Chinese herbal medicine for migraine management: A hospital-based retrospective analysis of electronic medical records

Chinese medicine for headaches in emergency department: a retrospective analysis of real-world electronic medical records

Background

Headaches are common complaints in the emergency department (ED) and have raised concern about acute medication overuse. Chinese medicine is a major complementary and alternative medicine in China and effective for headaches. This study aims to summarize characteristics of headache patients at EDs and the utilization of Chinese medicine for headache managements in EDs.

Methods

The study conducted a retrospective analysis based on existing electronic medical records at EDs from four branches of Guangdong Provincial Hospital of Chinese Medicine. Only complete medical records with a first diagnosis of headache within the specified timeframe were included. Data was extracted, screened and standardized using a structured approach. Descriptive analyses and Apriori algorithm-based association rules were employed for the study.

Results

A total of 3,355 medical records were analyzed, with over 86% of headaches classified as non-urgent. Approximately 97% of the patients received a general diagnosis of headaches without further classification. Hypertension was the most prevalent concomitant diagnosis, affecting 27.42% of the patients. Western medicine was prescribed to 66% of the patients for headaches and co-existing conditions, while each type of acute medication was prescribed to fewer than 10% of the patients. Conversely, over one-third of the patients utilized headache-specific patented Chinese herbal medicine products. Additionally, oral and topical Chinese herbal medicine treatments were also administered for headaches in the emergency departments.

Conclusion

The majority of headaches consulting in the EDs were non-urgent and treated with various forms of Chinese medicine, alone or in conjunction of western medicine. Chinese herbal medicine may be promoted as alternatives to Western acute medications for treating benign headaches.

Traditional Chinese Medicine and Headache Disorders-A Review of Categorization and Selected Therapeutic Approaches

Headaches have emerged as a prevailing global health concern, impacting millions of individuals and posing challenges to public health care systems. With an escalating number of patients seeking complementary therapies to attain a more holistic approach for headaches, Traditional Chinese Medicine has gained significant popularity. It plays a pivotal role in advancing the safeguarding of health and the alleviation of prevalent, recurrent, and complex medical conditions. Traditional Chinese Medicine covers a diverse array of therapeutic procedures for headaches, incorporating Chinese herbal medicine, acupuncture, auricular acupuncture, and life cultivation. This narrative review delves into the fundamental principles of Traditional Chinese Medicine and its categorization of headaches while exploring the potential selected applications of their treatment. Based on recent scientific findings and the ancient history of Traditional Chinese Medicine in the field of headaches, we conclude that selected Traditional Chinese Medicine therapies can be used as an alternative and complementary therapy against headaches.

Rimegepant orally disintegrating tablet 75 mg for acute treatment of migraine in adults from China: a subgroup analysis of a double-blind, randomized, placebo-controlled, phase 3 clinical trial

BACKGROUND

Rimegepant orally disintegrating tablet (ODT), an oral small-molecule calcitonin gene-related peptide receptor antagonist, is indicated for acute and preventive treatment of migraine in the United States and other countries. Previously, a large clinical trial assessed the efficacy and safety of rimegepant ODT 75 mg for the acute treatment of migraine in adults living in China or South Korea. A post hoc subgroup analysis of this trial was performed to evaluate the efficacy and safety of rimegepant for acute treatment of migraine in adults living in China.

METHODS

Eligible participants were ≥ 18 years of age and had a ≥ 1-year history of migraine, with 2 to 8 attacks of moderate or severe pain intensity per month and < 15 headache days per month during the 3 months before screening. Participants self-administered rimegepant ODT 75 mg or matching placebo to treat a single migraine attack of moderate or severe pain intensity. The co-primary endpoints were pain freedom and freedom from the most bothersome symptom (MBS) at 2 h post-dose. Key secondary endpoints included pain relief at 2 h post-dose, ability to function normally at 2 h post-dose, use of rescue medication within 24 h post-dose, and sustained pain freedom from 2 to 24 h and 2 to 48 h post-dose. All p values were nominal. Safety was assessed via treatment-emergent adverse events (TEAEs), electrocardiograms, vital signs, and routine laboratory tests.

RESULTS

Overall, 1075 participants (rimegepant, n = 538; placebo, n = 537) were included in the subgroup analysis. Rimegepant was more effective than placebo for the co-primary endpoints of pain freedom (18.2% vs. 10.6%, p = 0.0004) and freedom from the MBS (48.0% vs. 31.8%, p <  0.0001), as well as all key secondary endpoints. The incidence of TEAEs was comparable between the rimegepant (15.2%) and placebo (16.4%) groups. No signal of drug-induced liver injury was observed, and no study drug-related serious TEAEs were reported in the rimegepant group.

CONCLUSIONS

A single dose of rimegepant 75 mg rimegepant was effective for the acute treatment of migraine in adults living in China, with safety and tolerability similar to placebo.

TRIAL REGISTRATION

Clinicaltrials.gov NCT04574362 Date registered: 2020-10-05.

Real-world observations and impacts of Chinese herbal medicine for migraine: results of a registry-based cohort study

Background: Migraine is a prevalent, recurrent condition with substantial disease burden. Chinese herbal medicine (CHM) has been used frequently for migraine in controlled clinical settings. This study is to summarise the characteristics of patients who seek clinical care in a tertiary Chinese medicine hospital in China; to gather their preferences and values of using CHM; to explore the effect of CHM for migraine and its comorbidities in a real-world setting, and to collect first-hand expertise of clinicians' practice pattern in prescribing CHM for migraine. Methods: This registry-based cohort study was prospectively conducted at Guangdong Provincial Hospital of Chinese Medicine from December 2020 to May 2022. Adult migraine patients seeking their initial anti-migraine clinical care at the hospital were consecutively recruited and followed up for 12 weeks. Practitioners specialised in headache management prescribed individualised treatments without research interference. Standardised case report forms were employed to gather information on patients' preferences and perspective of seeking clinical care, as well as to assess participants' migraine severity, comorbidities, and quality of life, at 4-weeks intervals. Various analytical methods were utilised based on the computed data. Results: In this study, we observed 248 participants. Of these, 73 received CHM treatment for 28 days or longer. Notably, these participants exhibited a greater disease severity, compared to those treated with CHM for less than 28 days. Of the 248 participants, 83.47% of them expected CHM would effectively reduce the severity of their migraine, around 50% expected effects for migraine-associated comorbidities, while 51.61% expressing concerns about potential side effects. CHM appeared to be effective in reducing monthly migraine days and pain intensity, improving patients' quality of life, and potentially reducing comorbid anxiety, with a minimum of 28 days CHM treatment. Herbs such as gan cao, gui zhi, chuan xiong, fu ling, bai zhu, yan hu suo, etc. were frequently prescribed for migraine, based on patients' specific symptoms. Conclusion: CHM appeared to be beneficial for migraine and comorbid anxiety in real-world clinical practice when used continuously for 28 days or more. Clinical Trial Registration: clinicaltrials.gov, identifier ChiCTR2000041003.