Migraine is characterized by severe headache attacks with the development of accompanying symptoms. Among the most common are nausea and vomiting, which limit the intake of oral medications and thus reduce the speed of onset of pain relief and the efficacy of treatment in general. The development of gastric stasis in migraine is considered to be one of the most important reasons for the delayed absorption and inconsistent effect of oral triptans. The rapid action of triptans in the form of orally dispersible tablets, efficacy in relieving pain and accompanying symptoms, and ease of administration make this form favorable as a first-line agent for the relief of migraine attacks.

Objective: to conduct a comparative analysis of factors associated with the development of medication overuse headache (MOH), considering demographic characteristics of patients and comorbid pathology.

Material and methods. A prospective study was conducted at "Europe–Asia" International Medical Center. The main group comprised patients with primary headache (HA) aged 18 years and older with MOH, and the control group comprised patients with primary HA without MOH of comparable gender and age. A semi-structured interview was conducted with the patients and additional examinations were performed, including MRI of the brain if indicated. The study included 171 patients with MOH (mean age 43.3 years, 82% women) and 173 patients without MOH (mean age 41.4 years, 75% women).

Results. Chronic migraine occurred more frequently in the MOH group (53 and 16%, respectively; p<0.001; OR 5.9; 95% CI 3.6–9.8). One third of patients in both groups suffered from chronic tension-type headache (CTH). Episodic migraine and episodic CTH occurred more frequently in patients without MOH (p<0.001). Patients in the MOH group were more frequently divorced (11.7 and 2.9%, respectively; p=0.002; OR 4.5; 95% CI 1.6–12.2). The majority of patients (76%) in both groups were employed, had a higher education (65% with MOH and 74% without MOH) and were married (63% with MOH and 72% without MOH).The analysis of more than 20 comorbid diseases revealed that three factors were most frequently associated with the development of MOH: chronic insomnia (60.2 and 47.4% respectively; p=0.02; OR 1.7; 95% CI 1.1–2.6), restless legs syndrome (37.4 and 22% respectively; p=0.002; OR 2.1; 95% CI 1.3–3.4) and subjective cognitive impairment (76 and 53.2% respectively; p<0.001; OR 2.8; 95% CI 1.8–4.8).

Conclusion. Sleep disturbance, subjective cognitive impairment and marital status of patients are most frequently associated with MOH, indicating the great importance of these factors in the development of MOH and opening new opportunities for its prevention.

Migraine in children can manifest itself in non-pain clinical phenotypes, among which several episodic syndromes associated with migraine (ESAM) are identified. A significant association with the later development of migraine was found for infantile colic syndrome, benign torticollis, abdominal migraine (AM), cyclic vomiting syndrome (CVS) and benign paroxysmal vertigo (BPV).

Objective: to identify the clinical and epidemiological characteristics of childhood ESAM and its association with migraine.

Material and methods. The study was conducted in Tambov Children's Clinical Hospital. A total of 250 children were included in the study: 120 (48%) girls and 130 (52%) boys aged 5 to 18 years (mean age 13±2.9 years, median age 13 [11; 15] years) with headache complaints. The diagnosis of ESAM was made according to the ICHD-3 criteria.

Results. ESAM was observed in 95 (38%) patients aged 5–18 years. An analysis of the prevalence of ESAM in the different age groups showed that in children aged 5–10 years CVS (n=12; 4.8%) was more common than AM (n=6; 2.4%) and BPV (n=5; 2%). In the group of 11–14 year-old children, the frequency of AM clearly predominated (n=11; 4.4%), while in the group of 15–18 year-old adolescents, BPV (n=15; 6%) was observed more frequently compared to CVS (n=9; 3.5%) and AM (n=5; 2%).

Conclusion. The results of the study indicate a high incidence of ESAM in child and adolescent patients of somatic and neurological hospitals. The data obtained show the importance of timely diagnosis and correct treatment of ESAM.

Chronic migraine (CM) is a neurological disorder whose diagnosis requires not only knowledge of its diagnostic criteria, but also the physician's ability to differentiate between various forms of primary and secondary headache (HA), as well as to recognize comorbid neurological disorders that aggravate the course of CM. Timely and correct diagnosis of CM and comorbid disorders allows to prescribe effective treatment to a patient and convert the migraine from a chronic to an episodic form. The diagnostics of CM and comorbid neurological disorders has not been sufficiently investigated in our country, which formed the basis for this study.

Objective: to evaluate the quality of diagnostics of CM and comorbid neurological disorders in real-life neurological practice.

Material and methods. The study included 200 patients with CM (63 men and 137 women, mean age 33.1±7.1 years) admitted to A.Ya. Kozhevnikov Clinic of Nervous Diseases (CND) of Sechenov University, complaining of frequent headaches. They had previously been examined and treated by neurologists in other medical institutions on an outpatient and/or inpatient basis. A clinical interview was conducted with all patients to establish a diagnosis and analyze their previous treatment, and a psychometric test was performed to assess symptoms of anxiety and depression.

Results. Only 6% of patients had been previously diagnosed with CM, the remaining 94% were incorrectly diagnosed with secondary HA. All patients had previously been prescribed additional examinations, mainly neuroimaging of the brain and ultrasound of the cerebral vessels, although there were no "red flags". None of the patients had been previously assessed for their emotional state, while almost all patients had high situational anxiety (n=190; 95%) and high personal anxiety (n = 180; 90%), there were symptoms of depression (n=190; 95%) of varying severity. Comorbid neurological disorders (medication overuse HA), insomnia, musculoskeletal pain etc.) were diagnosed in 91.5% of patients in CND and in only in 8% of patients in other medical centers.

Conclusion. In real-life clinical practice, CM and comorbid neurological disorders are inadequately diagnosed and excessive and unjustified additional examinations are prescribed.

Currently, effective methods for the treatment of chronic migraine (CM) have been developed, but it remains unclear how they are used in real clinical practice and how often. The typical practice of treating patients with CM in our country has not been sufficiently investigated, which formed the basis for conducting this study.

Objective: to evaluate the quality of treatment of patients with CM in real-life neurological practice.

Material and methods. The study included 200 patients with CM (63 men and 137 women, mean age – 33.1±7.1 years) admitted to A.Ya. Kozhevnikov Clinic of Nervous Diseases (CND) of Sechenov University for frequent headaches, who were previously treated by neurologists in other medical institutions on an outpatient and/or inpatient basis. All patients were clinically interviewed to establish a diagnosis and analyze their previous treatment.

Results. All patients had an experience of incorrect or inadequate treatment, including ineffective drug and non-drug methods. All patients were taking painkillers to relieve migraine, but less than half of them was satisfied with their effectiveness. Only 12 (8.5%) patients with medication overuse headache had previously received treatment for drug overuse. None of the patients who were admitted to CND had previously received cognitive-behavioral therapy and treatment with an interdisciplinary approach that included not only pharmacotherapy but also psychological and behavioral methods and kinesiotherapy.

Conclusion. In real-life clinical practice, ineffective methods are often used to treat migraine, and an interdisciplinary approach that includes effective pharmacotherapy and non-pharmacological methods is lacking.

Objective: to identify characteristics of migraine in women in postmenopause (PM) by analyzing the frequency, duration and intensity of migraine attacks, assessment of quality of life, anxiety, depression and sleep disturbances in patients in the reproductive phase (RP) and in the PM.

Material and methods. The study comprised 60 migraine patients (30 patients in the RP, 30 patients in the PM). During the personal interview, age, migraine type, frequency and duration of attacks and headache (HA) intensity on the visual analogue scale (VAS) were recorded. The patients then completed the questionnaires: HIT-6, MIBS-4, HURT, Migraine- ACT, MIDAS, SF-36, HADS, ISQ. The statistical analysis was performed in Microsoft Office Excel 2021.

Results. The risk of high intensity HA (≥8 points on the VAS) was significantly higher in patients in the PM than in patients in the RP [p<0.05; relative risk (RR) 1.77]. The risk of necessity of a revision of therapy of attacks was higher in the PM than in the RP (p=0.004; RR=2.2). The risk of insomnia was higher in the PM than in the RP (p=0.004; RR=4.67). The risk of severe headache impact (HIT-6) and high migraine burden (MIBS-4) was higher in patients in the PM than in the RP (ORHIT6=1.7; ORMIBS4=1.78). All indicators of SF-36 quality of life questionnaire were significantly lower in patients in the PM group than in the RP group (p<0.05). The risk of subclinical and clinical anxiety (p<0.05; RR=4.33) and depression (p<0.05; RR=2.75) was significantly higher in the PM than in the RP.

Conclusion. Migraine attacks in women in the PM are more intense than in women in the RP, quality of life is lower, and revision of therapy for attacks is required more frequently. Patients with migraine in the PM are more likely to suffer from anxiety, depression and insomnia. Further research is needed to determine the causes of the observed phenomena and to develop migraine therapy in patients in the PM.

Medication overuse headache (MOH) is a common form of chronic headache with a high risk of relapse after therapy. Excessive use of analgesics most frequently leads to the development of MOH in migraine patients.

Objective: to analyze the short- and long-term efficacy of MOH therapy in patients with chronic migraine (CM) using different programs to discontinue the abused drug and a detoxification regimen.

Material and methods. The study included 44 patients with MOH and CM who were divided into two groups. Group A comprised 18 patients who discontinued the drug that triggered MOH and were simultaneously prescribed preventive treatment for migraine without undergoing "detoxification" therapy". Group B comprised 26 patients who received a multimodal therapeutic strategy including "detoxification treatment".

Results. The strategy of complex therapy with a "detoxification treatment" was significantly more effective during the 12-month observation period. In group B, a significant (p<0.01) decrease in the number of days with migraine per month was observed (before therapy – 22.6±7.4 days, after 3 months – 15.1±8.9 days, after 6 months – 12.7±9.1 days and after 12 months – 10.2±8.7 days). In the first 6 months, a similar dynamic was observed in group A, whereby the frequency of migraine increased in the 12th month of observation. Twelve months after the start of therapy, migraine occurred in episodes in the majority (84%) of patients in group B, which is significantly more than in group A (58.9%; p<0.01).

Conclusion. A comprehensive approach in the treatment of patients with CM and MOH with "detoxification" therapy" showed high efficacy in terms of reducing the number of headache days per month and converting CM to episodic migraine.

The available data indicate the important role of personality profile, psychoemotional disorders and psychosocial aspects in the development and maintenance of medication overuse headache (MOH). It is therefore important to identify predictors for the development and factors that influence the course and prognosis of treatment for this disorder.

Objective: to analyze the clinical and psychological profile of patients and to identify predictors of the course of MOH in order to develop a prognostic model.

Material and methods. We performed a comparative analysis of the characteristics of 117 patients with MOH (group 1) and 23 patients with chronic migraine (CM) without MOH (group 2) using clinical data and questionnaire data to determine the neuropsychological profile (PCS, Spielberger-Khanin Anxiety Scale, PHQ-9, BIS-11, TAS-26, SAGE test, Leeds Dependence Questionnaire – LDQ) at the time of admission to hospital and 9 months after the start of treatment.

Results. The study showed that 100% of patients with CM and MOH had various psychoemotional disorders. At the same time, the pre-therapy baseline indicators for the level of personal anxiety, pain catastrophizing scales, impulsive behavior, alexithymia and LDQ parameters were significantly higher in the group of patients with CM and MOH than in the group with CM without excessive analgesic use. Using multiple linear regression, it was found that an increase in the severity of depression by 1 point is significantly associated with an increase in the number of days with headache (HA) by 0.33 days per month. In addition, a significant direct correlation was found between the degree of addiction according to LDQ and the extent of pain catastrophizing and situational anxiety, as well as the level of cognitive functions (according to the SAGE questionnaire) in an inverse relationship. At the same time, the frequency of analgesics use per day in the group of patients with CM and MOH is significantly related to the level of pain catastrophizing, depression and personal anxiety.

Conclusion. The results obtained confirm the biobehavioral concept of MOH development. Effective therapy of the primary form of HA (in our study – CM) is significantly associated with a decrease in the severity of anxiety, depression, catastrophizing and the frequency of taking analgesics. Personality traits, especially the tendency to impulsive behavior, remain unchanged against the background of chronic HA treatment. The presented results emphasize the need for complex treatment of patients with CM and MOH.

Chronic migraine (CM) affects three out of every hundred people. As the frequency of attacks increases, so does the frequency of painkillers usage, and 85% of patients with CM are also diagnosed with medication overuse headache (MOH).

Objective: to investigate the efficacy of preventive therapy of CM with or without MOH.

Material and methods. The study involved 117 patients with CM and MOH (group 1) and 23 patients with CM without MOH (group 2), patients were examined at the initial visit and after 3 and 9 months of follow-up. All patients in the 1st group (CM+MOH) received a 7-day "detoxification" therapy. Patients in both groups were given an educational and information session on the type of their diagnosis, treatment methods and lifestyle correction. The choice of a preventive treatment in both groups was based on the current clinical recommendations, algorithms of modern international guidelines, concomitant pathology, the presence of contraindications in a particular patient, tolerability, as well as territorial and economic factors.

Results. A positive effect was found in both groups, regardless of the presence of MOH. The lack of significant differences between the groups of CM with/without MOH is probably due to the use of "detoxification" therapy and the cessation/restriction of the use of the drug of abuse in all patients with CM and MOH, although a more pronounced positive dynamics is observed in patients of the 2nd group (CM without MOH), which in turn emphasizes the severity of the disease, the greater disability and the poorer prognosis for response to preventive treatment in the presence of MOH. It was found that one third of patients in the study favored monoclonal antibodies (mAbs) due to convenience, rapid onset of action and tolerability. In the group of patients with MOH, the best results were obtained when using injection methods of treatment (anti-CGRP mAbs, botulinum therapy) or when using combined therapy compared to monotherapy with venlafaxine or topiramate.

Conclusion. All first-line drugs for the CM prophylactic treatment according to the clinical guidelines of the Ministry of Health of Russia are clearly effective, including cases with both CM and MOH. The use of combined therapy in CM with/without MOH can be effective even with a low initial response to one of the monotherapies.

Objective: to evaluate the quality of life in a personalized approach to the treatment of chronic tension-type headache (CTTH) in comparison with a standard treatment protocol.

Material and methods. The study involved 61 patients with CTTH. Patients were randomly divided into two groups. The first (main) group consisted of patients (n=30) who received a personalized approach with a psychotherapist contributing to the treatment. The comparison group consisted of patients (n=31) who were treated according to a standard protocol with counselling and observation by a neurologist. Pain intensity was assessed using the visual analogue pain scale (VAS). The SF-36 questionnaire was used to assess quality of life. Differences between the groups were analyzed by assessing individual changes in eight different domains of the SF-36 questionnaire for each patient.

Results. In the main group, parameters characterizing the physical (pain intensity) and emotional experience of the pain (mental health, social functioning, life activity; p<0.05) decreased after 6 months of treatment when a personalized approach to the treatment of CTTH was applied, compared to the control group (with a standard patient management protocol).

Conclusion. The personalized approach showed an improvement of the quality of life of patients with CTTH compared with the standard protocol, allowing us to recommend it for a wider application in clinical practice.

The most common forms of headache (HA) in clinical practice are migraine, tension-type headache (TTH), cervicocranialgia and medication overuse headache. Modern strategies for the treatment of HA include the prescription of painkillers based on their efficacy, safety, experience of use, and patient's and physician's preference. Non-steroidal anti-inflammatory drugs are a universal mean of controlling HA, associated with a high analgesic potential that has been studied in almost all forms of cephalgia. Introduction to practice, confirmed efficacy and safety of Nalgesin® forte (naproxen) in observational studies in clinical practice make it the drug of choice for the most common forms of HA, among others.