Moderate to severe migraine attacks are treated with triptans. However, about 25% of migraineurs fail to respond to triptans. We investigated the involvement of gene polymorphisms, personality traits and characteristics of headache, and made a scoring system for prediction of clinical response to triptans in patients with migraine. Gene polymorphisms including serotonin (5-HT)(1B) receptor G861C and dopamine receptor 2 (DRD2) C939T, personality traits and characteristics of headache were investigated in 46 consistent responders and 14 inconsistent responders to triptans. The multivariate stepwise logistic regression analysis revealed that age, periorbital/deep orbital pain and C/C genotype carrier at DRD2 C939T were significant factors that contributed independently to the negative response to triptans in patients with migraine. Their odds ratios were 6.329 (40-69 vs. 20-39 years, 95% CI 1.441-27.778), 6.772 (no vs. yes, periorbital/deep orbital pain, 95% CI 1.159-39.580) and 14.085 (non-C/C vs. C/C genotype at DRD2 C939T, 95% CI 1.253-166.667), respectively. The predictive index (PI) of clinical response to triptans in patients with migraine was calculated using these three factors. The score in inconsistent responders (1.6 ± 0.6) was significantly higher than that in consistent responders (0.8 ± 0.7, P < 0.001). Sensibility of low-score (RI = 0) group was 100%, and specificity of high-score (PI ≥ 2) group was 87%. The proposed scoring system should in the future be the object of larger studies to confirm its validity.

Migraine is a multifactorial disease with various factors, such as genetic polymorphisms and personality traits, but the contribution of those factors is not clear. To clarify the pathogenesis of migraine, the contributions of genetic polymorphisms and personality traits were simultaneously investigated using multivariate analysis. Ninety-one migraine patients and 119 non-headache healthy volunteers were enrolled. The 12 gene polymorphisms analysis and NEO-FFI personality test were performed. At first, the univariate analysis was performed to extract the contributing factors to pathogenesis of migraine. We then extracted the factors that independently contributed to the pathogenesis of migraine using multivariate stepwise logistic regression analysis. Using the multivariate analysis, three gene polymorphisms including monoamine oxidase A (MAOA) T941G, methylenetetrahydrofolate reductase (MTHFR) C677T, and tumor necrosis factor beta (TNF-β) G252Α, and the neuroticism and conscientiousness scores in NEO-FFI were selected as significant factors that independently contributed to the pathogenesis of migraine. Their odds ratios were 1.099 (per point of neuroticism score), 1.080 (per point of conscientiousness score), 2.272 (T and T/T or T/G vs G and G/G genotype of MAOA), 1.939 (C/T or T/T vs C/C genotype of MTHFR), and 2.748 (G/A or A/A vs G/G genotype of TNF-β), respectively. We suggested that multiple factors, such as gene polymorphisms and personality traits, contribute to the pathogenesis of migraine. The contribution of polymorphisms, such as MAOA T941G, MTHFR C677T, and TNF-β G252A, were more important than personality traits in the pathogenesis of migraine, a multifactorial disorder.

Pharmacists in a community pharmacy may recommend an over-the-counter (OTC) drug to patients with headache. However, it is not clear how pharmacists should distinguish the symptoms of patients and facilitate appropriate self-medication. Here, we investigated the role of pharmacists in a community pharmacy in recommending OTC drugs for self-medication by patients with headache and elucidated their future needs using a questionnaire intended for doctors and pharmacists. More than half of the pharmacists surveyed did not have any experience with recommending OTC drugs for patients with headache. To distinguish between patients for whom pharmacists should``recommend OTC drugs'' and patients who should be encouraged``to consult a hospital or clinic,'' doctors thought that pharmacists should use an``assistance tool to diagnosis headache, such as a screener for migraine'' and``guidelines for chronic headache.'' However, few pharmacists used these tools. About 68％ of doctors indicated that it would be``meaningful'' for pharmacists to distinguish patients with headache. Moreover, both doctors and pharmacists thought that pharmacists should provide patients not only with``instruction on the use of drugs'' but also suggest``when to consult a hospital or clinic.'' However, 32％ of doctors indicated that it is``meaningless'' for pharmacists to attempt to distinguish patients with headache and expressed concern about the increase of patients who overuse headache medication. Theseˆndings provide useful information to guide pharmacists in community pharmacy when recommending OTC drugs for self-medication by patients with headache.

It is often noted that the collaboration of hospital-to-hospital, hospital-to-clinic and clinic-to-clinic in medical care for patients with headache is important. However, the role of community pharmacies in the medical network for consultation of patients with headache is not clear. Here, we investigated the role of pharmacists in a community pharmacy in encouraging patients with headache to undergo medical examination and elucidated their future needs using a questionnaire intended for doctors and pharmacists. About 70％ of pharmacists had experience with recommending that patients with headache consult a hospital. However, only 17％ of doctors had experience with referral of patients with headache by pharmacists in a community pharmacy. About 22％ of pharmacists had experiences in which the patient with headache refused to consult a hospital despite the recommendation, suggesting that many patients did not think that their headache symptoms were severe. In addition, 90％ of doctors and 84％ of pharmacists felt the need for collaboration between hospitals or clinics and community pharmacies. Doctors needed information from pharmacists on thè`c urrent state of drugs'' taken by patients. However, pharmacists considered that they needed to provide not only``current state of drugs being taken'' but also``symptoms of headache'' to doctors. Although 67％ of doctors considered the medication notebook to be useful for pharmacists to provide patient information to doctors, pharmacists preferred to provide the information by telephone. Moreover, 56％ of pharmacists did not know how to search a website for medical specialists in headache. A medical network including not only hospitals or clinics but also community pharmacies might be useful for patients with headache.