IntroductionHeadache disorders are ubiquitous, common, disabling and to a very large extent treatable in primary care. Migraine headaches affect 12% of the adult population worldwide and cause significant economic loss due to decreased workplace productivity. Although interactions between pharmacists and individuals with headache are common, few pharmacists receive adequate training regarding migraine therapy. There are several misconceptions that hinder effective care, such as that migraine is a vascular disease, triptans cause rampant cardiac-related morbidity and even mortality. The last decade's experience with triptans in more than half a billion people worldwide reveals a benign adverse-effect profile, particularly when taken early in an attack. Published reports and real-world experiences illustrate that these drugs do not merit fears of triptan-induced cardiac consequences in appropriately selected individuals. Society's productivity loss due to migraine is measured in billions of dollars. Restoring a patient's ability to function normally is now recognised as the primary treatment goal, not merely relieving pain. Thus, the over-reliance on "pain killer" drugs such as butalbital-containing products and the continued underutilisation of migraine-specific drugs need to be addressed [1]. Attack treatmentOne of the main problems in treating migraine is how to treat attacks. In this situation it has been shown that stratified care is more efficacious and economic than step care strategies [2]. These results were confirmed later and a J Headache Pain (2005) 6:315-318 DOI 10.1007/s10194-005-0219-5 Abstract The cost-benefit and the risk-benefit ratios are two of the most relevant items in ongoing health organisation procedures. The choice of a new or an old therapeutic treatment depends on a number of factors and the evaluation of the cost, in terms of economics, but also in terms of quality of life and type of facilities necessary for one treatment are crucial criteria. Therefore, we have to consider in evaluating treatment strategies not only the activity of a drug in reaching the main endpoints, (i.e., pain free or headache relief) but also the safety and perception of safety by patients, and the cost effectiveness, including indirect costs compared with personal and social benefits. Because it is reasonable that a subgroup of migraine patients may have a clinically progressive disorder, studies should be necessary to assess strategies for migraine treatments. Risk-benefit and cost-benefit ratio in headache treatment H E A D A C H E : T H E R A P E U T I C C H

Clinical studies suggest that hyperhomocysteinemia could be considered an independent risk factor for premature cerebral, peripheral and vascular diseases. A number of authors found an epidemiological correlation between increased risk of cerebrovascular disease and migraine with aura. In this study, 34 patients suffering from migraine with aura and 36 healthy controls were evaluated with respect to total plasma homocysteine levels, measured with FPIA immunoassay in the fasting state and after methionine load. Moreover, vitamin B12, folate and other classic biochemical indicators of atherosclerosis disease were evaluated. In this study, homocysteine levels, both at basal and after load, and other cardiovascular risk factors such as vitamin B12 and apo-LpA were within the normal range. Other multicentric randomised trials are needed to carry on and confirm these data.

Despite the pharmacokinetic differences among triptans and the variety of ways of administration, the clinical differences in everyday use of these drugs do not allow a largely accepted decisional tree. There are a number of comparative trials showing similar results with regard to efficacy, safety, and tolerability of these drugs. This means that the patient’s preference is one of the most important decisive factors in choosing one triptan over another. A good migraine therapy requires a balance between patient satisfaction and drug efficacy and safety. All the marked triptans show a good benefit-risk ratio, and comorbidity should be considered when choosing between different triptans.

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Sirolimus is a immunosuppressive agent for renal transplant recipients. Monitoring of whole blood sirolimus concentration is necessary in order to improve clinical outcomes. An increasing number of clinical laboratories (4-14% during 2005) are using microparticle enzyme immunoassay (MEIA) for sirolimus quantitation but previous reports indicated a high variability, with a mean difference of 17% for MEIA method vs. high-performance liquid chromatography/ultraviolet (HPLC/UV). This study was aimed at comparing the reliability of MEIA with the HPLC/UV method. Blood samples from transplant patients were processed using both HPLC/UV and MEIA assays. Comparison and Bland-Altman plots, as well as regression analysis and paired t-test were used to compare results of the assays. Concentrations were stratified into three groups and used to investigate whether any observed difference between methods could be influenced by sirolimus concentration. Regression analysis yielded a coefficient of correlation R of 0.9756, the line of best fit being y=0.9832x+0.1976. The statistical analysis showed no difference between the two sets of experimental data. The average percentage difference between the two methods was found to be -0.2+/-19.2%. On the basis of our present results, the tested MEIA assay is able to quantify sirolimus concentration with a clinically acceptable imprecision, similar to that of HPLC/UV method.