patients with ruptured distal PICA aneurysms is generally favorable; the incidence of rebleeding after rupture of a distal PICA aneurysm is higher than the rebleeding rate of Il intracranial aneurysms (78% vs 34%) (7).

CONCLUSION: When we are confronted with a case of subarachnoid hemorrhage in the fourth ventricle of unknown origin, particular attention should also be made to the distal PICA due to the rare occurrence of aneurysm in the said location.

Human ; Humans ; Female ; Middle Aged ; Intracranial Aneurysm ; Subarachnoid Hemorrhage ; Vertebral Artery ; Magnetic Resonance Angiography ; Computed Tomography Angiography ; Fourth Ventricle ; Incidence ; Filing ; Pica ; Aneurysm, Ruptured ; Pons ; Syncope ; Sex Distribution ; Attention ; Headache