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Existe un creciente interés de los ciudadanos en el impacto que tiene la Ciencia de Datos en su vida diaria, principalmente debido a la enorme atención que los medios prestan a temas relacionados con el Big Data o la Inteligencia Artificial. Este interés se traduce en grandes expectativas sobre las potenciales aplicaciones de estas tecnologías, pero también en serias preocupaciones, como el uso de datos personales, los procesos de toma de decisiones dirigidos por máquinas o la desaparición de empleos. Junto a esas preocupaciones, también existe una falta de comprensión pública sobre unas tecnologías aún nuevas y cambiantes. La comunicación de la Ciencia de Datos, y particularmente del Big Data y la Inteligencia Artificial, se lleva a cabo en un momento en que los medios no son los únicos encargados de transmitir información sobre la ciencia, sino que otros actores entran en juego para comunicarse directamente con la sociedad a través de canales digitales, de manera que se hace más necesario garantizar la calidad de los procesos de comunicación científica.

Introducción Alrededor de 15 millones de personas sufren un ictus cada año, de los que un 10-15% ocurre en menores de 50 años (ictus en el adulto joven). La prevalencia de los distintos factores de riesgo vascular y las estrategias sanitarias para el manejo del ictus varían a nivel mundial, siendo interesante conocer la epidemiología y las características específicas de cada región. El objetivo de este estudio fue determinar la prevalencia de los diferentes factores de riesgo vascular, la etiología y las características de los ictus isquémicos en el adulto joven en la comunidad autónoma de Aragón. Métodos Estudio multicéntrico, de corte transversal, realizado por los Servicios de Neurología de todos los hospitales del Servicio Aragonés de Salud (SALUD). Se identificó a todos los pacientes entre 18 y 50 años que ingresaron en cualquiera de estos hospitales con el diagnóstico de ictus isquémico o AIT entre enero del 2005 y diciembre del 2015. Se recogieron variables demográficas, factores de riesgo vascular y tipo de ictus isquémico entre otras. Resultados En el periodo de estudio, 786 pacientes entre 18 y 50 años ingresaron con el diagnóstico de ictus isquémico o AIT en algún hospital del SALUD, con una tasa anual promedio de 12, 3 por 100.000 habitantes. La mediana de su edad fue de 45 años (RIQ: 40-48 años). El factor de riesgo vascular más prevalente fue el tabaquismo, 404 (51, 4%). La mayoría fue de causa indeterminada (36, 2%), seguida por «otras causas» (26, 5%). La mediana de puntuación en la escala NIHSS fue de 3, 5 (RIQ: 2, 07, 0). En total, 211 (26, 8%) de los ingresos fueron por AIT. De los pacientes que ingresaron con el diagnóstico de ictus isquémico, 59 (10, 3%) se fibrinolizaron. Conclusiones El ictus isquémico en el adulto joven no es infrecuente en Aragón y en un importante número de casos es de etiología indeterminada, por lo que es necesario implementar medidas que nos permitan mejorar su estudio, disminuir su incidencia y prevenir su recurrencia. Introduction: Stroke affects around 15 million people per year, with 10%-15% occurring in individuals under 50 years old (stroke in young adults). The prevalence of different vascular risk factors and healthcare strategies for stroke management vary worldwide, making the epidemiology and specific characteristics of stroke in each region an important area of research. This study aimed to determine the prevalence of different vascular risk factors and the aetiology and characteristics of ischaemic stroke in young adults in the autonomous community of Aragon, Spain. Methods: A cross-sectional, multi-centre study was conducted by the neurology departments of all hospitals in the Aragonese Health Service. We identified all patients aged between 18 and 50 years who were admitted to any of these hospitals with a diagnosis of ischaemic stroke or TIA between January 2005 and December 2015. Data were collected on demographic variables, vascular risk factors, and type of stroke, among other variables. Results: During the study period, 786 patients between 18 and 50 years old were admitted with a diagnosis of ischaemic stroke or TIA to any hospital of Aragon, at a mean annual rate of 12.3 per 100 000 population. The median age was 45 years (IQR: 40-48 years). The most prevalent vascular risk factor was tobacco use, in 404 patients (51.4%). The majority of strokes were of undetermined cause (36.2%), followed by other causes (26.5%). The median NIHSS score was 3.5 (IQR: 2.0-7.0). In total, 211 patients (26.8%) presented TIA. Fifty-nine per cent of the patients admitted with a diagnosis of ischaemic stroke (10.3%) were treated with fibrinolysis. Conclusions: Ischaemic stroke in young adults is not uncommon in Aragon, and is of undetermined aetiology in a considerable number of cases; it is therefore necessary to implement measures to improve study of the condition, to reduce its incidence, and to prevent its recurrence.

Introduction Stroke affects around 15 million people per year, with 10%-–15% occurring in individuals under 50 years old (stroke in young adults). The prevalence of different vascular risk factors and healthcare strategies for stroke management vary worldwide, making the epidemiology and specific characteristics of stroke in each region an important area of research. This study aimed to determine the prevalence of different vascular risk factors and the aetiology and characteristics of ischaemic stroke in young adults in the autonomous community of Aragon, Spain. Methods A cross-sectional, multi-centre study was conducted by the neurology departments of all hospitals in the Aragonese Health Service. We identified all patients aged between 18 and 50 years who were admitted to any of these hospitals with a diagnosis of ischaemic stroke or TIA between January 2005 and December 2015. Data were collected on demographic variables, vascular risk factors, and type of stroke, among other variables. Results During the study period, 786 patients between 18 and 50 years old were admitted with a diagnosis of ischaemic stroke or TIA to any hospital of Aragon, at a mean annual rate of 12.3 per 100 000 population. The median age was 45 years (IQR: 40-−48 years). The most prevalent vascular risk factor was tobacco use, in 404 patients (51.4%). The majority of strokes were of undetermined cause (36.2%), followed by other causes (26.5%). The median NIHSS score was 3.5 (IQR: 2.0-–7.0). In total, 211 patients (26.8%) presented TIA. Fifty-nine per cent of the patients admitted with a diagnosis of ischaemic stroke (10.3%) were treated with fibrinolysis. Conclusions Ischaemic stroke in young adults is not uncommon in Aragon, and is of undetermined aetiology in a considerable number of cases; it is therefore necessary to implement measures to improve study of the condition, to reduce its incidence, and to prevent its recurrence.

Resumen basado en el de la publicación Se presenta la Escuela Bellaterra, que tiene entre sus nuestros objetivos pedagógicos acercar a los niños y niñas al mundo del arte desde la idea de que se cree en el valor de una educación amplia, global y humanística. Se explica un proceso de aprendizaje en el que se quiere mostrar cómo se enlaza la comprensión del hecho artístico con una actividad matemática, que tiene un papel muy especial en la comprensión del arte, de la realidad y de la propia matemática. Biblioteca del Ministerio de Educación y Formación Profesional; Calle San Agustín, 5 - 3 Planta; 28014 Madrid; Tel. +34917748000; biblioteca@educacion.gob.es ESP

Topiramate and onabotulinumtoxin A have proven to be effective in chronic migraine with or without medication abuse according to recent criteria of the International Headache Society's Headache Classification.To show that flunarizine is as effective as topiramate in cases of chronic migraine without medication abuse.We conducted a prospective, non-randomised, comparative study of two groups of patients paired by age and sex, with chronic migraine without abuse, who had been treated preventively for the first time with topiramate or flunarizine.Forty patients treated with flunarizine were assigned a patient of their same sex and age who was being treated with topiramate. The mean rate of reduction in intense migraines in the topiramate group was 59% and in the flunarizine group, 58.5% (p = 0.9444); the responder rate at four months of treatment did not show any significant differences either, the figures being 75% for topiramate and 70% for flunarizine (p = 0.6236). The mean reduction of other headaches in the topiramate group was 57% and in the flunarizine group, 64% (p = 0.4261); the responder rate at four months of treatment was similar in the two groups: 76%. The percentage of dropouts from treatment was higher with topiramate (19.5%) than with flunarizine (10%) (p = 0.3493). No serious side effects occurred in either of the groups. In all, 78.9% of the patients who took topiramate said they were satisfied with the drug versus 75% of those in the flunarizine group (p = 0.7903).Flunarizine proved to be as effective as topiramate in the treatment of chronic migraine without medication abuse.Estudio comparativo de la efectividad del topiramato y la flunaricina en series independientes de pacientes con migraña cronica sin abuso de medicacion.Introduccion. El topiramato y la onabotulinumtoxina A han mostrado ser eficaces en la migraña cronica con o sin abuso de farmacos segun los criterios recientes de la Clasificacion de Cefaleas de la Sociedad Internacional de Cefaleas. Objetivo. Demostrar que la flunaricina es tan efectiva como el topiramato en la migraña cronica sin abuso de farmacos. Pacientes y metodos. Estudio prospectivo, no aleatorizado, comparativo de dos grupos de pacientes con similar edad y sexo, con migraña cronica sin abuso, tratados preventivamente por primera vez con topiramato o flunaricina. Resultados. A 40 pacientes tratados con flunaricina se les asigno un paciente del mismo sexo y edad tratado con topiramato. La media de reduccion de las migrañas intensas en el grupo del topiramato fue del 59% y en el grupo de la flunaricina, del 58,5% (p = 0,9444); la tasa de respondedores al cuarto mes de tratamiento tampoco mostro diferencias significativas, ya que fue del 75% para el topiramato y del 70% para la flunaricina (p = 0,6236). La media de reduccion de otras cefaleas en el grupo del topiramato fue del 57%, y en el grupo de la flunaricina, del 64% (p = 0,4261); la tasa de respondedores al cuarto mes de tratamiento fue del 76%, similar en ambos grupos. El porcentaje de abandonos del tratamiento fue mayor con el topiramato (19,5%) que con la flunaricina (10%) (p = 0,3493). En ninguno de los dos grupos hubo efectos adversos graves. Un 78,9% de los pacientes que tomo topiramato presento satisfaccion con el farmaco frente al 75% del grupo de la flunaricina (p = 0,7903). Conclusion. La flunaricina mostro ser tan efectiva como el topiramato en el tratamiento de la migraña cronica sin abuso de farmacos.

The drop-out rate among patients receiving preventive treatment for migraine is higher than 30%. This situation is not very widely known and the risk factors that lead patients to drop out from treatment have yet to be identified.To evaluate some of the factors that can predispose patients to drop out of preventive treatment.We conducted a prospective study of patients suffering from migraine who required preventive treatment for the first time with one of what are considered the top three first-choice drugs, i.e. a beta-blocker (nadolol), a neuromodulator (topiramate) or a calcium antagonist (flunarizine). Two groups were established according to whether patients dropped out of treatment or not. Different demographic and clinical variables were analysed and compared in the two groups.Of 800 patients with migraine who required preventive treatment for the first time, the drop-out rate was 19.7%. In the drop-out group, the variables 'age', 'number of seizures', 'number of seizures prior to preventive treatment' and 'side effects' showed significant differences with those from the group of patients who did not drop out of preventive treatment.The drug used as preventive treatment, the side effects, a younger age and a lower number of seizures before starting the preventive treatment favoured higher drop-out rates. Whether the migraine was episodic or chronic, the presence of medication abuse and the drugs used to treat the seizures were not related with dropping out of preventive treatment.

Topiramate and nadolol with levels A and C of scientific evidence, respectively, would be indicated as preventive treatments of migraine. To date only one study of satisfaction has been carried out to compare the two pharmaceuticals.To compare the effectiveness parameters in independent groups of patients treated preventively with one of the pharmaceuticals from the study.From a database of 700 patients with migraine, those with episodic migraine and who had followed a course of preventive treatment, for the first time, with topiramate or nadolol were selected for the study. The effectiveness variables (reduction in the number of crises at four months of preventive treatment and responder rates) were analysed.Altogether 208 patients with were included for treatment: 140 with topiramate (77.8% females; mean age, 37.9) and 68 with nadolol (69% females; mean age, 36.9). The mean number of crises in the month prior to treatment was: topiramate group, 6.3 +/- 2.6; nadolol group 5.3 +/- 2.0 (p = 0.0066). At four months after starting treatment: topiramate group, 2.69 +/- 2.6; nadolol group 2.6 +/- 2.2 (NS). The percentage of reduction in the number of migraines was 56.6% with topiramate and 51.6% with nadolol (NS). The responder rate (reduction in the frequency of crises by at least 50%) was 71.3% with topiramate versus 69% with nadolol (NS). The excellent response rate (reduction in crises by at least 75%) was 53.3% with topiramate versus 32.2% with nadolol (p = 0.0077). Adverse side effects were reported by 54% of patients treated with topiramate versus 30.8% of those treated with nadolol (p = 0.0015). The rate of satisfaction was 61% for the topiramate group and 71% for the group with nadolol (NS).Both topiramate and nadolol proved to be effective in the preventive treatment of episodic migraine. Topiramate was found to be more effective than nadolol, although it was used in patients with a higher frequency of crises, and was not tolerated so well.

Chronic daily headache (CDH) includes primary headaches that last more than four hours with a frequency equal or superior to 15 days a month over the last three months. It has a prevalence of 4-5% in the general population and is a frequent reason for visiting the physician in headache units.To evaluate the effectiveness of topiramate, as the primary drug, in CDH due to probable chronic migraine with or without medication abuse.From the 447 patients with migraine in our database, we selected those: a) satisfying Silberstein criteria for CDH; b) that had not followed prior prophylactic treatment; and c) who were treated with topiramate as the primary drug. The mean number of days with headache and bouts of severe migraine in the fourth month of treatment using topiramate as compared to the month preceding treatment, as well as the percentage of responses and the rate of respondents in the fourth month were all analysed.Eighty-three patients (88% females) with a mean age of 38.0 +/- 14.13 years were selected. Medication abuse was reported in 44% of cases. At the fourth month of treatment, the mean number of days with headache dropped significantly from 20.8 to 7.9 (p0.0001) and the mean number of bouts of severe migraine diminished from 4.4 to 1.7 (p0.0001). The rate of respondents was 72%. Medication abuse continued in 14% of cases. Side effects were produced in 58% of patients and the dropout rate was 24%.Topiramate proved to be effective in the treatment of CDH due to probable chronic migraine and with probable medication abuse in de novo migraine patients.

Both flunarizine and, more recently, topiramate have proved to be effective in the prophylaxis of migraine.To compare two independent groups of patients with similar clinical and demographic characteristics who were treated with flunarizine or topiramate as the preferred drug in the prevention of their migraines and to evaluate effectiveness and safety according to the medication they received.All the patients reported more than four episodes a month and/or transformed migraine according to Silberstein's criteria, and had never received prophylactic treatment. Data determined: the number and average number of migraines in the previous month and at the fourth month of treatment, and the rate of respondents.A total of 125 patients were included in each group. No significant differences were found between the groups as regards mean age or the average number of migraines in the previous month. With both drugs there was a significant decrease (0.0001) in the mean number of episodes in the fourth month of treatment, but with no significant difference between them: topiramate (5.88 +/- 3.7 to 2.1 +/- 2.5) and flunarizine (5.24 +/- 3.2 to 2.3 +/- 2.7). The mean reduction in the number of migraines at the fourth month was 58.2 +/- 38.2% with topiramate, and 55.4 +/- 37.5% with flunarizine. The respondent rate was 71% with topiramate and 67% with flunarizine. The percentage of dropouts with topiramate (28%) was higher than with flunarizine (11%) (0.0013). With topiramate 69 patients reported side effects and 53 patients reported them with flunarizine (0.0427).Both drugs showed a high degree of effectiveness when used as the preferred drug in the preventive treatment of migraine. Topiramate offered better results as far as effectiveness is concerned, but also more side effects, none of which were serious.

Open-label studies and three large and controlled trials had demostrated the efficacy of topiramate in migraine prophylaxis.The objective of this study was to assess the effectiveness and tolerability of topiramate in patients not previously treated with any prophylactic drug.Patients selection was made on sequential patients attending our outpatient clinic. Patients were adults diagnosed of either transformed migraine or migraine with a frequency of more than four migraine attacks per month. Topiramate was started at 25 mg and titrated in 4 weeks by weekly increments of 25 mg, up to 100 mg/day. Patients were then followed up for a 12-week maintenance phase. Efficacy was assessed by change in mean monthly migraine attack frequency from baseline. Additional assessments included responder rates, mean number of migraine days and global impression by a seven-point improvement scale.Mean monthly migraine attacks decreased significantly from baseline (from 5.2 +/- 2.6 to 2.1 +/- 2.2; p0.0001). Sixty-nine percent of patients were considered responders and mean reduction rate in migraine was 55.6 %. Topiramare was overall well tolerated. Twentyfive (28.4 %) patients stopped treatment due to adverse events. The most common adverse events were paresthesia, weight loss and cognitive effects. Some grade of satisfaction was reported by 55 % of patients at the end of the study.This naturalistic study confirms clinical trial data that 100 mg/day is an effective target dose for patients with migraine and presents the possible beneficial effect in transformed migraine.

To perform an economic evaluation of migraine attack treatment comparing standard doses of existing triptans in 2003, and using different outcome measurements of anti-migraine effectiveness.A cost-effectiveness analysis was performed from the National Health System perspective, using 2003 prices, comparing almotriptan 12.5 mg, eletriptan 40 mg, naratriptan 2.5 mg, rizatriptan 10 mg, sumatriptan 50 mg, sumatriptan 100 mg, zolmitriptan 2.5 mg and zolmitriptan 5 mg. Effectiveness measurements were obtained from an efficacy meta-analysis of published clinical trials, and they consisted of therapeutic gain (crude effect of triptan after placebo effect subtraction) for 2 h--anti-migraine response, pain free at 2 h, and 24 h--sustained pain free. Rescue medication use and 24 h-attack relapse rates were assessed.Thirty-eight clinical trials (19,872 patients) were used to assess triptans effectiveness. Eletriptan 40 mg and rizatriptan 10 mg showed the highest 24 h-sustained pain free response (20.2 % in both cases), pain-free at 2 h (27.7 % and 32.2 %) and antimigraine response at 2 h (38.6 % and 31.3 %), respectively. Less rescue medication was used with eletriptan 40 mg and sumatriptan 50 mg (21 % and 20 %), and the lowest 24 h-relapse rates were observed with eletriptan 40 mg and naratriptan 2.5 mg (27 % and 21 %). Eletriptan 40 mg and sumatriptan 50 mg showed the lowest costs per successfully treated attacks with 2 h--anti-migraine response (16.50 and 17.44e) and with 24 h--sustained pain free (31.47 and 33.61e), while the lowest costs per attack that was pain free at 2 h were observed with rizatriptan 10 mg (21.36e) and eletriptan 40 mg (22.99e).Considering the cost-effectiveness measurements assessed, eletriptan 40 mg was the most costeffective triptan in the majority of economic analyses carried out.

Migraine accounts for 10% of patients first visits due to neurological reasons in Spain and over half the new visits in headache units (HU) and hence the importance of this pathology.The aim of this study is to determine whether there are any differences between migraine patients referred to a general neurology service (GNS) or to a HU.Two groups of patients with migraine were compared: those sent for the first time to a GNS and the others, who were sent directly to a HU.In a GNS, 10.7% (374 patients) of the overall number of new visits concerned migraines; these were compared with 107 migraines (64%) from the total number of headaches treated for the first time in the HU during the year 2000. The average age and distribution of sexes were similar in both groups. In the group of migraines from the HU there were more requests for CAT/MRI (20%), 77.5% had previous treatment, 71% were given preventive therapy, 51% received triptans and 44.8% needed an examination. In the group of migraines from visits to general service, there were fewer requests for CAT/MRI (14%), only 20% had previous therapy, preventive therapy was started in 45%, 6% received triptans and 25% required an examination.The group of patients with migraine who were sent to the HU presented a more serious pathology, required more preventive therapies, more triptans and more monitoring than the group of patients with migraine referred to the GNS.

Introduccion. Los pacientes con migrana cronica (MC) y abuso de medicacion son dificiles de tratar y tienen peor calidad de vida que otros pacientes con migranas. Objetivo. Valorar si la presencia de abuso de farmacos disminuye la efectividad del topiramato. Pacientes y metodos. Una serie de pacientes con MC fueron agrupados segun presentasen criterios de abuso o no abuso de farmacos. Se les aconsejo la supresion del farmaco del cual abusaban. Se ajusto el tratamiento de sus crisis y se inicio tratamiento preventivo desde el principio con topiramato. Se valoro el numero dias con cefalea y migranas intensas en el mes previo y al cuarto mes de tratamiento. Resultados. Fueron seleccionados 262 pacientes con criterios de MC, y de ellos 167 (63,7%) cumplieron criterios de abuso. En ambos grupos hubo una reduccion significativa del numero de dias con cefalea/mes y numero de crisis de migrana/mes al cuarto mes de tratamiento con topiramato. Porcentaje de reduccion de dias con cefalea/mes en MC sin abuso, 59,3 ± 36,1%; y con abuso, 48,7 ± 41,7% (p = 0,0574). Porcentaje de reduccion de migranas intensas/mes en MC sin abuso, 61,2%; y con abuso, 50% (p = 0,0224). Tasa de respondedores segun numero de dias con cefalea/mes en MC sin abuso, 69%; y con abuso, 57%. Tasa de respondedores segun numero de migranas intensas/mes en MC sin abuso, 76,8%; y en MC con abuso, 61% (p = 0,0097). Conclusiones. El topiramato fue efectivo en pacientes con MC sin y con abuso de farmacos, aunque con menor efectividad en estos ultimos.

Introduccion. El topiramato y la onabotulinumtoxina A han mostrado ser eficaces en la migrana cronica con o sin abuso de farmacos segun los criterios recientes de la Clasificacion de Cefaleas de la Sociedad Internacional de Cefaleas. Objetivo. Demostrar que la flunaricina es tan efectiva como el topiramato en la migrana cronica sin abuso de farmacos. Pacientes y metodos. Estudio prospectivo, no aleatorizado, comparativo de dos grupos de pacientes con similar edad y sexo, con migrana cronica sin abuso, tratados preventivamente por primera vez con topiramato o flunaricina. Resultados. A 40 pacientes tratados con flunaricina se les asigno un paciente del mismo sexo y edad tratado con topiramato. La media de reduccion de las migranas intensas en el grupo del topiramato fue del 59% y en el grupo de la flunaricina, del 58,5% (p = 0,9444); la tasa de respondedores al cuarto mes de tratamiento tampoco mostro diferencias significativas, ya que fue del 75% para el topiramato y del 70% para la flunaricina (p = 0,6236). La media de reduccion de otras cefaleas en el grupo del topiramato fue del 57%, y en el grupo de la flunaricina, del 64% (p = 0,4261); la tasa de respondedores al cuarto mes de tratamiento fue del 76%, similar en ambos grupos. El porcentaje de abandonos del tratamiento fue mayor con el topiramato (19,5%) que con la flunaricina (10%) (p = 0,3493). En ninguno de los dos grupos hubo efectos adversos graves. Un 78,9% de los pacientes que tomo topiramato presento satisfaccion con el farmaco frente al 75% del grupo de la flunaricina (p = 0,7903). Conclusion. La flunaricina mostro ser tan efectiva como el topiramato en el tratamiento de la migrana cronica sin abuso de farmacos.

Introduccion. La flunaricina y recientemente el topiramato han mostrado su eficacia en la profilaxis de la migrana. Objetivo. Comparar dos grupos independientes de pacientes con similares caracteristicas clinicas y demograficas tratados con flunaricina o topiramato como primer farmaco en la prevencion de sus migranas y valorar la eficacia y tolerabilidad segun el farmaco recibido. Pacientes y metodos. Todos los pacientes presentaban mas de cuatro crisis al mes y/o migrana transformada segun los criterios de Silberstein y nunca habian recibido tratamiento profilactico. Se determino: numero y media de crisis en el mes previo y al cuarto mes de tratamiento y tasa de respondedores. Resultados. Se incluyo a 125 pacientes en cada grupo. No hubo diferencias significativas entre ambos grupos en edad media y media de crisis en el mes previo. Con ambos farmacos hubo un descenso significativo (0,0001) de la media de crisis en el cuarto mes de tratamiento, aunque sin diferencias significativas: topiramato (5,88 ± 3,7 a 2,1 ± 2,5) y flunaricina (5,24 ± 3,2 a 2,3 ± 2,7). La reduccion media de crisis al cuarto mes fue del 58,2 ± 38,2% con topiramato y del 55,4 ± 37,5% con flunaricina. La tasa de respondedores fue del 71% con topiramato y 67% con flunaricina. El porcentaje de abandonos con topiramato (28%) fue superior que con flunaricina (11%) (0,0013). Con topiramato 69 pacientes refirieron efectos adversos y 53 pacientes con flunaricina (0,0427). Conclusiones. Ambos farmacos mostraron una alta efectividad cuando se usaron como primer farmaco en el tratamiento preventivo de la migrana. El topiramato mostro mejores resultados de efectividad, pero mas efectos adversos, aunque ninguno grave

Patients with headache and medication abuse (HMA) are difficult to treat, have a greater tendency towards chronification and a poorer quality of life than those with other types of headache. AIM. To evaluate the indicators showing that these patients are responding to ambulatory treatment.From a series of patients with migraine, we selected those who satisfied HMA criteria according to the appendix of the 2006 International Classification of the Headache Disease (ICHD-2) and who had never previously undergone treatment. As outpatients, they were advised to stop taking the drug that they were abusing. The treatment of their seizures was adjusted with the most efficient drugs and preventive treatment was started from the outset with topiramate or flunarizine. Patients were grouped according to whether they continued with HMA or not. Comparisons were made between the number of days with headache during the previous month and after four months of treatment and the persistence of abuse.HMA criteria were met by 178 patients (mean age 40.9; 88.7% females). Results showed that 68.5% (122 patients) responded and no longer met HMA criteria after treatment. The treatment used for their seizures (triptans, nonsteroidal antiinflammatory drugs, analgesics) and preventive treatment (topiramate or flunarizine) were similar in both groups. The average number of days with headache prior to treatment was 18.52 in the group that responded and 20.87 (p = 0.0263) in the group that did not respond to treatment. In the group of responders 7.3% dropped out of preventive treatment compared with 35% (p = 0.0001) in the group of non-responders.A higher number of days with headache during the previous month and withdrawing from preventive treatment were indicators of a bad progression.

Medication overuse headache (MOH) implies secondary headache on a daily or near daily basis, for 15 days or more a month for 3 month and chronic migraine CM is the most common subtypes of MOH in speciality care [1]. Flunarizine and topiramate are considered as first-choice drugs in prophylactic treatment of episodic or transformed migraine(2). Topiramate is considered as first-choice drug in treatment of CM (3).