Migraine treatment: a chain of adverse effects

Abstract

This clinical vignette presents a 14 years old female, with a past medical history relevant only for migraine with typical aura of less than monthly frequency, complaining of a severe unilateral headache with rising intensity for the previous 4 h, associated with nausea, vomiting, photophobia and phonophobia. This episode of migraine with aura in a patient with recurrent migraine was complicated by side effects of medical diagnostic and therapeutic procedures (extrapyramidal symptoms, delirium, post-lumbar puncture headache, hospital admission) all of which could have been prevented—quaternary prevention. This case illustrates several important messages in migraine management: (1) use of acetaminophen is not based in high-quality evidence and better options exist; (2) among youngsters, domperidone should be preferred over metoclopramide because it does not cross the blood–brain barrier; (3) moderate to severe migraine crisis can be managed with triptans in teenagers over 12 years old; (4) it is important to recognize adverse drug effects; (5) harmful consequences of medical interventions do occur; (6) the school community must be informed about chronic diseases of the young.

What Is Known About Preventing, Detecting, and Reversing Prescribing Cascades: A Scoping Review

“…Case studies described prescribing cascades associated with a variety of drug therapies, including angiotensin‐converting enzyme inhibitor–induced rhinorrhea and dexamethasone‐induced psychosis. Case studies also illustrated the expanded prescribing cascade concept, which is when the prescribing cascade is extended beyond initiation of a new prescribed drug to consider other potentially unnecessary interventions, such as new use of over‐the‐counter self‐medication or medical devices.…”

Successful intervention to mitigate an acetylcholinesterase inhibitor-induced rhinorrhea prescribing cascade: a case report

“…A prescribing cascade occurs when a drug‐induced adverse event (DIAE) is misinterpreted as a new medical condition resulting in the prescription of a new, potentially unnecessary medication . Case reports have previously described the negative impacts of prescribing cascades in older adults . Currently, there are a limited number of case reports that have described a successful intervention to mitigate a prescribing cascade by discontinuing the medication contributing to the DIAE .…”

“…1 Case reports have previously described the negative impacts of prescribing cascades in older adults. [2][3][4][5][6][7][8][9] Currently, there are a limited number of case reports that have described a successful intervention to mitigate a prescribing cascade by discontinuing the medication contributing to the DIAE. [2][3][4][5] However, the initial medication may not be able to be discontinued depending on the patient and medication in question.…”

Quaternary prevention: First, do not harm

“…Migren tedavisinde dördüncül koruma bağlamında mesajlar verilmiştir. [44] Bu mesajlara göre ilaçların olumlu ve olumsuz etkilerinin iyi bilinmesi ve tedavinin kişiselleştirilmesi öneril-mekte; tıbbi girişimlerin zarar verebileceği uyarısı yapılmaktadır. Dördüncül korumanın yaşam sonu bakımında da önemli rolü olduğu bildirilmektedir.…”