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González Mingot C, Santos Lasaosa S, Colàs Campàs L, Chilangua Canaval L, Gil Sánchez A, Brieva Ruiz L, Marzo Alonso MC, Peralta Moncusi S, Valls Marsal J, Cambray Carner S, Purroy García F. Prophylactic treatment can modify vascular risk biomarkers in high-frequency episodic and chronic migraine patients: a pilot study. Sci Rep 2023; 13:19416. [PMID: 37940678 PMCID: PMC10632400 DOI: 10.1038/s41598-023-44522-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
To evaluate whether preventive treatment can modify endothelial and oxidative biomarkers of vascular disease risk in patients with high-frequency episodic and chronic migraine. In this observational, prospective pilot study, 88 prophylactic treatment-naïve patients with episodic and chronic migraine and 56 healthy sex/age matched controls underwent ultrasonography exams and blood tests at baseline, and again in the migraine patients after 3 months' treatment with metoprolol or topiramate. Biomarkers for endothelial function and oxidative stress were analyzed. At baseline, patients with migraine in the low-frequency episodic group had differences exclusively in nitrates 17.6 versus 27.33 µM; p = 0.046 compared to the controls. However, when comparing the group comprised of patients with high-frequency episodic migraine and chronic migraine versus controls, statistically significant differences appeared in hsCRP 2.68 versus 1.64 mg/dL; p = 0.049, vWF antigen (133% vs. 110%; p = 0.020, vWF activity (111% vs. 90%; p = 0.010) and isoprostane levels (181 vs. 238 µM; p = 0.05). Only in the chronic migraine subgroup did we found statistically significant differences in CIMT (0.60 vs. 0.54 mm; p = 0.042) which were significantly greater than in the controls. After treatment, patients who respond to preventive treatment exhibited significantly higher levels of nitrates (24.2-13.8 µM; p = 0.022) and nitrites (10.4-3.43 µM; p = 0.002) compared than non-responders. Moreover, biomarker levels improved in treatment-responsive patients with migraine; hsCRP levels decreased from 2.54 to 1.69 mg/dL (p < 0.05), vWF activity levels decreased from 124 to 103 IU/dL (p = 0.003) and prothrombin activity decreased from 1.01 to 0.93 (p = 0.01). These differences were also observed in the high-frequency and chronic migraine subgroup and reach statistical significance in the case of hsCRP, which decreased from 2.12 to 0.83 mg/dL (p = 0.048). Patients with migraines have differences in biomarker levels compared to controls, suggesting endothelial and oxidative dysfunction. The greatest differences in biomarker levels compared to controls are observed in migraine patients in the high-frequency and chronic migraine subgroups. Based on our results, preventive treatment is capable of modifying markers of endothelial dysfunction and oxidative stress in migraine patients, even in cases of chronic and high-frequency migraine.
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Affiliation(s)
- Cristina González Mingot
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, Alcalde Rovira Roure 80, 25198, Lleida, Spain.
- Neurology Service of Hospital Arnau de Vilanova of Lleida, Lleida, Spain.
| | | | | | | | - Anna Gil Sánchez
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, Alcalde Rovira Roure 80, 25198, Lleida, Spain
| | - Luis Brieva Ruiz
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, Alcalde Rovira Roure 80, 25198, Lleida, Spain
- Neurology Service of Hospital Arnau de Vilanova of Lleida, Lleida, Spain
| | | | - Silvia Peralta Moncusi
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, Alcalde Rovira Roure 80, 25198, Lleida, Spain
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George A, Minen MT. Episodic Migraine and Psychiatric Comorbidity: A Narrative Review of the Literature. Curr Pain Headache Rep 2023; 27:461-469. [PMID: 37382869 DOI: 10.1007/s11916-023-01123-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE OF REVIEW We evaluate the evolving evidence of psychiatric comorbidities associated with episodic migraine. Utilizing recent research publications, we aim to assess traditional treatment option considerations and discuss recent and evolving non-pharmacologic treatment progress for episodic migraine and related psychiatric conditions. RECENT FINDINGS Recent findings indicate that episodic migraine is strongly linked to comorbid depression, anxiety, posttraumatic stress disorder, and sleep disorders. Not only do patients with episodic migraine have higher rates of psychiatric comorbidity, but a higher number of headache days reported is also strongly linked to an increased risk of developing a psychiatric disorder, indicating there may be a link between frequency and psychiatric comorbidity and that patients with high-frequency episodic migraine should be assessed for psychiatric comorbidity. Few migraine preventive medications have examined the effect of the medication on both migraine and psychiatric comorbidity though we discuss what has been reported in the literature. Non-pharmacologic-based treatments including behavioral therapies and mind-body interventions previously developed for psychiatric conditions, e.g., mindfulness-based CBT (MBCT), acceptance and commitment therapy (ACT), and mindfulness-based stress reduction (MBSR) therapy, have promising results for patients diagnosed with episodic migraine and may therefore be useful in treating migraine and comorbid psychiatric conditions. Psychiatric comorbidity may affect the efficacy of the treatment of episodic migraine. Thus, we must assess for psychiatric comorbidities to inform better treatment plans for patients. Providing patients with episodic migraine with alternate modalities of treatment may help to improve patient-centered care and increase patients' sense of self-efficacy.
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Affiliation(s)
- Alexis George
- Department of Neurology, NYU Langone Health, 222 East 41st Street, New York, NY, 10017, USA
| | - Mia T Minen
- Department of Neurology, NYU Langone Health, 222 East 41st Street, New York, NY, 10017, USA.
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3
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Ferretti A, Gatto M, Velardi M, Di Nardo G, Foiadelli T, Terrin G, Cecili M, Raucci U, Valeriani M, Parisi P. Migraine, Allergy, and Histamine: Is There a Link? J Clin Med 2023; 12:jcm12103566. [PMID: 37240671 DOI: 10.3390/jcm12103566] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
The relationship between migraines and allergies is controversial. Though they are epidemiologically linked, the underlying pathophysiological connection between them remains unclear. Migraines and allergic disorders have various underlying genetic and biological causes. As per the literature, these conditions are epidemiologically linked, and some common pathophysiological pathways have been hypothesized. The histaminergic system may be the clue to understanding the correlation among these diseases. As a neurotransmitter in the central nervous system with a vasodilatory effect, histamine has a well-documented influence on the allergic response and could be involved in the pathophysiology of migraines. Histamine may influence hypothalamic activity, which may play a major role in migraines or may simply influence their severity. In both cases, antihistamine drugs could prove useful. This review examines whether the histaminergic system, particularly H3 and H4 receptors, may provide a mechanistic link between the pathophysiology of migraines and allergic disorders, two common and debilitating conditions. Identifying their connection could help identify novel therapeutic strategies.
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Affiliation(s)
- Alessandro Ferretti
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Mattia Gatto
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Margherita Velardi
- General and Emergency Department, Bambino Gesù Children's Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, 00165 Rome, Italy
| | - Giovanni Di Nardo
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Gianluca Terrin
- Department of Mother and Child, Gynecological and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, 00185 Rome, Italy
| | - Manuela Cecili
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Umberto Raucci
- General and Emergency Department, Bambino Gesù Children's Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, 00165 Rome, Italy
| | - Massimiliano Valeriani
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, 00165 Rome, Italy
| | - Pasquale Parisi
- Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
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4
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Urtecho M, Wagner B, Wang Z, VanderPluym JH, Halker Singh RB, Noyes J, Butler ME, Murad MH. A qualitative evidence synthesis of patient perspectives on migraine treatment features and outcomes. Headache 2023; 63:185-201. [PMID: 36602191 DOI: 10.1111/head.14430] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES We aimed to identify migraine treatment features preferred by patients and treatment outcomes most valued by patients. BACKGROUND The values and preferences of people living with migraine are critical for both the choice of acute therapy and management approach of migraine. METHODS We conducted a qualitative evidence synthesis. Two reviewers independently selected studies, appraised methodological quality, and undertook a framework synthesis. We developed summary of findings tables following the approach of Grading of Recommendations, Assessment, Development and Evaluations Confidence in the Evidence from Reviews of Qualitative Research to assess confidence in the findings. RESULTS Of 1691 candidate references, we included 19 studies (21 publications) involving 459 patients. The studies mostly recruited White women from North America (11 studies) and Europe (8 studies). We identified eight themes encompassing features preferred by patients in a migraine treatment process. Themes described a treatment process that included shared decision-making, a tailored approach, trust in health-care professionals, sharing of knowledge and diversity of treatment options, a holistic approach that does not just address the headache, ease of communication especially for complex treatments, a non-undermining approach, and reciprocity with mutual respect between patient and provider. In terms of the treatment itself, seven themes emerged including patients' preferences for nonpharmacologic treatment, high effectiveness, rapidity of action, long-lasting effect, lower cost and more accessibility, self-management/self-delivery option that increases autonomy, and a mixed preference for abortive versus prophylactic treatments. The treatment outcomes that have high value to patients included maintaining or improving function; avoiding side effects, potential for addiction to medications, and pain reoccurrence; and avoiding non-headache symptoms such as nausea, vomiting, and sensitivity to light or sounds. CONCLUSION Patient values and preferences were individually constructed, varied widely, and could be at odds with conventional medical perspectives and evidence of treatment effects. Considering the availability of numerous treatments for acute migraine, it is necessary that decision-making incorporates patient values and preferences identified in qualitative research. The findings of this qualitative synthesis can be used to facilitate an individually tailored approach, strengthen the patient-health-care system relationship, and guide choices and decisions in the context of a clinical encounter or a clinical practice guideline.
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Affiliation(s)
- Meritxell Urtecho
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brittin Wagner
- Minnesota Evidence-Based Practice Center, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Zhen Wang
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.,Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Juliana H VanderPluym
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Rashmi B Halker Singh
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Mary E Butler
- Minnesota Evidence-Based Practice Center, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Mohammad Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
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Grazzi L, Montisano DA, Rizzoli P, Guastafierro E, Marcassoli A, Fornari A, Raggi A. A Single-Group Study on the Effect of OnabotulinumtoxinA in Patients with Chronic Migraine Associated with Medication Overuse Headache: Pain Catastrophizing Plays a Role. Toxins (Basel) 2023; 15:toxins15020086. [PMID: 36828401 PMCID: PMC9967692 DOI: 10.3390/toxins15020086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
Pain catastrophizing and cutaneous allodynia are commonly altered in patients with chronic migraine associated with medication overuse headache (CM-MOH) and tend to improve in parallel with clinical improvement. The relation between pain catastrophizing and cutaneous allodynia is poorly understood in patients with CM-MOH receiving OnabotulinumtoxinA therapy. In this single-arm open-label longitudinal observational study, patients with CM-MOH were assigned to structured withdrawal and then administered OnabotulinumtoxinA (5 sessions on a three-month basis, 195 UI per 31 sites). Headache frequency, medication intake, disability, impact, cutaneous allodynia and pain catastrophizing were evaluated with specific questionnaires. In total, 96 patients were enrolled and 79 completed the 12-month follow-up. With the exclusion of cutaneous allodynia and the magnification subscale of the pain catastrophizing questionnaire, all variables showed significant improvement by the sixth month, which was maintained at 12 months. Reduction of pain catastrophizing, and particularly of its helplessness subscale, was a significant predictor of reduction in headache frequency and medication intake. Pain catastrophizing is often implicated in the clinical improvement in patients with CM-MOH receiving behavioral treatments, but, in this study, also showed a role in patients receiving OnabotulinumtoxinA; combining OnabotulinumtoxinA and behavioral treatments specifically addressing pain catastrophizing might further enhance patients' clinical outcome.
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Affiliation(s)
- Licia Grazzi
- Centro Cefalee, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
- Correspondence: (L.G.); (A.R.)
| | | | - Paul Rizzoli
- Brigham & Women’s Faulkner Hospital, John Graham Headacche Center, Harvard Medical School, Boston, MA 02115, USA
| | - Erika Guastafierro
- UOC Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Alessia Marcassoli
- UOC Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Arianna Fornari
- UOC Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Alberto Raggi
- UOC Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
- Correspondence: (L.G.); (A.R.)
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6
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Reis ACSDSE, Gonçalves ALR, Santos BORD, Silva JMPE, Câmara LDÁGCD, Jurno ME. Prevalence of postpartum depression in patients with migraine. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2022.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction
Migraine is a frequent and chronic condition that affects 3 times more women than men. Overall, it shows that migraine is influenced by variables such as fluctuating hormones levels throughout life with migraine. Women can also experience symptoms of postpartum depression (PPD) which can cause issues for new moms in terms of behavior, emotion and cognition. Clinical investigations have shown that headaches affects pregnants and parturients.
Objective
To verify PPD in migraine and non-migrainous parturients.
Methods
Data was collected from a sample of 155 women over 18 years old in the obstetric center of Santa Casa de Misericórdia de Barbacena, from October 2021 to August 2022, in the first 24 hours after labor. Parturients who did not agree to participate and those with cognitive impairment were excluded. All patients signed an informed consent form and answered the Edinburgh Postnatal Depression Scale (EPDS) and the ID-MigraineTM, in addition to clinic data and concomitant disorders from the patient's record.
Results
25 of the 155 postpartum women achieved the criteria for migraine and 130 for non-migraine. Of the patients with postpartum depression associated with migraine, 4 were classified as migraine and 8 as non-migrainous. Among patients who had headaches during pregnancy, 11 had PPD compared to those who did not have headaches during pregnancy: 1. The OR=8.9 (CI 1.12-70) and RR=7.9 (CI 1.05-60) were higher compared to those who did not have PPD. The analysis did not find a relation between migraine and PPD. However, a relation was found between headaches during pregnancy and the presence of PPD (p<0.05).
Conclusion
Patients who experienced headaches while pregnant are more likely to have postpartum depression. However, migraine-diagnosed puerperal women do not present considerable concerns for the development of depression.
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Park S, Han S, Suh HS. The disease burden of migraine patients receiving prophylactic treatments in Korea: a population-based claims database analysis. BMC Health Serv Res 2022; 22:902. [PMID: 35821030 PMCID: PMC9277836 DOI: 10.1186/s12913-022-08191-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Despite guideline recommendations, the limited benefits and failure of prophylactic treatment in patients with migraine have been reported. This study aimed to estimate the incremental burden (i.e., healthcare resource use and cost) of disease in patients who received at least one prophylactic treatment compared to those who did not. Methods This study analyzed the Health Insurance Review and Assessment Service database, which covers the entire population of Korea from December 2014 to November 2019. We included adult patients with migraine (≥18 years) who had ≥1 claim with migraine diagnosis (G43) or received ≥1 prescription of triptan or ergotamine between December 2015 and November 2018. We defined two groups: (1) migraine patients who received at least one prophylactic treatment (prophylaxis group) and (2) migraine patients who never received prophylactic treatments (non-prophylaxis group). We performed propensity score matching to balance the baseline covariates between the two groups. In a matched cohort, we estimated healthcare resource use and costs in terms of outpatient visits, outpatient visits to neurologists, emergency department (ED) visits, and hospitalizations. Results After matching, 633,709 and 633,709 patients were identified in the prophylaxis and non-prophylaxis groups, respectively. The healthcare resource utilization was significantly higher in the prophylaxis group than in the non-prophylaxis group in terms of the number of outpatient visits (2.34 vs 1.70), outpatient visits to neurologists (2.23 vs 1.61), ED visits (1.07 vs 1.05), and hospitalizations (1.12 vs 1.09) (all P < 0.05). The estimated annual costs per patient were significantly higher in the prophylaxis group than in the non-prophylaxis group for outpatient (102.37 USD vs. 62.46 USD), neurology outpatient (141.80 USD vs. 120.30 USD), and ED visits (550.51 USD vs. 234.14 USD) and hospitalization (817.01 USD vs. 645.97 USD) (all P < 0.001). Conclusions Migraine patients who received ≥1 prophylactic treatment had a higher burden of disease than migraine patients who received no prophylaxis. This indicates that despite migraine prophylaxis, the migraine-related disease burden remains high, and more efficient migraine prophylaxis strategies are needed.
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Affiliation(s)
- Seonyoung Park
- College of Pharmacy, Pusan National University, Busan, South Korea
| | - Sola Han
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea.,College of Pharmacy, Kyung Hee University, Seoul, South Korea.,College of Pharmacy, University of Texas at Austin, Austin, TX, USA
| | - Hae Sun Suh
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea. .,College of Pharmacy, Kyung Hee University, Seoul, South Korea.
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Silvestro M, Tessitore A, Orologio I, De Micco R, Tartaglione L, Trojsi F, Tedeschi G, Russo A. Galcanezumab effect on "whole pain burden" and multidimensional outcomes in migraine patients with previous unsuccessful treatments: a real-world experience. J Headache Pain 2022; 23:69. [PMID: 35698070 PMCID: PMC9195341 DOI: 10.1186/s10194-022-01436-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical trials have demonstrated galcanezumab as safe and effective in migraine prevention. However, real-life data are still lacking and overlook the impact of galcanezumab on those different migraine facets strongly contributing to migraine burden. Herein we report the clinical experience from an Italian real-world setting using galcanezumab in patients with migraine experiencing previous unsuccessful preventive treatments. METHODS Forty-three patients with migraine and failure of at least 3 migraine preventive medication classes received monthly galcanezumab 120 mg s.c. At the first administration and after 3 and 6 months, patients underwent extensive interviews to assess clinical parameters of disease severity. Furthermore, validated questionnaires were administered to explore migraine-related disability, impact, and quality of life as well as symptoms of depression or anxiety, pain catastrophizing, sleep quality and the ictal cutaneous allodynia. RESULTS After the third and the sixth administration of monthly galcanezumab 120 mg s.c., headache attacks frequency reduced from 20.56 to 7.44 and 6.37 headache days per month, respectively. Moreover, a significant improvement in headache pain intensity (from 8.95 to 6.84 and 6.21) and duration (from 9.03 to 3.75 and 2.38) as well as in scores assessing migraine related disability and impact, depressive and anxious symptoms, and pain catastrophizing was observed. Furthermore, we demonstrated a significant reduction in the values of "whole pain burden", a composite score derived from the product of the average of headache frequency, intensity, and duration in the last three months. CONCLUSION Real-world data support monthly galcanezumab 120 mg s.c. as a safe and effective preventive treatment in reducing headache frequency, intensity, and duration as well as comorbid depressive or anxious symptoms, pain catastrophizing and quality of life in both episodic and chronic migraine patients with previous unsuccessful preventive treatments. Furthermore, we demonstrated that monthly galcanezumab 120 mg s.c. is able to induce a significant improvement in the scores of "whole pain burden". The latter is a reliable and easy-to-handle tool to be employed in clinical setting to evaluate the effectiveness of preventive drugs (in this case, galcanezumab) or when the decision of continuing the treatment with anti-CGRP mAbs is mandatory.
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Affiliation(s)
- Marcello Silvestro
- Headache Center, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Piazza Miraglia 2 - I-80138, Naples, Italy
| | - Alessandro Tessitore
- Headache Center, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Piazza Miraglia 2 - I-80138, Naples, Italy
| | - Ilaria Orologio
- Headache Center, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Piazza Miraglia 2 - I-80138, Naples, Italy
| | - Rosa De Micco
- Headache Center, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Piazza Miraglia 2 - I-80138, Naples, Italy
| | - Lorenzo Tartaglione
- Headache Center, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Piazza Miraglia 2 - I-80138, Naples, Italy
| | - Francesca Trojsi
- Headache Center, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Piazza Miraglia 2 - I-80138, Naples, Italy
| | - Gioacchino Tedeschi
- Headache Center, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Piazza Miraglia 2 - I-80138, Naples, Italy
| | - Antonio Russo
- Headache Center, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Piazza Miraglia 2 - I-80138, Naples, Italy.
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Chua AL, Mehla S, Orlova YY. Drug Safety in Episodic Migraine Management in Adults. Part 2: Preventive Treatments. Curr Pain Headache Rep 2022; 26:493-504. [PMID: 35587859 DOI: 10.1007/s11916-022-01051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to aid in decision-making when choosing safe and effective options for preventive migraine medications. RECENT FINDINGS In Part 2, we have compiled clinically relevant safety considerations for commonly used migraine prophylactic treatments. Preventive treatment of episodic migraine includes nonspecific and migraine-specific drugs. While medications from several pharmacological classes-such as anticonvulsants, beta-blockers, and antidepressants-have an established efficacy in migraine prevention, they are associated with a number of side effects. The safety of migraine-specific treatments such as anti-CGRP monoclonal antibodies and gepants are also discussed. This review highlights safety concerns of commonly used migraine prophylactic agents and offers suggestions on how to mitigate those risks.
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Affiliation(s)
- Abigail L Chua
- Geisinger Health Systems, Neurology, 1000 E. Mountain Boulevard, Wilkes-Barre, PA, 18711, USA.
| | - Sandhya Mehla
- Ayer Neurosciences Institute, Hartford HealthCare Medical Group, University of Connecticut School of Medicine, Norwich, CT, USA
| | - Yulia Y Orlova
- Neurology Department, University of Florida, Gainesville, USA
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Fremanezumab in the prevention of high-frequency episodic and chronic migraine: a 12-week, multicenter, real-life, cohort study (the FRIEND study). J Headache Pain 2022; 23:46. [PMID: 35397503 PMCID: PMC8994302 DOI: 10.1186/s10194-022-01396-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fremanezumab has demonstrated to be effective, safe, and tolerated in the prevention of episodic or chronic migraine (CM) in randomized, placebo-controlled trials (RCTs). Real-life studies are needed to explore drug effects in unselected patients in routine circumstances and to provide higher generalizability results. This study explores the effectiveness, safety, and tolerability of fremanezumab in a real-life population of individuals affected by high-frequency episodic (HFEM: 8-14 days/month) or CM. METHODS This is a 12-week multicenter, prospective, cohort, real-life study. We considered all consecutive patients affected by HFEM or CM visited at 9 Italian headache centers from 28/07/2020 to 11/11/2020. Eligible patients were given subcutaneous fremanezumab at the doses of 225 mg monthly or 675 mg quarterly, according to their preference. Primary study endpoints were the change in monthly migraine days (MMDs) in HFEM and monthly headache days (MHDs) in CM patients at weeks 9-12 compared to baseline. Secondary endpoints encompassed variation in monthly analgesic intake (MAI), Numerical Rating Scale (NRS), HIT-6 and MIDAS scores, and ≥ 50%, ≥ 75% and 100% responder rates at the same time intervals. RESULTS Sixty-seventh number migraine patients had received ≥ 1 subcutaneous fremanezumab dose and were considered for safety analysis, while 53 patients completed 12 weeks of treatment and were included also in the effectiveness analysis. Fremanezumab was effective in both HFEM and CM, inducing at week 12 a significant reduction in MMDs (-4.6, p < 0.05), MHDs (-9.4, p < 0.001), MAI (-5.7, p < 0.05; -11.1, p < 0.001), NRS (-3.1, p < 0.001; -2.5, p < 0.001), and MIDAS scores (-58.3, p < 0.05; -43.7; p < 0.001). HIT-6 was significantly reduced only in HFEM patients (-18.1, p < 0.001). Remission from CM to episodic migraine and from MO to no-MO occurred in 75% and 67.7% of the patients. The ≥ 50%, ≥ 75% and 100% responder rates at week 12 were 76.5%, 29.4% and 9.9% in HFEM and 58.3%, 25% and 0% in CM. Younger age emerged as a positive response predictor (OR = 0.91; 95% CI 0.85-0.98, p = 0.013). Treatment-emergent adverse events were uncommon (5.7%) and mild. No patient discontinued fremanezumab for any reason. CONCLUSIONS Fremanezumab seems more effective in real-life than in RCTs. Younger age emerges as a potential response predictor.
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Efficacy and Safety of Chuanxiong Qingnao Granule in Patients with Migraine: A Randomized, Double-Blind, Placebo-Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2021:6203999. [PMID: 34976097 PMCID: PMC8716194 DOI: 10.1155/2021/6203999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/01/2021] [Accepted: 12/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of Chuanxiong Qingnao Granule (CQG) to treat migraine. METHOD This study was a randomized, double-blind, placebo-controlled trial. All migraineurs were recruited and randomly assigned into a treatment group treated with CQG and a control group treated with a placebo. The whole research process included a 4-week baseline, 12-week intervention, and 12-week follow-up. The primary outcome was responder rate, defined as the percentage of migraineurs with 50% or more reduction in the frequency of migraine attack during treatment and posttreatment period compared with the baseline. The secondary outcomes were the number of migraine days, migraine attack frequency, visual analogue scale (VAS), Fatigue Severity Scale (FSS), Hamilton Depression Scale (HAMD), and Migraine Disability Assessment (MIDAS). RESULTS A total of 346 migraineurs completed the research and were included in the intention-treatment analyses. The response rates differed significantly between the treatment group and the control group (71.5% vs. 12.1% at week 12 and 83.1% vs. 3.4% at week 24). Attack frequency, days of headache attack, VAS, FSS, HAMD, and MIDAS decreased at week 12 in both groups with more reduction in the treatment group (P < 0.001). No severe adverse events were observed in this trial. CONCLUSION Chuanxiong Qingnao Granule can significantly improve headache symptoms in patients with migraine while improving disability, fatigue, and depression with a good safety profile.
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Seng EK, Conway AB, Grinberg AS, Patel ZS, Marzouk M, Rosenberg L, Metts C, Day MA, Minen MT, Buse DC, Lipton RB. Response to Mindfulness-Based Cognitive Therapy Differs Between Chronic and Episodic Migraine. Neurol Clin Pract 2021; 11:194-205. [PMID: 34484887 DOI: 10.1212/cpj.0000000000000984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/21/2020] [Indexed: 11/15/2022]
Abstract
Objective Evaluate whether the benefits of Mindfulness-Based Cognitive Therapy for Migraine (MBCT-M) on headache disability differs among people with episodic and chronic migraine (CM). Methods This is a planned secondary analysis of a randomized clinical trial. After a 30-day baseline, participants were stratified by episodic (6-14 d/mo) and CM (15-30 d/mo) and randomized to 8 weekly individual sessions of MBCT-M or wait list/treatment as usual (WL/TAU). Primary outcomes (Headache Disability Inventory; Severe Migraine Disability Assessment Scale [scores ≥ 21]) were assessed at months 0, 1, 2, and 4. Mixed models for repeated measures tested moderation with fixed effects of treatment, time, CM, and all interactions. Planned subgroup analyses evaluated treatment*time in episodic and CM. Results Of 60 participants (MBCT-M N = 31, WL/TAU N = 29), 52% had CM. CM moderated the effect of MBCT-M on Severe Migraine Disability Assessment Scale, F(3, 205) = 3.68, p = 0.013; MBCT-M vs WL/TAU reduced the proportion of people reporting severe disability to a greater extent among people with episodic migraine (-40.0% vs -14.3%) than CM (-16.4% vs +8.7%). Subgroup analysis revealed MBCT-M (vs WL/TAU) significantly reduced Headache Disability Inventory for episodic (p = 0.011) but not CM (p = 0.268). Conclusions MBCT-M is a promising treatment for reducing headache-related disability, with greater benefits in episodic than CM. Trial Registration Information ClinicalTrials.gov Identifier: NCT02443519. Classification of Evidence This study provides Class III evidence that MBCT-M reduces headache disability to a greater extent in people with episodic than CM.
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Affiliation(s)
- Elizabeth K Seng
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Alexandra B Conway
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Amy S Grinberg
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Zarine S Patel
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Maya Marzouk
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Lauren Rosenberg
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Christopher Metts
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Melissa A Day
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Mia T Minen
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Dawn C Buse
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Richard B Lipton
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
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Minen M, Kaplan K, Akter S, Espinosa-Polanco M, Guiracocha J, Khanns D, Corner S, Roberts T. Neuroscience Education as Therapy for Migraine and Overlapping Pain Conditions: A Scoping Review. PAIN MEDICINE 2021; 22:2366-2383. [PMID: 34270769 DOI: 10.1093/pm/pnab131] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuroscience Education Therapy (NET) has been successfully used for numerous overlapping pain conditions, but few studies have investigated NET for migraine. OBJECTIVE We sought to (1) review the literature on NET used for the treatment of various pain conditions to assess how NET has been studied thus far and (2) recommend considerations for future research of NET for the treatment of migraine. DESIGN/METHODS Following the PRISMA guideline for scoping reviews (PRISMA-ScR) Co-author (TR), a Medical Librarian, searched the MEDLINE, PsychInfo, Embase & Cochrane Central Clinical Trials Registry databases for peer-reviewed articles describing NET to treat migraine and other chronic pain conditions. Each citation was reviewed by two trained independent reviewers. Conflicts were resolved through consensus. RESULTS Overall, a NET curriculum consists of the following topics: pain does not equate to injury, pain is generated in the brain, perception, genetics, reward systems, fear, brain plasticity, and placebo/nocebo effects. Delivered through individual, group, or a combination of individual and group sessions, NET treatments often incorporate exercise programs and/or components of other evidence-based behavioral treatments. NET has significantly reduced catastrophizing, kinesiophobia, pain intensity, and disability in overlapping pain conditions. In migraine-specific studies, when implemented together with traditional pharmacological treatments, NET has emerged as a promising therapy by reducing migraine days, pain intensity and duration, and acute medication intake. CONCLUSION NET is an established treatment for pain conditions, and future research should focus on refining NET for migraine, examining delivery modality, dosage, components of other behavioral therapies to integrate, and migraine-specific NET curricula.
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Affiliation(s)
- Mia Minen
- Department of Neurology, NYU Langone Health, 222 E 41st Street, Floor 9, New York, NY, 10017.,Department of Population Health, NYU Langone Health
| | - Kayla Kaplan
- Department of Biological Sciences, Barnard College, New York, NY
| | - Sangida Akter
- Department of Psychology, The City College of New York, New York, NY
| | | | - Jenny Guiracocha
- Department of Psychology, The City College of New York, New York, NY
| | - Dennique Khanns
- Department of Chemistry and Biochemistry, The City College of New York, New York, NY, USA
| | - Sarah Corner
- Department of Neurology, NYU Langone Health, 222 E 41st Street, Floor 9, New York, NY, 10017
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TEPE N. The effect of gender differences on the use of valproic acid for migraine prophylaxis. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.903329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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15
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Gago-Veiga AB, Huhn JI, Latysheva N, Vieira Campos A, Torres-Ferrus M, Alpuente Ruiz A, Sacco S, Frattale I, Ornello R, Ruscheweyh R, Marques IB, Gryglas-Dworak A, Stark C, Gallardo VJ, Pozo-Rosich P. InterMiG: international differences in the therapeutic approach to migraine patients in specialized headache centers. J Headache Pain 2021; 22:43. [PMID: 34030634 PMCID: PMC8142511 DOI: 10.1186/s10194-021-01258-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/12/2021] [Indexed: 12/03/2022] Open
Abstract
Background There is currently a wide therapeutic arsenal for migraine patients, without a single first-line preventive drug and we choose the different available alternatives taking into account comorbidities, national guidelines, previous treatments and personal experiences. Our objective was to evaluate the differences in the use of migraine treatments between neurologists from different countries. Methods This is a multi-centre observational study carried out by neurologists from specialized headache units in seven countries, retrospective with consecutive inclusion of all patients presenting with a migraine diagnosis, over a period of three months. Results A total of 734 patients were recruited but only 600 were considered in the analysis in order to homogenize the patient cohorts from countries: 200 Spain (ES), 100 Italy (IT), 85 Russia (RUS), 80 Germany (DE), 60 Portugal (PT), 45 Poland (PL) and 30 Australia (AU). 85.4 % of patients were women with a mean age of 42.6 ± 11.8 years. Considering previous and current preventive treatment, the order of use was: antidepressants (69.3 %), antiepileptic drugs (54.7 %), beta-blockers and antihypertensive drugs (49.7 %), OnabotulinumtoxinA (44.0 %) and others (36.2 %). Statistically significant differences were found between all pharmacological classes: antidepressants were commonly used in all countries, with the exception of Poland (AU: 76.7 %, IT: 71.0 %, DE: 60.0 %, PL: 31.1 %, PT: 71.7 %, RUS: 70.6 %, ES: 78.5 %; p < 0.0001); antiepileptic drugs were more frequently prescribed in Portugal, Australia and Spain (AU: 73.3 %, IT: 40.0 %, DE: 37.5 %, PL: 48.9 %, PT: 85.0 %, RUS: 29.4 % and ES: 69.0 %; p < 0.0001); beta-blockers and antihypertensive drugs were frequently used in all countries except Italy (AU: 60.0 %, IT: 14.0 %, DE: 53.8 %, PL: 48.9 %, PT: 68.3 %, RUS: 49.4 % and ES: 59.0 %; p < 0.0001); BTX-A were predominately used in Spain, Italy and Australia (AU:56.7 %, IT:58.0 %, DE:20.0 %, PL: 42.2 %, PT: 26.7 %, RUS: 24.7 % and ES: 58.5 %; p < 0.0001) and others were most frequently used in Poland (AU: 0.0 %, IT: 19.0 %, DE: 42.5 %, PL: 95.6 %, PT: 31.7 %, RUS: 3.5 % and ES: 49.5 %; p < 0.0001). If only patients without comorbidities are considered (200/600), statistically differences between countries persist in all preventive treatments. Conclusions There is heterogeneity in the choice of preventive treatment between different countries. Prospective comparative studies of the different oral and subcutaneous alternatives would help to create a global therapeutic algorithm that would guarantee the best option for our patients.
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Affiliation(s)
- A B Gago-Veiga
- Headache Unit, Department of Neurology, La Princesa Research Institute. Hospital Universitario de la Princesa, Madrid, Spain.
| | - J-I Huhn
- Praxis Gendolla. Zentrum für Neurologie und Schmerztherapie, Essen, Germany
| | - N Latysheva
- Department of Neurology, Institute for Professional Education, I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A Vieira Campos
- Headache Unit, Department of Neurology, La Princesa Research Institute. Hospital Universitario de la Princesa, Madrid, Spain
| | - M Torres-Ferrus
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Alpuente Ruiz
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L´Aquila, Italy
| | - I Frattale
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L´Aquila, Italy
| | - R Ornello
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L´Aquila, Italy
| | - R Ruscheweyh
- Department of Neurology, Ludwig Maximilians University Munich, Munich, Germany
| | - I B Marques
- Department of Neurology, Hospital da Luz Lisboa, Lisbon, Portugal
| | | | - C Stark
- Austin Health, Heidelberg, Australia
| | - V J Gallardo
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Sokolov AY, Volynsky MA, Zaytsev VV, Osipchuk AV, Kamshilin AA. Advantages of imaging photoplethysmography for migraine modeling: new optical markers of trigemino-vascular activation in rats. J Headache Pain 2021; 22:18. [PMID: 33794769 PMCID: PMC8015037 DOI: 10.1186/s10194-021-01226-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/12/2021] [Indexed: 12/25/2022] Open
Abstract
Background Existent animal models of migraine are not without drawbacks and limitations. The aim of our study was to evaluate imaging photoplethysmography (PPG) as a method of assessing intracranial blood flow in rats and its changes in response to electrical stimulation of dural trigeminal afferents. Methods Experiments were carried out with 32 anesthetized adult male Wistar rats. Trigeminovascular system (TVS) was activated by means of electrical stimulation of dural afferents through a closed cranial window (CCW). Parameters of meningeal blood flow were monitored using a PPG imaging system under green illumination with synchronous recording of an electrocardiogram (ECG) and systemic arterial blood pressure (ABP). Two indicators related to blood-flow parameters were assessed: intrinsic optical signals (OIS) and the amplitude of pulsatile component (APC) of the PPG waveform. Moreover, we carried out pharmacological validation of these indicators by determining their sensitivity to anti-migraine drugs: valproic acid and sumatriptan. For statistical analysis the non-parametric tests with post-hoc Bonferroni correction was used. Results Significant increase of both APC and OIS was observed due to CCW electrical stimulation. Compared to saline (n = 11), intravenous administration of both the sumatriptan (n = 11) and valproate (n = 10) by using a cumulative infusion regimen (three steps performed 30 min apart) lead to significant inhibitory effect on the APC response to the stimulation. In contrast, intravenous infusion of any substance or saline did not affect the OIS response to the stimulation. It was found that infusion of either sumatriptan or valproate did not affect the response of ABP or heart rate to the stimulation. Conclusions Imaging PPG can be used in an animal migraine model as a method for contactless assessment of intracranial blood flow. We have identified two new markers of TVS activation, one of which (APC) was pharmacologically confirmed to be associated with migraine. Monitoring of changes in APC caused by CCW electrical stimulation (controlling efficiency of stimulation by OIS) can be considered as a new way to assess the peripheral mechanism of action of anti-migraine interventions.
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Affiliation(s)
- Alexey Y Sokolov
- Department of Neuropharmacology, Valdman Institute of Pharmacology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia.,Laboratory of Cortico-Visceral Physiology, Pavlov Institute of Physiology of the Russian Academy of Sciences, Saint Petersburg, Russia
| | - Maxim A Volynsky
- Faculty of Applied Optics, ITMO University, Saint Petersburg, Russia
| | - Valery V Zaytsev
- Faculty of Applied Optics, ITMO University, Saint Petersburg, Russia.,Research Laboratory of Neuromodulation, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Anastasiia V Osipchuk
- Department of Neuropharmacology, Valdman Institute of Pharmacology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Alexei A Kamshilin
- Research Laboratory of Neuromodulation, Almazov National Medical Research Centre, Saint Petersburg, Russia. .,Laboratory of New Functional Materials for Photonics, Institute of Automation and Control, Russian Academy of Sciences, Vladivostok, Russia.
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Abstract
Migraine is a common and disabling disorder affecting approximately 1.02 billion people worldwide. Calcitonin gene-related peptide (CGRP) has been identified as playing an important role in the pathophysiology of migraine and several migraine-specific therapies targeting the CGRP ligand or its receptor have been approved since 2018 for the acute and preventive treatment of migraine. This review focuses on the pharmacology, clinical efficacy and safety/tolerability of galcanezumab, an anti-CGRP monoclonal antibody approved for the prevention of migraine.
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Affiliation(s)
- Lindsay M Frerichs
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390, USA.,Department of Neurology at Washington University School of Medicine in St. Louis, 660 S. Euclid Ave. Saint Louis, MO 63110, USA
| | - Deborah I Friedman
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390, USA.,Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390, USA
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Orlando V, Mucherino S, Monetti VM, Trama U, Menditto E. Treatment patterns and medication adherence among newly diagnosed patients with migraine: a drug utilisation study. BMJ Open 2020; 10:e038972. [PMID: 33148742 PMCID: PMC7643506 DOI: 10.1136/bmjopen-2020-038972] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/30/2020] [Accepted: 10/17/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Prophylactic drugs currently used for migraine treatment are not specific. Furthermore, few studies in existing literature describe drugs utilisation patterns and adherence to migraine prophylactic treatment. This study is aimed to describe utilisation patterns of migraine drugs, evaluate adherence to prophylactic medications and investigate drug-related costs. DESIGN Retrospective population-based study using an administrative health-related database. SETTING Primary care setting in the Campania region, Southern Italy. PARTICIPANTS This study was carried out between 1 January 2016 and 31 December 2018, involving 12 894 subjects with any primary or secondary hospital discharge with migraine diagnosis, or at least two medical dispensations of migraine-specific acute or prophylactic medications (triptans or pizotifen). Subjects were classified into four treatment cohorts: no treatment, acute, prophylactic and both acute and prophylactic. Subjects were followed-up for 1 year. OUTCOME MEASURES Utilisation patterns of migraine drugs at treatment initiation; adherence to prophylactic treatment; discontinuation, restart and switching rates; annual migraine drug costs per patient. RESULTS Overall, 81.1% of subjects received acute treatment as their initial migraine treatment regimen, 10.7% prophylactic treatment, 8.2% both acute and prophylactic treatment. 599 patients were treated prophylactically; of these, 26.2% adhered to their initial treatment while 73.8% reported interruptions in treatment. Among the latter, 46.4% of patients discontinued the treatment completely within 103 days (IQR 89.0), 31% restarted treatment 46 days after interruption (IQR 60.0) and 22.6% switched to another treatment within 98 days (IQR 57.5) (p<0.001). The median annual cost of drugs per patient was €103 for those treated acutely, €75 for those treated prophylactically, €163 for those treated both. CONCLUSIONS Migraine treatment with acute medications is still prevalent in Italy; only few patients received prophylactic treatment with poor adherence to treatment. These findings reflect an unmet need for improved prophylactic therapies in order to provide a better disease management.
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Affiliation(s)
- Valentina Orlando
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Sara Mucherino
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Valeria Marina Monetti
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Ugo Trama
- Regional Pharmaceutical Unit, Campania Region, Naples, Italy
| | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
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Parikh SK, Delbono MV, Silberstein SD. Managing migraine in pregnancy and breastfeeding. PROGRESS IN BRAIN RESEARCH 2020; 255:275-309. [PMID: 33008509 DOI: 10.1016/bs.pbr.2020.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/16/2020] [Accepted: 05/01/2020] [Indexed: 02/08/2023]
Abstract
The disproportionate prevalence of migraine among women in their reproductive years underscores the clinical significance of migraine during pregnancy. This paper discusses how migraine evolves during pregnancy, secondary headache disorders presenting in pregnancy and puerperium, and acute and preventive options for migraine management during pregnancy and lactation. Migraine is influenced by rising estrogen levels during pregnancy and their sharp decline in puerperium. Migraine, and migraine aura, can present for the first time during pregnancy and puerperium. There is also a higher risk for the development of preeclampsia and cerebrovascular headache during these periods. New or refractory headache, hypertension, and abnormal neurological signs are important "red flags" to consider. This paper reviews the diagnostic utility of neuroimaging studies and the risks of each during pregnancy. Untreated migraine can itself lead to preterm delivery, preeclampsia, and low birth weight infants. Behavioral interventions and lifestyle modifications are the cornerstone for migraine treatment during pregnancy. In addition, one should consider the risks and efficacy of each treatment during pregnancy on an individual basis. The protective nature of breastfeeding for migraine is debated, but there is no evidence to suggest breastfeeding worsens migraine. Acute and preventive migraine treatment options are available for nursing mothers. Neuromodulation and neurostimulation devices are additional options for treatment during pregnancy and lactation, while the safety of using calcitonin gene-related peptide receptor antagonists during these times remains to be determined.
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Affiliation(s)
- Simy K Parikh
- Thomas Jefferson University, Philadelphia, PA, United States
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20
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Sanchez-Sanchez PA, García-González JR, Rúa Ascar JM. Automatic migraine classification using artificial neural networks. F1000Res 2020; 9:618. [PMID: 34745568 PMCID: PMC8564744 DOI: 10.12688/f1000research.23181.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2020] [Indexed: 04/05/2024] Open
Abstract
Background: Previous studies of migraine classification have focused on the analysis of brain waves, leading to the development of complex tests that are not accessible to the majority of the population. In the early stages of this pathology, patients tend to go to the emergency services or outpatient department, where timely identification largely depends on the expertise of the physician and continuous monitoring of the patient. However, owing to the lack of time to make a proper diagnosis or the inexperience of the physician, migraines are often misdiagnosed either because they are wrongly classified or because the disease severity is underestimated or disparaged. Both cases can lead to inappropriate, unnecessary, or imprecise therapies, which can result in damage to patients' health. Methods: This study focuses on designing and testing an early classification system capable of distinguishing between seven types of migraines based on the patient's symptoms. The methodology proposed comprises four steps: data collection based on symptoms and diagnosis by the treating physician, selection of the most relevant variables, use of artificial neural network models for automatic classification, and selection of the best model based on the accuracy and precision of the diagnosis. Results: The neural network models used provide an excellent classification performance, with accuracy and precision levels >97% and which exceed the classifications made using other model, such as logistic regression, support vector machines, nearest neighbor, and decision trees. Conclusions: The implementation of migraine classification through neural networks is a powerful tool that reduces the time to obtain accurate, reliable, and timely clinical diagnoses.
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Affiliation(s)
| | | | - Juan Manuel Rúa Ascar
- School of Engineering, Universidad Simón Bolívar, Barranquilla, Atlántico, 00000, Colombia
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21
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Yu S, Zhang Y, Yao Y, Cao H. Migraine treatment and healthcare costs: retrospective analysis of the China Health Insurance Research Association (CHIRA) database. J Headache Pain 2020; 21:53. [PMID: 32404048 PMCID: PMC7222520 DOI: 10.1186/s10194-020-01117-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/28/2020] [Indexed: 12/11/2022] Open
Abstract
Background Adult migraine remains underdiagnosed and undertreated, despite significant negative effects on physical and emotional functioning. Information on prescribing patterns and treatment costs of migraine in China is limited. Methods This retrospective analysis of the China Health Insurance Research Association (CHIRA) medical insurance claims database in 2016 to 2017 evaluated treatment patterns, direct medical costs, and healthcare resource utilization among adults with migraine in mainland China. Results Of 108,375 patients with headache-related outpatient visits, 10,652 were adults with migraine (mean age 51.4 years, 55.4% female). Common comorbidities were major depressive disorder (4.1%), insomnia (3.8%), and anxiety (2.3%). Migraine patients were prescribed acute medication (26.4%), preventive medication (15.0%), and Chinese patent and herbal medicines (24.5% and 11.7%, respectively). Of patients prescribed acute medication, 68.8% received non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs), 7.1% received opioids, while only 3.3% received triptans. Mean annual outpatient costs per patient were 46.5 United States dollars (USD), with mean (standard deviation) 1.8 (2.0) outpatient visits per year. Medication costs for traditional Chinese medicine (22.4 USD per patient) were higher than for Western medicine (13.5 USD). Conclusion Among migraine patients in China, NSAIDs were commonly prescribed as acute medication, while utilization of migraine-specific triptans and preventive medications was low.
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Affiliation(s)
- Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Yanlei Zhang
- Lilly Suzhou Pharmaceutical Co., Ltd. Shanghai Branch, 19F, Centre T1, HKRI Taikoo, No. 288, Shimen No.1 Road, Shanghai, 200021, China.
| | - Yuan Yao
- Lilly Suzhou Pharmaceutical Co., Ltd. Shanghai Branch, 19F, Centre T1, HKRI Taikoo, No. 288, Shimen No.1 Road, Shanghai, 200021, China
| | - Haijun Cao
- Lilly Suzhou Pharmaceutical Co., Ltd. Shanghai Branch, 19F, Centre T1, HKRI Taikoo, No. 288, Shimen No.1 Road, Shanghai, 200021, China
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Garcia-Martinez LF, Raport CJ, Ojala EW, Dutzar B, Anderson K, Stewart E, Kovacevich B, Baker B, Billgren J, Scalley-Kim M, Karasek C, Allison D, Latham JA. Pharmacologic Characterization of ALD403, a Potent Neutralizing Humanized Monoclonal Antibody Against the Calcitonin Gene-Related Peptide. J Pharmacol Exp Ther 2020; 374:93-103. [DOI: 10.1124/jpet.119.264671] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022] Open
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