title: Monitoring of adherence to headache treatments by means of hair analysis.
abstract: OBJECTIVE
  The aim of this study was to evaluate the potential of hair analysis to monitor medication adherence in headache patients undergoing chronic therapy. For this purpose, the following parameters were analyzed: the detection rate of 23 therapeutic drugs in headache patients' hair, the degree of agreement between the self-reported drug and the drug found in hair, and whether the levels found in hair reflected the drug intake reported by the patients.
  
  
  METHODS
  The study included 93 patients suffering from primary headaches declaring their daily intake of at least one of the following drugs during the 3 months before the hair sampling: alprazolam, amitriptyline, citalopram, clomipramine, clonazepam, delorazepam, diazepam, duloxetine, fluoxetine, flurazepam, levomepromazine, levosulpiride, lorazepam, lormetazepam, mirtazapine, paroxetine, quetiapine, sertraline, topiramate, trazodone, triazolam, venlafaxine, and zolpidem. A detailed pharmacological history and a sample of hair were collected for each patient. Hair samples were analyzed by liquid chromatography-electrospray tandem mass spectrometry, using a previously developed method.
  
  
  RESULTS
  All 23 drugs were detected in the examined hair samples. The agreement between the self-reported drug and the drug found in hair was excellent for most analytes (P < 0.001, Cohen's kappa); a statistically significant relationship (P < 0.05, linear regression analysis) between dose and hair level was found for amitriptyline, citalopram, delorazepam, duloxetine, lorazepam, and venlafaxine.
  
  
  CONCLUSIONS
  Hair analysis proved to be a unique matrix to document chronic drug use in headache patients, and the level found for each individual drug can represent a reliable marker of adherence to pharmacological treatments.
authors.affiliation: Unit of Medical Toxicology, Headache Centre and Drug Abuse; Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico, Via del Pozzo, 71, 41124, Modena, Italy. anna.ferrari@unimore.it.
authors.forename: Anna
authors.identifier: http://orcid.org/0000-0001-9536-3995
authors.initials: A
authors.lastname: Ferrari
authors.affiliation: Forensic Toxicology Laboratory, Department of Diagnostic Medicine, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Licata
authors.affiliation: Department of Life Sciences, University of Modena and Reggio Emilia, via G. Campi, 103, 41125, Modena, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Rustichelli
authors.affiliation: Unit of Medical Toxicology, Headache Centre and Drug Abuse; Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico, Via del Pozzo, 71, 41124, Modena, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Baraldi
authors.affiliation: Forensic Toxicology Laboratory, Department of Diagnostic Medicine, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Vandelli
authors.affiliation: Forensic Toxicology Laboratory, Department of Diagnostic Medicine, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Marchesi
authors.affiliation: Forensic Toxicology Laboratory, Department of Diagnostic Medicine, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Palazzoli
authors.affiliation: Forensic Toxicology Laboratory, Department of Diagnostic Medicine, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Verri
authors.affiliation: Unit of Forensic Medicine, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Silingardi
mesh_terms: D000328:Adult; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006197:Hair / Q000737:chemistry*; D006261:Headache / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000032:analysis; D057566:Self Report
chemical_list: D004364:Pharmaceutical Preparations
keywords: Adherence; Drug treatment; Hair analysis; Headache; Monitoring; Prophylaxis