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Amitriptyline Dose and Treatment Outcomes in Specialty Headache Practice: A Retrospective Cohort Study.

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Title: Amitriptyline Dose and Treatment Outcomes in Specialty Headache Practice: A Retrospective Cohort Study.
Authors: Doyle Strauss, Lauren, Weizenbaum, Emma, Loder, Elizabeth W., Rizzoli, Paul B.
Source: Headache: The Journal of Head & Face Pain. Nov/Dec2016, Vol. 56 Issue 10, p1626-1634. 9p. 1 Diagram, 3 Charts, 2 Graphs.
Subjects: Headache, Asians, Black people, Chi-squared test, Dose-response relationship in biochemistry, Drug side effects, Hispanic Americans, Research funding, White people, Comorbidity, Treatment effectiveness, Amitriptyline, Data analysis software, Prevention
Abstract: Objective To characterize treatment patterns and real world outcomes in headache patients treated with amitriptyline in an academic headache center. Design and methods A retrospective chart review identified 178 patients in our center who were given a new prescription for amitriptyline in treatment of headache, and who were seen in follow-up within one year. Charts were reviewed to identify dosing patterns (initial and maximum dose) and persistence, patient-reported headache benefit, and reported side effects. Variables assessed in relation to medication use were comorbid psychiatric disease, headache characteristics, and prior use of a preventive medication. Results We followed patients for an average of 6.5 months. Initial and maximum prescribed amitriptyline doses were characterized as: 'very low' (≤10 mg daily), 'low' (11-25 mg daily), and 'traditional' (≥25 mg daily). The initial dose of amitriptyline ranged from 2.5 to 50 mg daily, though most patients were started on a dose of 10 mg daily (112/178, 63%). Approximately 3/4 of the patients were found to have improvement (134/178) and 85% (129/151) were still taking amitriptyline at the last follow-up appointment. Maximum dosing ranged from 2.5 to 100 mg daily with most patients taking 10-25 mg (86/146, 58%). The most commonly reported adverse effect was daytime fatigue (17/151, 11%). There did not appear to be any effect from gender, ethnicity, race, diagnosis of sleep apnea, chronicity of migraine, presence of aura on our outcome measures. Conclusion Our study supports the common clinical practice of using low doses of amitriptyline to treat chronic headache disorders and suggests that it was effective and well tolerated at doses lower than those used in many clinical trials. Use of low dosage amitriptyline may also improve medication persistence, an important clinical consideration in the management of this common and chronic condition. A subgroup of patients may experience a dramatic benefit from amitriptyline and this could warrant further investigation. [ABSTRACT FROM AUTHOR]
Copyright of Headache: The Journal of Head & Face Pain is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Amitriptyline Dose and Treatment Outcomes in Specialty Headache Practice: A Retrospective Cohort Study.
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  Data: <searchLink fieldCode="JN" term="%22Headache%3A+The+Journal+of+Head+%26+Face+Pain%22">Headache: The Journal of Head & Face Pain</searchLink>. Nov/Dec2016, Vol. 56 Issue 10, p1626-1634. 9p. 1 Diagram, 3 Charts, 2 Graphs.
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  Data: <searchLink fieldCode="DE" term="%22Headache%22">Headache</searchLink><br /><searchLink fieldCode="DE" term="%22Asians%22">Asians</searchLink><br /><searchLink fieldCode="DE" term="%22Black+people%22">Black people</searchLink><br /><searchLink fieldCode="DE" term="%22Chi-squared+test%22">Chi-squared test</searchLink><br /><searchLink fieldCode="DE" term="%22Dose-response+relationship+in+biochemistry%22">Dose-response relationship in biochemistry</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+side+effects%22">Drug side effects</searchLink><br /><searchLink fieldCode="DE" term="%22Hispanic+Americans%22">Hispanic Americans</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22White+people%22">White people</searchLink><br /><searchLink fieldCode="DE" term="%22Comorbidity%22">Comorbidity</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+effectiveness%22">Treatment effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Amitriptyline%22">Amitriptyline</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis+software%22">Data analysis software</searchLink><br /><searchLink fieldCode="DE" term="%22Prevention%22">Prevention</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective To characterize treatment patterns and real world outcomes in headache patients treated with amitriptyline in an academic headache center. Design and methods A retrospective chart review identified 178 patients in our center who were given a new prescription for amitriptyline in treatment of headache, and who were seen in follow-up within one year. Charts were reviewed to identify dosing patterns (initial and maximum dose) and persistence, patient-reported headache benefit, and reported side effects. Variables assessed in relation to medication use were comorbid psychiatric disease, headache characteristics, and prior use of a preventive medication. Results We followed patients for an average of 6.5 months. Initial and maximum prescribed amitriptyline doses were characterized as: 'very low' (≤10 mg daily), 'low' (11-25 mg daily), and 'traditional' (≥25 mg daily). The initial dose of amitriptyline ranged from 2.5 to 50 mg daily, though most patients were started on a dose of 10 mg daily (112/178, 63%). Approximately 3/4 of the patients were found to have improvement (134/178) and 85% (129/151) were still taking amitriptyline at the last follow-up appointment. Maximum dosing ranged from 2.5 to 100 mg daily with most patients taking 10-25 mg (86/146, 58%). The most commonly reported adverse effect was daytime fatigue (17/151, 11%). There did not appear to be any effect from gender, ethnicity, race, diagnosis of sleep apnea, chronicity of migraine, presence of aura on our outcome measures. Conclusion Our study supports the common clinical practice of using low doses of amitriptyline to treat chronic headache disorders and suggests that it was effective and well tolerated at doses lower than those used in many clinical trials. Use of low dosage amitriptyline may also improve medication persistence, an important clinical consideration in the management of this common and chronic condition. A subgroup of patients may experience a dramatic benefit from amitriptyline and this could warrant further investigation. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Headache: The Journal of Head & Face Pain is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=119457059
RecordInfo BibRecord:
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      – Type: doi
        Value: 10.1111/head.12987
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 9
        StartPage: 1626
    Subjects:
      – SubjectFull: Headache
        Type: general
      – SubjectFull: Asians
        Type: general
      – SubjectFull: Black people
        Type: general
      – SubjectFull: Chi-squared test
        Type: general
      – SubjectFull: Dose-response relationship in biochemistry
        Type: general
      – SubjectFull: Drug side effects
        Type: general
      – SubjectFull: Hispanic Americans
        Type: general
      – SubjectFull: Research funding
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      – SubjectFull: White people
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      – SubjectFull: Comorbidity
        Type: general
      – SubjectFull: Treatment effectiveness
        Type: general
      – SubjectFull: Amitriptyline
        Type: general
      – SubjectFull: Data analysis software
        Type: general
      – SubjectFull: Prevention
        Type: general
    Titles:
      – TitleFull: Amitriptyline Dose and Treatment Outcomes in Specialty Headache Practice: A Retrospective Cohort Study.
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              M: 11
              Text: Nov/Dec2016
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              Y: 2016
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