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Alpuente A, Gallardo VJ, Asskour L, Caronna E, Torres-Ferrus M, Pozo-Rosich P. Dynamic fluctuations of salivary CGRP levels during migraine attacks: association with clinical variables and phenotypic characterization. J Headache Pain 2024; 25:58. [PMID: 38637736 PMCID: PMC11027425 DOI: 10.1186/s10194-024-01772-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Migraine is a complex neurological disorder with significant heterogeneity in its clinical presentation and molecular mechanisms. Calcitonin gene-related peptide (CGRP) has emerged as a key player in migraine pathophysiology, but challenges remain in its utilization as a biomarker. This study aimed to investigate salivary CGRP levels during migraine attacks across the frequency spectrum and explore associations with clinical variables. METHODS A prospective longitudinal pilot study was conducted, recruiting migraine patients from an outpatient headache clinic. Salivary CGRP levels were measured at interictal, onset, post-2 h of onset and end-of-attack. Using generalized linear mixed models, we explored the effect of CGRP changes over the attack in presence of depressive symptoms (DS), acute attack treatment, and after three-months of erenumab treatment. Finally, patients were classified and compared according to their CGRP phenotype. RESULTS A total of 44 migraine patients were included (90.9% women), with 80 migraine attacks analyzed. Salivary CGRP levels increased at the onset of migraine attacks. We observed statistically significant interactions between DS and both the linear (Est. [SE]: 19.4 [5.8], p = 0.001) and quadratic terms of time (-19.1 [6.0], p = 0.002). Additionally, a significant three-way interaction within the use of acute treated attack (linear-term: -18.5 [6.2], p = 0.005; quadratic-term: 19.2 [6.8], p = 0.005) was also found. Molecular phenotyping revealed that 72.7% (32/44) of patients presented only CGRP-dependent attacks, while 27.3% (12/44) presented non-CGRP-dependent migraine attacks. Patients with only CGRP-dependent attacks were associated with younger age, shorter disease evolution time, a higher proportion of aura, and fewer monthly headache days (p < 0.05). Exploratory analysis of erenumab treatment effects did not result in changes in CGRP levels during migraine attacks. CONCLUSIONS Our study underscores the dynamic nature of migraine at a molecular level and emphasizes the importance of integrating clinical variables, such as depressive symptoms, in understanding its pathophysiology. The identification of distinct migraine subtypes based on CGRP dependence suggests potential opportunities for personalized treatment approaches.
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Affiliation(s)
- Alicia Alpuente
- Neurology Department, Headache Clinic, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laila Asskour
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Caronna
- Neurology Department, Headache Clinic, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Neurology Department, Headache Clinic, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Neurology Department, Headache Clinic, Vall d'Hebron University Hospital, 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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Lazaro-Hernandez C, Caronna E, Rosell-Mirmi J, Gallardo VJ, Alpuente A, Torres-Ferrus M, Pozo-Rosich P. Early and annual projected savings from anti-CGRP monoclonal antibodies in migraine prevention: a cost-benefit analysis in the working-age population. J Headache Pain 2024; 25:21. [PMID: 38347485 PMCID: PMC10860274 DOI: 10.1186/s10194-024-01727-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Migraine is one of the main causes of disability worldwide. Anti-CGRP monoclonal antibodies (MAbs) have proven to be safe and efficacious as preventive migraine treatments. However, their use is restricted in many countries due to their apparently high cost. Cost-benefit studies are needed. OBJECTIVE To study the cost-benefit of anti-CGRP MAbs in working-age patients with migraine. METHODS This is a prospective cohort study of consecutive migraine patients treated with anti-CGRP MAbs (erenumab, fremanezumab and galcanezumab) following National reimbursement policy in a specialized headache clinic. Migraine characteristics and the work impact scale (WPAI) were compared between baseline (M0) and after 3 (M3) and 6 months (M6) of treatment. Using WPAI and the municipal average hourly wage, we calculated indirect costs (absenteeism and presenteeism) at each time point. Direct costs (emergency visits, acute medication use) were also analysed. A cost-benefit study was performed considering the different costs and savings of treating with MAbs. Based on these data an annual projection was conducted. RESULTS From 256 treated working-age patients, 148 were employed (89.2% women; mean age 48.0 ± 8.5 years), of which 41.2% (61/148) were responders (> 50% reduction in monthly headache days (MHD)). Statistically significant reductions between M0 and M3/M6 were found in absenteeism (p < 0.001) and presenteeism (p < 0.001). Average savings in indirect costs per patient at M3 were absenteeism 105.4 euros/month and presenteeism 394.3 euros/month, similar for M6. Considering the monthly cost of anti-CGRP MAbs, the cost-benefit analysis showed savings of 159.8 euros per patient at M3, with an annual projected savings of 639.2 euros/patient. Both responders and partial responders (30-50% reduction in MHD) presented a positive cost-benefit balance. The overall savings of the cohort at M3/M6 compensated the negative cost-benefit balance for non-responders (< 30% reduction in MHD). CONCLUSION Anti-CGRP MAbs have a positive impact in the workforce significantly reducing absenteeism and presenteeism. In Spain, this benefit overcomes the expenses derived from their use already at 3 months and is potentially sustainable at longer term; also in patients who are only partial responders, prompting reconsideration of current reimbursement criteria and motivating the extension of similar cost-benefit studies in other countries.
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Affiliation(s)
| | - Edoardo Caronna
- Headache Clinic, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joana Rosell-Mirmi
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alicia Alpuente
- Headache Clinic, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Headache Clinic, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache Clinic, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Torres-Ferrús M, Gallardo VJ, Alpuente A, Caronna E, Giné-Ciprés E, Pozo-Rosich P. Improvement of migraine depressive symptoms is not related to headache frequency: exploring the impact of anti-CGRP therapies. Cephalalgia 2024; 44:3331024231222923. [PMID: 38307497 DOI: 10.1177/03331024231222923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
BACKGROUND The present study aimed to describe the prevalence and evolution of depressive symptoms in a cohort of migraine patients treated with anti-CGRP monoclonal antibodies. METHODS This is an exploratory, prospective, unicentric, one-year longitudinal study. We included migraine patients who started treatment with anti-CGRP monoclonal antibodies. Baseline demographic data, medical history, concomitant medication and migraine characteristics were collected. The presence of depressive symptoms was evaluated using the Beck Depression Inventory-II quarterly and treatment response was categorized according to the reduction in monthly headache days. A generalized mixed-effect regression model was used to model depression score over a one-year treatment taking into account frequency response rates. RESULTS We included 577 patients: 84.2% females; median (range) age 47.0 (39.0-53.0) years, 46.1% (266/577) of them presented depressive symptoms at baseline (16.1% mild, 13.3% moderate and 16.6% severe). After six-month treatment, 47.4% (126/266) reduced headache frequency ≥50% after one year and 63.5% (169/266) achieved a clinically significant improvement in depression symptoms. We observed a 30.8% (-50.0%, -3.2%) main reduction in depression score during the first quarter. The improvement in depression symptoms was independently associated with headache frequency response: non-responders, -25.0% (-43.9%, -1.1%); partial responders, -30.2% (-51.3%, -7.6%); and good responders, -33.3% (-54.6%, -7.5%). CONCLUSIONS Anti-CGRP monoclonal antibodies targeting CGRP are effective in reducing depressive symptoms in patients with migraine. The main change of depression score happens during the first three months of treatment. The reduction in depressive symptoms is independent of migraine frequency improvement.
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Affiliation(s)
- Marta Torres-Ferrús
- 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
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alicia Alpuente
- 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
| | - Edoardo Caronna
- 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
| | - Eulalia Giné-Ciprés
- 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
| | - Patricia 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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Ikumi N, Marti-Marca A, Torre-Suñe ADL, Cerda-Company X, Vilà-Balló A, Gallardo VJ, Caronna E, Alpuente A, Pozo-Rosich P. Quantifying sensory thresholds along the migraine cycle: An exploratory longitudinal study. Cephalalgia 2024; 44:3331024241230279. [PMID: 38416486 DOI: 10.1177/03331024241230279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND To date, a number of studies on migraine have cross-sectionally evaluated sensory sensitivity with aversion thresholds/scores along the migraine cycle, reporting a decreased tolerance to sensory stimuli in different sensory modalities. Our hypothesis was that patients with migraine would exhibit heightened sensitivity to sound, light, touch and smell on days where they reported greater headache intensity. METHODS This is an exploratory, longitudinal study, carried out over the course of 27 days. Aversion thresholds or scores to sound, light, touch and smell were quantified in six patients with migraine (11.33 ± 6.53 headache days/month). RESULTS Patients reported an increased sensitivity to light (padj = 0.0297), touch (padj = 0.0077), and smell (padj = 0.0201) on days with higher headache intensity. However, a greater sensitivity to sound on days with higher headache intensity was only reported when anxiety levels were high (padj = 1.4e-06). Interestingly, variable levels of tolerance to bothersome light over time can also influence the correlation between light sensitivity and headache intensity (padj = 1.4e-06). CONCLUSIONS Based on the present findings, future longitudinal studies evaluating sensory threshold changes along the migraine cycle in patients with migraine should account for the increased tolerance to bothersome light over time as well as the effect of anxiety on auditory sensitivity.
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Affiliation(s)
- Nara Ikumi
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angela Marti-Marca
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna de la Torre-Suñe
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xim Cerda-Company
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Adrià Vilà-Balló
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Caronna
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alicia Alpuente
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Torres-Ferrus M, López-Veloso AC, Gonzalez-Quintanilla V, González-García N, Díaz de Teran J, Gago-Veiga A, Camiña J, Ruiz M, Mas-Sala N, Bohórquez S, Gallardo VJ, Pozo-Rosich P. The MIGREX study: Prevalence and risk factors of sexual dysfunction among migraine patients. Neurologia 2023; 38:541-549. [PMID: 37802552 DOI: 10.1016/j.nrleng.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/07/2021] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Migraine attacks have a high impact on daily activities. There is limited research on the burden of migraine on sexual functioning. OBJECTIVE To determine the prevalence of sexual dysfunction in patients with migraine and its relationship with migraine features and comorbidities. METHOD This is a cross-sectional study. We included migraine patients between 18 and 60 years-old from 8 Headache Clinics in Spain. We recorded demographic data and migraine features. Patients fulfilled a survey including comorbidities, Arizona Sexual Experiences Scale, Hospital Anxiety and Depression Scale and a questionnaire about migraine impact on sexual activity. A K-nearest neighbor supervised learning algorithm was used to identify differences between migraine patients with and without sexual dysfunction. RESULTS We included 306 patients (85.6% women, mean age 42.3±11.1 years). A 41.8% of participants had sexual dysfunction. Sexual dysfunction was associated with being female (OR [95% CI]: 2.42 [1.17-5.00]; p<0.001), being older than 46.5 years (4.04 [2.48-6.59]; p<0.001), having chronic migraine (2.31 [1.41-3.77]; p=0.001), using preventive medication (2.45 [1.35-4.45]; p=0.004), analgesic overusing (3.51 [2.03-6.07]; p<0.001), menopause (4.18 [2.43-7.17]; p<0.001) and anxiety (2.90 [1.80-4.67]; p<0.001) and depression (6.14 [3.18-11.83]; p<0.001). However, only female gender, age, menopause and depression were the statistically significant variables selected in the model to classify migraine patients with or without sexual dysfunction (Accuracy [95% CI]: 0.75 (0.62-0.85), Kappa: 0.48, p=0.005). CONCLUSIONS Sexual dysfunction is frequent in migraine patients visited in a headache clinic. However, migraine characteristics or use of preventive medication are not directly associated with sexual dysfunction. Instead, risk factors for sexual dysfunction were female gender, higher age, menopause and depression.
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Affiliation(s)
- M Torres-Ferrus
- Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - A C López-Veloso
- Neurology Department, Gran Canaria Dr. Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | | | | | - J Díaz de Teran
- Neurology Department, La Paz University Hospital, Madrid, Spain
| | - A Gago-Veiga
- Neurology Department, La Princesa University Hospital, Madrid, Spain
| | - J Camiña
- Neurology Department, Rotger Clinic, Palma de Mallorca, Spain
| | - M Ruiz
- Neurology Department, San Juan Hospital, Alicante, Spain
| | - N Mas-Sala
- Neurology Department, Althaia Hospital, Red Asistencial Universitaria de Manresa, Spain
| | - S Bohórquez
- Neurology Department, Sabana University, Bogotá, Colombia
| | - V J Gallardo
- Neurology Department, Sabana University, Bogotá, Colombia
| | - P Pozo-Rosich
- Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Winsvold BS, Harder AVE, Ran C, Chalmer MA, Dalmasso MC, Ferkingstad E, Tripathi KP, Bacchelli E, Børte S, Fourier C, Petersen AS, Vijfhuizen LS, Magnusson SH, O'Connor E, Bjornsdottir G, Häppölä P, Wang Y, Callesen I, Kelderman T, Gallardo VJ, de Boer I, Olofsgård FJ, Heinze K, Lund N, Thomas LF, Hsu C, Pirinen M, Hautakangas H, Ribasés M, Guerzoni S, Sivakumar P, Yip J, Heinze A, Küçükali F, Ostrowski SR, Pedersen OB, Kristoffersen ES, Martinsen AE, Artigas MS, Lagrata S, Cainazzo MM, Adebimpe J, Quinn O, Göbel C, Cirkel A, Volk AE, Heilmann‐Heimbach S, Skogholt AH, Gabrielsen ME, Wilbrink LA, Danno D, Mehta D, Guðbjartsson DF, Rosendaal FR, Willems van Dijk K, Fronczek R, Wagner M, Scherer M, Göbel H, Sleegers K, Sveinsson OA, Pani L, Zoli M, Ramos‐Quiroga JA, Dardiotis E, Steinberg A, Riedel‐Heller S, Sjöstrand C, Thorgeirsson TE, Stefansson H, Southgate L, Trembath RC, Vandrovcova J, Noordam R, Paemeleire K, Stefansson K, Fann CS, Waldenlind E, Tronvik E, Jensen RH, Chen S, Houlden H, Terwindt GM, Kubisch C, Maestrini E, Vikelis M, Pozo‐Rosich P, Belin AC, Matharu M, van den Maagdenberg AM, Hansen TF, Ramirez A, Zwart J. Cluster Headache Genomewide Association Study and Meta-Analysis Identifies Eight Loci and Implicates Smoking as Causal Risk Factor. Ann Neurol 2023; 94:713-726. [PMID: 37486023 PMCID: PMC10952302 DOI: 10.1002/ana.26743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/22/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE The objective of this study was to aggregate data for the first genomewide association study meta-analysis of cluster headache, to identify genetic risk variants, and gain biological insights. METHODS A total of 4,777 cases (3,348 men and 1,429 women) with clinically diagnosed cluster headache were recruited from 10 European and 1 East Asian cohorts. We first performed an inverse-variance genomewide association meta-analysis of 4,043 cases and 21,729 controls of European ancestry. In a secondary trans-ancestry meta-analysis, we included 734 cases and 9,846 controls of East Asian ancestry. Candidate causal genes were prioritized by 5 complementary methods: expression quantitative trait loci, transcriptome-wide association, fine-mapping of causal gene sets, genetically driven DNA methylation, and effects on protein structure. Gene set and tissue enrichment analyses, genetic correlation, genetic risk score analysis, and Mendelian randomization were part of the downstream analyses. RESULTS The estimated single nucleotide polymorphism (SNP)-based heritability of cluster headache was 14.5%. We identified 9 independent signals in 7 genomewide significant loci in the primary meta-analysis, and one additional locus in the trans-ethnic meta-analysis. Five of the loci were previously known. The 20 genes prioritized as potentially causal for cluster headache showed enrichment to artery and brain tissue. Cluster headache was genetically correlated with cigarette smoking, risk-taking behavior, attention deficit hyperactivity disorder (ADHD), depression, and musculoskeletal pain. Mendelian randomization analysis indicated a causal effect of cigarette smoking intensity on cluster headache. Three of the identified loci were shared with migraine. INTERPRETATION This first genomewide association study meta-analysis gives clues to the biological basis of cluster headache and indicates that smoking is a causal risk factor. ANN NEUROL 2023;94:713-726.
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Affiliation(s)
- Bendik S. Winsvold
- Department of Research and Innovation, Division of Clinical NeuroscienceOslo University HospitalOsloNorway
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Department of NeurologyOslo University HospitalOsloNorway
- Norwegian Centre for Headache Research (NorHEAD), Department of Neuromedicine and Movement ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Aster V. E. Harder
- Department of Human GeneticsLeiden University Medical CenterLeidenThe Netherlands
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Caroline Ran
- Centre for Cluster Headache, Department of NeuroscienceKarolinska InstitutetStockholmSweden
| | - Mona A. Chalmer
- Department of Neurology, Danish Headache Center, Rigshospitalet‐GlostrupUniversity of Copenhagen University HospitalGlostrupDenmark
| | - Maria Carolina Dalmasso
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
- Neurosciences and Complex Systems Unit (EnyS), CONICET, Hospital El Cruce 'N. Kirchner'National University A. Jauretche (UNAJ)Florencio VarelaArgentina
| | | | - Kumar Parijat Tripathi
- Division of Neurogenetics and Molecular Psychiatry, Department of PsychiatryUniklinik KölnCologneGermany
| | - Elena Bacchelli
- Department of Pharmacy and BiotechnologyUniversity of BolognaBolognaItaly
| | - Sigrid Børte
- Department of Research and Innovation, Division of Clinical NeuroscienceOslo University HospitalOsloNorway
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Norwegian Centre for Headache Research (NorHEAD), Department of Neuromedicine and Movement ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Carmen Fourier
- Centre for Cluster Headache, Department of NeuroscienceKarolinska InstitutetStockholmSweden
| | - Anja S. Petersen
- Department of Neurology, Danish Headache Center, Rigshospitalet‐GlostrupUniversity of Copenhagen University HospitalGlostrupDenmark
| | | | | | - Emer O'Connor
- Department of Neuromuscular Diseases, Institute of NeurologyUniversity College LondonLondonUK
| | | | - Paavo Häppölä
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of HelsinkiHelsinkiFinland
| | - Yen‐Feng Wang
- Department of NeurologyTaipei Veterans General HospitalTaipeiTaiwan
- Brain Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Ida Callesen
- Department of Neurology, Danish Headache Center, Rigshospitalet‐GlostrupUniversity of Copenhagen University HospitalGlostrupDenmark
| | - Tim Kelderman
- Department of NeurologyGhent University HospitalGhentBelgium
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de MedicinaUniversitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
| | - Irene de Boer
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | | | | | - Nunu Lund
- Department of Neurology, Danish Headache Center, Rigshospitalet‐GlostrupUniversity of Copenhagen University HospitalGlostrupDenmark
| | - Laurent F. Thomas
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Department of Clinical and Molecular MedicineNorwegian University of Science and Technology (NTNU)TrondheimNorway
- BioCore–Bioinformatics Core FacilityNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Clinic of Laboratory MedicineSt. Olavs Hospital, Trondheim University HospitalTrondheimNorway
| | - Chia‐Lin Hsu
- Institute of Biomedical Sciences, Academia SinicaTaipeiTaiwan
| | - Matti Pirinen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of HelsinkiHelsinkiFinland
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
- Department of Mathematics and StatisticsUniversity of HelsinkiHelsinkiFinland
| | - Heidi Hautakangas
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of HelsinkiHelsinkiFinland
| | - Marta Ribasés
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and AddictionUniversitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
- Department of PsychiatryVall d'Hebron University HospitalBarcelonaSpain
- Biomedical Network Research Centre on Mental Health (CIBERSAM)Instituto de Salud Carlos IIIMadridSpain
- Department of Genetics, Microbiology, and Statistics, Faculty of BiologyUniversitat de BarcelonaBarcelonaSpain
| | | | - Prasanth Sivakumar
- Department of Neuromuscular Diseases, Institute of NeurologyUniversity College LondonLondonUK
| | - Janice Yip
- Department of Neuromuscular Diseases, Institute of NeurologyUniversity College LondonLondonUK
| | - Axel Heinze
- Kiel Migraine and Headache CentreKielGermany
| | - Fahri Küçükali
- Complex Genetics of Alzheimer's Disease Group, Center for Molecular Neurology, VIBAntwerpBelgium
- Department of Biomedical SciencesUniversity of AntwerpAntwerpBelgium
| | - Sisse R. Ostrowski
- Department of Clinical Immunology, Centre of Diagnostic InvestigationRigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Ole B. Pedersen
- Department of Clinical ImmunologyZealand University HospitalKøgeDenmark
| | - Espen S. Kristoffersen
- Department of Research and Innovation, Division of Clinical NeuroscienceOslo University HospitalOsloNorway
- Norwegian Centre for Headache Research (NorHEAD), Department of Neuromedicine and Movement ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Department of General PracticeUniversity of OsloOsloNorway
- Department of NeurologyAkershus University HospitalLørenskogNorway
| | - Amy E. Martinsen
- Department of Research and Innovation, Division of Clinical NeuroscienceOslo University HospitalOsloNorway
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Norwegian Centre for Headache Research (NorHEAD), Department of Neuromedicine and Movement ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
| | - María S. Artigas
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and AddictionUniversitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
- Department of PsychiatryVall d'Hebron University HospitalBarcelonaSpain
- Biomedical Network Research Centre on Mental Health (CIBERSAM)Instituto de Salud Carlos IIIMadridSpain
- Department of Genetics, Microbiology, and Statistics, Faculty of BiologyUniversitat de BarcelonaBarcelonaSpain
| | - Susie Lagrata
- Headache and Facial Pain GroupUniversity College London Queen Square Institute of Neurology and National Hospital for Neurology and NeurosurgeryLondonUK
| | | | - Joycee Adebimpe
- Department of Neuromuscular Diseases, Institute of NeurologyUniversity College LondonLondonUK
| | - Olivia Quinn
- Department of Neuromuscular Diseases, Institute of NeurologyUniversity College LondonLondonUK
| | - Carl Göbel
- Kiel Migraine and Headache CentreKielGermany
- Department of NeurologyUniversity Hospital Schleswig‐HolsteinLübeckGermany
| | - Anna Cirkel
- Kiel Migraine and Headache CentreKielGermany
- Department of NeurologyUniversity Hospital Schleswig‐HolsteinLübeckGermany
| | - Alexander E. Volk
- Institute of Human GeneticsUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Stefanie Heilmann‐Heimbach
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital BonnBonnGermany
| | - Anne Heidi Skogholt
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Maiken E. Gabrielsen
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | | | - Daisuke Danno
- Headache and Facial Pain GroupUniversity College London Queen Square Institute of Neurology and National Hospital for Neurology and NeurosurgeryLondonUK
| | - Dwij Mehta
- Headache and Facial Pain GroupUniversity College London Queen Square Institute of Neurology and National Hospital for Neurology and NeurosurgeryLondonUK
| | | | | | - Frits R. Rosendaal
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Ko Willems van Dijk
- Department of Human GeneticsLeiden University Medical CenterLeidenThe Netherlands
- Einthoven Laboratory for Experimental Vascular MedicineLeiden University Medical CenterLeidenThe Netherlands
- Department of Internal Medicine, Division of EndocrinologyLeiden University Medical CenterLeidenThe Netherlands
| | - Rolf Fronczek
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric PsychiatryUniversity Hospital BonnBonnGermany
- German Center for Neurodegenerative Diseases (DZNE Bonn)BonnGermany
| | - Martin Scherer
- Department of Primary Medical CareUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | | | - Kristel Sleegers
- Complex Genetics of Alzheimer's Disease Group, Center for Molecular Neurology, VIBAntwerpBelgium
- Department of Biomedical SciencesUniversity of AntwerpAntwerpBelgium
| | - Olafur A. Sveinsson
- Faculty of Medicine, School of Health SciencesUniversity of IcelandReykjavikIceland
| | - Luca Pani
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
- Department of Psychiatry and Behavioral SciencesUniversity of MiamiMiamiFL
| | - Michele Zoli
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Josep A. Ramos‐Quiroga
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and AddictionUniversitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
- Department of PsychiatryVall d'Hebron University HospitalBarcelonaSpain
- Biomedical Network Research Centre on Mental Health (CIBERSAM)Instituto de Salud Carlos IIIMadridSpain
- Department of Psychiatry and Forensic MedicineUniversitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
| | - Efthimios Dardiotis
- Department of Neurology, Faculty of MedicineUniversity of ThessalyVolosGreece
| | - Anna Steinberg
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Department of NeurologyKarolinska University HospitalStockholmSweden
| | - Steffi Riedel‐Heller
- Institute of Social Medicine, Occupational Health and Public HealthUniversity of LeipzigLeipzigGermany
| | - Christina Sjöstrand
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Department of NeurologyDanderyd HospitalStockholmSweden
| | | | | | - Laura Southgate
- Molecular and Clinical Sciences Research InstituteSt. George's, University of LondonLondonUK
- Department of Medical & Molecular Genetics, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - Richard C. Trembath
- Department of Medical & Molecular Genetics, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - Jana Vandrovcova
- Department of Neuromuscular Diseases, Institute of NeurologyUniversity College LondonLondonUK
| | - Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and GeriatricsLeiden University Medical CenterLeidenThe Netherlands
| | - Koen Paemeleire
- Department of NeurologyGhent University HospitalGhentBelgium
| | - Kari Stefansson
- deCODE genetics/Amgen Inc.ReykjavikIceland
- Faculty of Medicine, School of Health SciencesUniversity of IcelandReykjavikIceland
| | | | - Elisabet Waldenlind
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Department of NeurologyKarolinska University HospitalStockholmSweden
| | - Erling Tronvik
- Norwegian Centre for Headache Research (NorHEAD), Department of Neuromedicine and Movement ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Department of Neurology and Clinical NeurophysiologySt. Olavs Hospital, Trondheim University HospitalTrondheimNorway
| | - Rigmor H. Jensen
- Department of Neurology, Danish Headache Center, Rigshospitalet‐GlostrupUniversity of Copenhagen University HospitalGlostrupDenmark
| | - Shih‐Pin Chen
- Brain Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Medical Research, Division of Translational ResearchTaipei Veterans General HospitalTaipeiTaiwan
| | - Henry Houlden
- Department of Neuromuscular Diseases, Institute of NeurologyUniversity College LondonLondonUK
| | - Gisela M. Terwindt
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Christian Kubisch
- Institute of Human GeneticsUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Elena Maestrini
- Department of Pharmacy and BiotechnologyUniversity of BolognaBolognaItaly
| | | | - Patricia Pozo‐Rosich
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de MedicinaUniversitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
- Headache Unit, Neurology DepartmentVall d'Hebron University HospitalBarcelonaSpain
| | - Andrea C. Belin
- Centre for Cluster Headache, Department of NeuroscienceKarolinska InstitutetStockholmSweden
| | - Manjit Matharu
- Headache and Facial Pain GroupUniversity College London Queen Square Institute of Neurology and National Hospital for Neurology and NeurosurgeryLondonUK
| | - Arn M.J.M. van den Maagdenberg
- Department of Human GeneticsLeiden University Medical CenterLeidenThe Netherlands
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Thomas F. Hansen
- Department of Neurology, Danish Headache Center, Rigshospitalet‐GlostrupUniversity of Copenhagen University HospitalGlostrupDenmark
- Novo Nordic Foundation Center for Protein ResearchUniversity of CopenhagenCopenhagenDenmark
| | - Alfredo Ramirez
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
- Department of Neurodegenerative Diseases and Geriatric PsychiatryUniversity Hospital BonnBonnGermany
- German Center for Neurodegenerative Diseases (DZNE Bonn)BonnGermany
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative DiseasesUniversity of Texas Health Sciences CenterSan AntonioTX
- Cluster of Excellence Cellular Stress Responses in Aging‐associated Diseases (CECAD)University of CologneCologneGermany
| | - John‐Anker Zwart
- Department of Research and Innovation, Division of Clinical NeuroscienceOslo University HospitalOsloNorway
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Norwegian Centre for Headache Research (NorHEAD), Department of Neuromedicine and Movement ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
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7
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González R, Aymerich FX, Alberich M, Caronna E, Gallardo VJ, Pozo-Rosich P, Rovira À, Pareto D. Estimation of the density of veins from susceptibility-weighted imaging by using Mamdani fuzzy-type rule-based system. Investigating the neurovascular coupling in migraine. Neuroimage Clin 2023; 39:103489. [PMID: 37611372 PMCID: PMC10466899 DOI: 10.1016/j.nicl.2023.103489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/25/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND AND PURPOSE An impaired neurovascular coupling has been described as a possible player in neurodegeneration and cognitive decline. Migraine is a recurrent and incapacitating disorder that starts early in life and has shown neurovascular coupling abnormalities. Despite its high prevalence, the physiology and underlying mechanisms are poorly understood. In this context, new biomarkers from magnetic resonance imaging (MRI) are needed to bring new knowledge into the field. The aim of this study was to determine the vein density from Susceptibility-Weighted Imaging (SWI) MRI, in subjects with migraine and healthy controls; and to assess whether it relates to Resting-State functional MRI (RS-fMRI). MATERIALS AND METHODS The cohort included 30 healthy controls and 70 subjects with migraine (26 episodic, 44 chronic) who underwent a brain 3.0 T MRI. Clinical characteristics were also collected. Maps of density of veins were generated based on a Mamdani Fuzzy-Type Rule-Based System from the SWI MRI. Mean values of vein density were obtained in grey (GM) and white matter (WM) Freesurfer lobar parcellations. The Amplitude of Low-Frequency Fluctuations (ALFF) image was calculated for the RS-fMRI, and the mean values over the parcellated GM lobes were estimated. Differences between groups were assessed through and analysis of variance (age, sex, education and anxiety as covariates; p < 0.05), followed by post-hoc comparisons. Associations were run between clinical and MRI-derived variables. RESULTS When comparing the density of veins in GM, no differences between groups were found, neither associations with clinical variables. The density of veins was significantly higher in the WM of the occipital lobe for subjects with chronic migraine compared to controls (30%, p < 0.05). WM vein density in either frontal, temporal or cingulate regions was associated with clinical variables such as headache days, disability scores, and cognitive impairment (r between 0.25 and 0.41; p < 0.05). Mean values of ALFF did not differ significantly between controls and subjects with migraine. Strong significant associations between vein density and ALFF measures were obtained in most GM lobes for healthy subjects (r between 0.50 and 0.67; p < 0.05), instead, vein density in WM was significantly associated with ALFF for subjects with migraine (r between 0.32 and 0.58; p < 0.05). CONCLUSIONS Results point towards an increase in vein density in subjects with migraine, when compared to healthy controls. In addition, the association between GM vein density and ALFF found in healthy subjects was lost in migraine. Taken together, these results support the idea of abnormalities in the neurovascular coupling in migraine. Quantitative SWI MRI indicators in migraine might be an interesting target that may contribute to its comprehension.
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Affiliation(s)
- R González
- Neuroradiology Group, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F X Aymerich
- Neuroradiology Group, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Radiology Department (IDI), Vall Hebron University Hospital, Barcelona, Spain; Automatic Control Department (ESAII), Univesitat Politècnica de Catalunya Barcelona Tech, Barcelona, Spain
| | - M Alberich
- Neuroradiology Group, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Radiology Department (IDI), Vall Hebron University Hospital, Barcelona, Spain
| | - E Caronna
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V J Gallardo
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Pozo-Rosich
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - À Rovira
- Neuroradiology Group, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Radiology Department (IDI), Vall Hebron University Hospital, Barcelona, Spain
| | - D Pareto
- Neuroradiology Group, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Radiology Department (IDI), Vall Hebron University Hospital, Barcelona, Spain.
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8
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Marti-Marca A, Vilà-Balló A, Cerda-Company X, Ikumi N, Torres-Ferrus M, Caronna E, Gallardo VJ, Alpuente A, Torralba Cuello M, Soto-Faraco S, Pozo-Rosich P. Exploring sensory sensitivity, cortical excitability, and habituation in episodic migraine, as a function of age and disease severity, using the pattern-reversal task. J Headache Pain 2023; 24:104. [PMID: 37545005 PMCID: PMC10405481 DOI: 10.1186/s10194-023-01618-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/20/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Migraine is a cyclic, neurosensory disorder characterized by recurrent headaches and altered sensory processing. The latter is manifested in hypersensitivity to visual stimuli, measured with questionnaires and sensory thresholds, as well as in abnormal cortical excitability and a lack of habituation, assessed with visual evoked potentials elicited by pattern-reversal stimulation. Here, the goal was to determine whether factors such as age and/or disease severity may exert a modulatory influence on sensory sensitivity, cortical excitability, and habituation. METHODS Two similar experiments were carried out, the first comparing 24 young, episodic migraine patients and 28 healthy age- and gender-matched controls and the second 36 middle-aged, episodic migraine patients and 30 healthy age- and gender-matched controls. A neurologist confirmed the diagnoses. Migraine phases were obtained using eDiaries. Sensory sensitivity was assessed with the Sensory Perception Quotient and group comparisons were carried out. We obtained pattern-reversal visual evoked potentials and calculated the N1-P1 Peak-to-Peak amplitude. Two linear mixed-effects models were fitted to these data. The first model had Block (first block, last block) and Group (patients, controls) as fixed factors, whereas the second model had Trial (all trials) and Group as fixed factors. Participant was included as a random factor in both. N1-P1 first block amplitude was used to assess cortical excitability and habituation was defined as a decrease of N1-P1 amplitude across Blocks/Trials. Both experiments were performed interictally. RESULTS The final samples consisted of 18 patients with episodic migraine and 27 headache-free controls (first experiment) and 19 patients and 29 controls (second experiment). In both experiments, patients reported increased visual hypersensitivity on the Sensory Perception Quotient as compared to controls. Regarding N1-P1 peak-to-peak data, there was no main effect of Group, indicating no differences in cortical excitability between groups. Finally, significant main effects of both Block and Trial were found indicating habituation in both groups, regardless of age and headache frequency. CONCLUSIONS The results of this study yielded evidence for significant hypersensitivity in patients but no significant differences in either habituation or cortical excitability, as compared to headache-free controls. Although the alterations in patients may be less pronounced than originally anticipated they demonstrate the need for the definition and standardization of optimal methodological parameters.
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Affiliation(s)
- Angela Marti-Marca
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Adrià Vilà-Balló
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Xim Cerda-Company
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Nara Ikumi
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
- Headache Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Edoardo Caronna
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Alicia Alpuente
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
- Headache Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mireia Torralba Cuello
- Multisensory Research Group, Center for Brain and Cognition, Pompeu Fabra University, 08005, Barcelona, Spain
| | - Salvador Soto-Faraco
- Multisensory Research Group, Center for Brain and Cognition, Pompeu Fabra University, 08005, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), 08010, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research (VHIR), Department of Medicine, Universitat Autonoma Barcelona, Barcelona, Spain.
- Headache Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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9
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Torres-Ferrús M, Gallardo VJ, Alpuente A, Caronna E, Giné-Ciprés E, Pozo-Rosich P. Patterns of response to anti-CGRP monoclonal antibodies during first 6-months of treatment in resistant migraine patients: impact on outcome. Eur J Neurol 2023. [PMID: 37038303 DOI: 10.1111/ene.15816] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND The response pattern to monoclonal antibodies against calcitonin gene-related peptide (anti-CGRP MAbs) shown in migraine prevention clinical trials is not always reproducible at an individual-level. OBJECTIVE To describe patterns of start and consistency of the response to anti-CGRP MAbs during first six months of treatment and the association to baseline clinical characteristics METHODS: This is a prospective clinical cohort observational study. We included migraine patients treated with erenumab or galcanezumab evaluated at baseline and after three and six months (M3-M6) of treatment. The response was categorized according to reduction in monthly headache days (MHD): Sustained-response (SustainedR, ≥50% at M3 and M6); Short-Response (ShortR, M3≥50% and M6<50%), Later-Response (LaterR, M3<50% and M6≥50%); Limited-Response (LimitedR, 25-50% at M3 and M6) and No-Response (NoR, <25% at M3 and M6). Response patterns were compared at baseline and with outcome variables at M3 and M6. RESULTS We included 357 patients with a headache frequency of 21.0(16.0, 28.0) MHD and 84.0% (300/357) were chronic migraine. The distribution according to response pattern was: 37.0% (110/297) Sustained-Response, 16.8% (50/297) Later-Response, 10.4% (31/297) Short-Response, 22.6% (67/297) Limited-Response and 13.1% showed No-Response (39/297). Sustained-R and Later-R groups showed statistically significant anxiety and depression score reduction at M3 and M6 compared to other groups. CONCLUSION Initial response to anti-CGRP MAbs is not consistent in all patients. Persistence of anxiety and depression might be associated with lower response rates at month 6.
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Affiliation(s)
- Marta Torres-Ferrús
- 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
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alicia Alpuente
- 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
| | - Edoardo Caronna
- 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
| | - Eulalia Giné-Ciprés
- 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
| | - Patricia 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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10
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Alpuente A, Gallardo VJ, Asskour L, Caronna E, Torres‐Ferrus M, Pozo‐Rosich P. Salivary
CGRP
and Erenumab Treatment Response: Towards Precision Medicine in Migraine. Ann Neurol 2022; 92:846-859. [DOI: 10.1002/ana.26472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Alicia Alpuente
- Headache Clinic, Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Laila Asskour
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Edoardo Caronna
- Headache Clinic, Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Marta Torres‐Ferrus
- Headache Clinic, Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Patricia Pozo‐Rosich
- Headache Clinic, Neurology Department Vall d'Hebron University Hospital 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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11
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Gallardo VJ, Alpuente A, Pozo-Rosich P. Association of a Cyclical Migraine Phenotype With Disease Progression: A One-Year Time Series Analysis. Neurology 2022; 99:e1326-e1334. [PMID: 35953289 DOI: 10.1212/wnl.0000000000200887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/11/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Longitudinal studies assessing cyclic fluctuations of migraine attacks using time-series analysis are scarce. Here we analyze headache frequency fluctuations over a year in a cohort of migraine patients and we then evaluate how this behaviour has an impact on clinical evolution. METHODS Monthly headache frequency was prospectively collected using an eDiary. Prognosis after one year was calculated as the headache frequency change rate after 12 months (HCR-M12) as a dependent variable. Monthly headache time series was decomposed into all the possible sum of sinusoids through a Fast Fourier Transform algorithm (FFT) and the frequencies with the highest power were used to define the patient's cyclic phenotype during one year (patient's number of cycles per year, c/y). Patients with a cyclic phenotype were those with >2 cycles/year. Finally, we studied how this cyclic phenotype was associated to HCR-M12 using Generalized Linear Models (GLM). RESULTS 142 patients were included (85.2% female; mean age 48.0±9.7 years), 50.0% fulfilled IHCD-3 criteria for chronic migraine (CM). After one year, a 50.7% (72/142) of patients changed their initial diagnosis and progression (frequency worsening) was observed in 14.1% (10/71) of episodic migraine (EM) patients. After applying a FFT, 45.1% (64/142) of patients fitted into a cyclic phenotype. In GLM, statistically significant main effects associated to HCR-M12 were the use of preventive therapy (Beta [SE]: 74.1 [34.6]; p=0.034) and cyclic phenotype (Beta [SE]: 158.33 [55.1]; p=0.005). A post-hoc analysis found that EM patients with cyclic phenotype without adequate preventive therapy were statistically significantly associated to progression. CONCLUSIONS Monthly headache frequency data can be fitted by sinusoidal models. Having a cyclic phenotype has an impact on clinical evolution and has been statistically significantly associated to migraine progression after one year. Particularly, EM patients with cyclic phenotype tend to increase their headache frequency over time. Preventive treatment seems to play a fundamental role in modulating this cyclic behaviour, especially in low-frequency EM patients.
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Affiliation(s)
- Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alicia Alpuente
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Headache Clinic, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; .,Headache Clinic, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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12
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Garcia-Azorin D, Layos-Romero A, Porta-Etessam J, Membrilla JA, Caronna E, Gonzalez-Martinez A, Mencia ÁS, Segura T, Gonzalez-García N, Díaz-de-Terán J, Gallardo VJ, Gago-Veiga AB, Ballvé A, Trigo López J, Sastre-Real M, Llauradó A, Cornejo A, de Lorenzo Í, Guerrero-Peral Á, Pozo-Rosich P. Post-COVID-19 persistent headache: A multicentric 9-months follow-up study of 905 patients. Cephalalgia 2022; 42:804-809. [PMID: 35166156 DOI: 10.1177/03331024211068074] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Headache is a frequent symptoms of coronavirus disease 2019 (COVID-19). Its long-term evolution remains unknown. We aim to evaluate the long-term duration of headache in patients that presented headache during the acute phase of COVID-19. METHODS This is a post-hoc multicenter ambisective study including patients from six different third-level hospitals between 1 March and 27 April 2020. Patients completed 9 months of neurological follow-up. RESULTS We included 905 patients. Their median age was 51 (IQR 45-65), 66.5% were female, and 52.7% had a prior history of primary headache. The median duration of headache was 14 (6-39) days; however, the headache persisted after 3 months in 19.0% (95% CI: 16.5-21.8%) and after 9 months in 16.0% (95% confidence interval: 13.7-18.7%). Headache intensity during the acute phase was associated with a more prolonged duration of headache (Hazard ratio 0.655; 95% confidence interval: 0.582-0.737). CONCLUSION The median duration of headache was 2 weeks, but in approximately a fifth of patients it became persistent and followed a chronic daily pattern.
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Affiliation(s)
- David Garcia-Azorin
- Hospital Clinico Universitario de Valladolid, Headache Unit, 16238Hospital Clinico Universitario de Valladolid, Department of Neurology, Valladolid, Spain
| | | | - Jesús Porta-Etessam
- Headache Unit, Department of Neurology, Hospital San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Javier A Membrilla
- Neurology Department, University Hospital "La Paz", Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain, Madrid, Spain
| | - Edoardo Caronna
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache Research Group, Vall d'Hebron Research Institute, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Álvaro Sierra Mencia
- Hospital Clinico Universitario de Valladolid, Headache Unit, 16238Hospital Clinico Universitario de Valladolid, Department of Neurology, Valladolid, Spain
| | - Tomás Segura
- Department of Neurology, Hospital General de Albacete, Albacete, Spain
| | - Nuria Gonzalez-García
- Headache Unit, Department of Neurology, Hospital San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Díaz-de-Terán
- Neurology Department, University Hospital "La Paz", Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain, Madrid, Spain
| | - Victor J Gallardo
- Headache Research Group, Vall d'Hebron Research Institute, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Alejandro Ballvé
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Javier Trigo López
- Hospital Clinico Universitario de Valladolid, Headache Unit, 16238Hospital Clinico Universitario de Valladolid, Department of Neurology, Valladolid, Spain
| | - María Sastre-Real
- Neurology Department, University Hospital "La Paz", Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain, Madrid, Spain
| | - Arnau Llauradó
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ana Cornejo
- Valladolid East Primary Care Basic Health Area, Valladolid, Spain
| | - Íñigo de Lorenzo
- Neurology Department, University Hospital "La Paz", Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain, Madrid, Spain
| | - Ángel Guerrero-Peral
- Hospital Clinico Universitario de Valladolid, Headache Unit, 16238Hospital Clinico Universitario de Valladolid, Department of Neurology, Valladolid, Spain.,Department of Medicine, University of Valladolid, Valladolid, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache Research Group, Vall d'Hebron Research Institute, Universitat Autónoma de Barcelona, Barcelona, Spain
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13
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Alpuente A, Gallardo VJ, Caronna E, Torres-Ferrus M, Pozo-Rosich P. In search of a gold standard patient-reported outcome measure to use in the evaluation and treatment-decision making in migraine prevention. A real-world evidence study. J Headache Pain 2021; 22:151. [PMID: 34903177 PMCID: PMC8903583 DOI: 10.1186/s10194-021-01366-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/29/2021] [Indexed: 11/12/2022] Open
Abstract
Background Patient-Reported Outcomes (PROs) have been developed to numerically quantify disability, impact and quality of life. They have been widely used in migraine clinical trials. However, we still do not know which PRO more accurately reflects preventive treatment response from a patient’s perspective or which one may help us with treatment decisions in clinical practice. They have been used to enforce the efficacy results in clinical trials and real-world evidence so far. The aim of this study was to analyze which PROM is (1) better correlated with all primary efficacy endpoints and (2) which one is better associated with treatment continuation with CGRP-mAbs at week-12, which is usually the moment when this decision is made. Methods Patients with migraine who had received 3 administrations of CGRP-mAbs were evaluated in this prospective cohort study. Primary efficacy outcomes considered: a change in migraine days (MMD), headache days (MHD), pain intensity (INT), acute medication days (AMD) and 50% responder rate. The Spearman coefficient (rs) was the measure used for quantify the strength of the correlation between PROMs and treatment efficacy outcomes changes. A stepwise logistic regression identified which PROM was independently associated with treatment continuation at week-12. Results 263 patients completed 12 weeks of treatment. The efficacy outcomes and PROMs scores were statistically significantly reduced at week-12 for all patients. The role function-restrictive (RFR) domain of the Migraine-Specific Quality of Life (MSQ) questionnaire was statistically significantly correlated with all primary efficacy outcomes. Relative changes in MSQ total score (OR[95%]: 0.840[0.619-0.973]; p=0.037) and Patient Global Impression of Change (PGIC) scale (OR[95%]: 15.569[6.254-31.533]; p<0.001) were the PROMs associated with treatment continuation as independent factors at week-12. Conclusions Changes in MSQ questionnaire and PGIC scale at week-12 were the PROMs with higher association with CGRP-mAbs response from a patient’s perspective and medical decision-taking. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01366-9.
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Affiliation(s)
- Alicia Alpuente
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Caronna
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain. .,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, 119-129 Passeig de la Vall d'Hebron, 08035, Barcelona, Spain.
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14
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Gallardo VJ, Alpuente A, Cerda-Company X, Torres-Ferrus M, Sanchez Del Rio M, Lainez JM, Leira R, Trochet J, Pozo-Rosich P. The impact of a digital platform on migraine patient-centered outcome research. Evaluation of midolordecabeza.org, a headache website in Spanish. Headache 2021; 61:1403-1410. [PMID: 34601726 DOI: 10.1111/head.14225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/30/2021] [Accepted: 07/19/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This internet survey aimed to analyze the activity of midolordecabeza.org, a specialized website for headache stakeholders. BACKGROUND eHealth tools, such as websites, can be educational for stakeholders of a specific disease, such as patients. This is particularly helpful in chronic disorders such as migraine. eHealth also enhances patient-centered outcome research. The website midolordecabeza.org has the stated aim of organizing key information on headache making it accessible and useful for all stakeholders, and, eventually promoting patient participation. METHODS We analyzed Google Analytics (GA) data to study the web's activity, traffic source, geographical distribution of access, registered-user behavior, electronic device performance, and temporary references with greater web activity. RESULTS From January 2015 until December 2020, the website registered 1,121,585 visitors, 1,775,953 sessions, and a total of 3,833,144 views with an average time per session of nearly 2 min. Higher data traffic has been registered in Spanish-speaking countries such as Spain (33.3%; 591,256/1,775,953), where Spain's regions with higher views were statistically significantly correlated with the nationwide migraine prevalence (ρ = 0.505; p = 0.039). In regard to social behavior, returning users were statistically significantly associated with being a woman (84.0%; 5696/6781), and they predominantly acceded from organic searches (50.6%; 3434/6781). When answering available open surveys, 72.5% (1827/2520) described their migraine as a disabling disease with high impact on their daily tasks and 64.4% (14,016/21,764) were unaware of what their headache diagnosis is. CONCLUSIONS Spanish-speaking patients with migraine around the world increasingly visited the headache-specialized website midolordecabeza.org using different electronic devices, showing great interest in their disease. This website allowed them to get updated information on their disease, share clinical data with physicians, and finally express their concerns.
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Affiliation(s)
- Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alicia Alpuente
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Headache Unit, Neurology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Xim Cerda-Company
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Headache Unit, Neurology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - José Miguel Lainez
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valencia, Spain
| | - Rogelio Leira
- Headache Unit, Neurology Department, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Patricia Pozo-Rosich
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Headache Unit, Neurology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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15
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Alpuente A, Gallardo VJ, Asskour L, Caronna E, Torres-Ferrus M, Pozo-Rosich P. Salivary CGRP can monitor the different migraine phases: CGRP (in)dependent attacks. Cephalalgia 2021; 42:186-196. [PMID: 34601944 DOI: 10.1177/03331024211040467] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND CGRP plays a key role in the transmission and modulation of nociceptive signals and is a critical component in the pathogenesis of migraine. OBJECTIVE To assess saliva as a substrate to measure CGRP by comparing interictal levels in patients with episodic migraine and controls; and to evaluate CGRP's temporal profile during migraine attacks. METHODS This prospective observational pilot study included young women with episodic migraine and healthy controls. We monitored salivary CGRP-like immunoreactivity (CGRP-LI) during 30 consecutive days and during migraine attacks. We considered six timepoints for the analysis: interictal (72h headache free), preictal (PRE-24h before the attack), ictal (headache onset, after 2h, after 8h), postictal (POST-24h after the attack). CGRP levels were quantified by ELISA. RESULTS 44 women (22 with episodic migraine, 22 healthy controls) were recruited. Differences in interictal salivary levels of CGRP between patients and controls (Me [IQR]: 98.0 [80.3] (95% CI 56.6, 124.0) vs. 54.3 [44.0] (95% CI 42.2, 70.1) pg/mL, p = 0.034) were found. An increase in CGRP levels during migraine attacks was detected (pre:169.0 [95% CI 104.2-234.0]; headache onset: 247.0 [181.9-312.0]; after 2h: 143.0 [77.6-208.0]; after 8h: 169.0 [103.5-234.0], post: 173.0 [107.8-238.0]). Patients were classified as having CGRP-dependent (79.6%) and non-CGRP dependent migraine attacks (20.4%) according to the magnitude of change between preictal and ictal phase. Accompanying symptoms such as photophobia and phonophobia were significantly associated to the first group. CONCLUSIONS Salivary CGRP-LI levels, which interictally are elevated in episodic migraine patients, usually increase during a migraine attack in the majority of patients. However, not every attack is CGRP-dependent, which in turn, might explain different underlying pathophysiology and response to treatment.
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Affiliation(s)
- Alicia Alpuente
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laila Asskour
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Caronna
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, 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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16
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Torres-Ferrus M, Pareto D, Gallardo VJ, Cuberas-Borrós G, Alpuente A, Caronna E, Vila-Balló A, Lorenzo-Bosquet C, Castell-Conesa J, Rovira A, Pozo-Rosich P. Cortical metabolic and structural differences in patients with chronic migraine. An exploratory 18FDG-PET and MRI study. J Headache Pain 2021; 22:75. [PMID: 34273945 PMCID: PMC8285838 DOI: 10.1186/s10194-021-01289-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022] Open
Abstract
Background To describe interictal brain structural and metabolic differences between patients with episodic migraine (EM), chronic migraine (CM) and healthy controls (HC). Methods This is an exploratory study including right-handed age-matched women with EM, CM and HC. On the same day, a sequential interictal scan was performed with 18FDG-PET and MRI. 3D T1-weighted images were segmented with FreeSurfer, normalized to a reference atlas and the mean values of metabolism, cortical thickness (CTh) and local gyrification index (IGI) were determined. Groups were compared using age-adjusted linear models, corrected for multiple comparisons. 18FDG-PET measurements between groups were also analysed adjusting by patient’s age, CTh and lGI. The variables independently associated with diagnosis were obtained using a logistic regression analysis. Results Fifteen patients (8 EM, 7 CM) and 11 HC were included. Morphometric data showed an increased CTh in 6 frontal areas (L/R-Caudal Middle Frontal, L/R-Rostral Middle Frontal, L-Medial Orbitofrontal and L-Superior Frontal) in CM patients compared to HC without differences for IGI. The structural adjusted analysis in CM showed a statistically significantly hypometabolism in 9 frontal areas (L-Lateral Orbitofrontal, L/R-Medial Orbitofrontal, L-Frontal Superior, R-Frontal pole, R-Parts Triangularis, L/R-Paracentral and R-Precentral) and 7 temporal areas (L/R-Insula, L/R-Inferior temporal, L/R-Temporal pole and R-Banks superior temporal sulcus) compared to HC. EM patients presented intermediate metabolic values between EM and HC (non-significant). Conclusions CM patients showed frontotemporal hypometabolism and increased frontal cortical thickness when compared to HC that may explain some cognitive and behavioural pain-processing and sensory integration alterations in CM patients. Combined information from sequential or simultaneous PET and MRI could optimize the study of complex functional neurological disorders such as migraine. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01289-5.
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Affiliation(s)
- Marta Torres-Ferrus
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital and Research Institute (VHIR), Barcelona, Spain
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gemma Cuberas-Borrós
- Research and Innovation Unit , Althaia Xarxa Assistencial Universitària de Manresa , Manresa, Spain.,Nuclear Medicine Department , Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alicia Alpuente
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Caronna
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Adrià Vila-Balló
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Joan Castell-Conesa
- Nuclear Medicine Department , Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital and Research Institute (VHIR), Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain. .,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Alpuente A, Gallardo VJ, Caronna E, Torres-Ferrús M, Pozo-Rosich P. Partial and nonresponders to onabotulinumtoxinA can benefit from anti-CGRP monoclonal antibodies preventive treatment: A real-world evidence study. Eur J Neurol 2021; 28:2378-2382. [PMID: 33730441 DOI: 10.1111/ene.14828] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Monoclonal antibodies targeting CGRP or its receptor, anti-CGRP mAbs, are proven to be effective treatments in migraine prevention. Real-world evidence studies assessing their efficacy are scarce. METHODS Our objective was to assess the efficacy of anti-CGRP mAbs in our clinical cohort resistant to onabotulinumtoxinA. We prospectively analyzed ≥50% response rate in patients who initiated treatment with anti-CGRP mAbs and who were partial or nonresponders to onabotulinumtoxinA. RESULTS One hundred fifty-five patients completed treatment with anti-CGRP mAbs at 3 months of follow-up. No statistically significant differences were found in ≥50% response in headache frequency in patients with prior onabotulinumtoxinA treatment partial or complete failure. Regarding dual therapy with onabotulinumtoxinA and anti-CGRP mAbs, no statistically significant differences were found in ≥50% response in headache frequency between monotherapy or dual therapy. CONCLUSIONS Patients with prior treatment failure or partial efficacy to onabotulinumtoxinA respond to anti-CGRP mAbs. After 3 months, in our cohort, dual therapy does not seem to add more benefit than anti-CGRP mAbs in monotherapy.
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Affiliation(s)
- Alicia Alpuente
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Department of Medicine, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Department of Medicine, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Caronna
- Headache and Neurological Pain Research Group, Department of Medicine, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrús
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Department of Medicine, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Department of Medicine, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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19
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Torres-Ferrús M, Gallardo VJ, Alpuente A, Caronna E, Gine-Cipres E, Pozo-Rosich P. The impact of anti-CGRP monoclonal antibodies in resistant migraine patients: a real-world evidence observational study. J Neurol 2021; 268:3789-3798. [PMID: 33772636 DOI: 10.1007/s00415-021-10523-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the frequency and headache-related impact response to monoclonal antibodies against calcitonin gene-related peptide (CGRP) in a clinical sample of refractory migraine patients. METHODS We included migraine patients with ≥ 8 headache days/month that had failed at least three preventive medications. Demographic, medical and migraine history were collected. Patients completed an electronic headache diary including headache days/month, migraine days/month, headache pain intensity (0-3 numerical scale), use of analgesics and completed Patient-Reported Outcome questionnaires at baseline and after 12 weeks. Patients were classified into ≥ 50%, ≥ 75% and 100% responders according to the improvement in frequency. RESULTS We included 155 patients (109 erenumab and 46 galcanezumab). After 12 weeks, headache frequency decreased - 9.1 headache days/month and - 8.5 migraine days/month from baseline. A 39.5% had a ≥ 50% headache days/month reduction and a 51.6% ≥ 50% migraine days/month reduction. In the ≥ 50% migraine days/month-responders group, frequency reduction was - 13,9 migraine days/month from baseline and showed clear improvements for all patient-reported outcomes. A 14.2% and 26.5% had a ≥ 75% response in headache and migraine days/month, respectively, and 11.0% showed a 100% migraine days/month reduction. Patients who were not on other preventive medications had less severe disability and higher ratio of migraine over headache days/month were more likely of being a ≥ 50% migraine days/month-responder. We did not record any severe adverse events, being the most common constipation (20.0%), fatigue (7.1%) and a transient increase in blood pressure (5.2%). CONCLUSIONS In real-world clinical practice, monoclonal antibodies against CGRP proved to be effective treatments in resistant migraine patients.
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Affiliation(s)
- Marta Torres-Ferrús
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, 119-129 Passeig de la Vall d'Hebron, 08035, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alicia Alpuente
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, 119-129 Passeig de la Vall d'Hebron, 08035, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Caronna
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eulalia Gine-Cipres
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, 119-129 Passeig de la Vall d'Hebron, 08035, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, 119-129 Passeig de la Vall d'Hebron, 08035, 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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20
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Torres-Ferrus M, López-Veloso AC, Gonzalez-Quintanilla V, González-García N, Díaz de Teran J, Gago-Veiga A, Camiña J, Ruiz M, Mas-Sala N, Bohórquez S, Gallardo VJ, Pozo-Rosich P. The MIGREX study: Prevalence and risk factors of sexual dysfunction among migraine patients. Neurologia 2021; 38:S0213-4853(21)00036-0. [PMID: 33766414 DOI: 10.1016/j.nrl.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/04/2021] [Accepted: 02/07/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Migraine attacks have a high impact on daily activities. There is limited research on the burden of migraine on sexual functioning. OBJECTIVE To determine the prevalence of sexual dysfunction in patients with migraine and its relationship with migraine features and comorbidities. METHOD This is a cross-sectional study. We included migraine patients between 18 and 60 years-old from 8 Headache Clinics in Spain. We recorded demographic data and migraine features. Patients fulfilled a survey including comorbidities, Arizona Sexual Experiences Scale, Hospital Anxiety and Depression Scale and a questionnaire about migraine impact on sexual activity. A K-nearest neighbor supervised learning algorithm was used to identify differences between migraine patients with and without sexual dysfunction. RESULTS We included 306 patients (85.6% women, mean age 42.3±11.1 years). A 41.8% of participants had sexual dysfunction. Sexual dysfunction was associated with being female (OR [95% CI]: 2.42 [1.17-5.00]; p<0.001), being older than 46.5 years (4.04 [2.48-6.59]; p<0.001), having chronic migraine (2.31 [1.41-3.77]; p=0.001), using preventive medication (2.45 [1.35-4.45]; p=0.004), analgesic overusing (3.51 [2.03-6.07]; p<0.001), menopause (4.18 [2.43-7.17]; p<0.001) and anxiety (2.90 [1.80-4.67]; p<0.001) and depression (6.14 [3.18-11.83]; p<0.001). However, only female gender, age, menopause and depression were the statistically significant variables selected in the model to classify migraine patients with or without sexual dysfunction (Accuracy [95% CI]: 0.75 (0.62-0.85), Kappa: 0.48, p=0.005). CONCLUSIONS Sexual dysfunction is frequent in migraine patients visited in a headache clinic. However, migraine characteristics or use of preventive medication are not directly associated with sexual dysfunction. Instead, risk factors for sexual dysfunction were female gender, higher age, menopause and depression.
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Affiliation(s)
- M Torres-Ferrus
- Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - A C López-Veloso
- Neurology Department, Gran Canaria Dr. Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | | | | | - J Díaz de Teran
- Neurology Department, La Paz University Hospital, Madrid, Spain
| | - A Gago-Veiga
- Neurology Department, La Princesa University Hospital, Madrid, Spain
| | - J Camiña
- Neurology Department, Rotger Clinic, Palma de Mallorca, Spain
| | - M Ruiz
- Neurology Department, San Juan Hospital, Alicante, Spain
| | - N Mas-Sala
- Neurology Department, Althaia Hospital, Red Asistencial Universitaria de Manresa, Spain
| | - S Bohórquez
- Neurology Department, Sabana University, Bogotá, Colombia
| | - V J Gallardo
- Neurology Department, Sabana University, Bogotá, Colombia
| | - P Pozo-Rosich
- Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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21
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Alpuente A, Gallardo VJ, Torres-Ferrús M, Santos-Lasaosa S, Guerrero AL, Laínez JM, Viguera J, Gago-Veiga A, Irimia P, Sánchez Del Rio M, Pozo-Rosich P. Evaluation of the concomitant use of oral preventive treatments and onabotulinumtoxinA in chronic migraine: the PREVENBOX study. Eur J Neurol 2020; 27:2102-2108. [PMID: 32421912 DOI: 10.1111/ene.14331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/07/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE OnabotulinumtoxinA is an effective preventive treatment for chronic migraine (CM). In CM, in addition to a reduction in headache frequency, a decreased reliance on oral prophylactics is also indicative of treatment effectiveness. This study aimed to quantify the change in the use of oral prophylactics after treatment with onabotulinumtoxinA in patients with CM. METHODS This was a retrospective, multicentric, cross-sectional study. Patients with CM (International Classification of Headache Disorders-3beta) that had been treated with onabotulinumtoxinA were enrolled consecutively. We collected parameters related to each patient's pre-treatment situation, as well as their current situation, focusing on frequency and intensity of migraine, number of oral prophylactics and the respective cycle of onabotulinumtoxinA. Univariate and logistic regression analyses were performed. RESULTS We included 542 patients, 90.0% of whom were taking oral preventive treatments. During treatment with onabotulinumtoxinA, 47.8% withdrew at least one prophylactic and 41.6% stopped using oral prophylactics altogether. Factors associated with a reduction or cessation of oral prophylactics were >50% improvement in frequency and intensity, remission to episodic migraine, use of topiramate as an initial treatment, increased number of infiltrations and shorter chronification period (P < 0.05). The multivariate analysis showed that a chronification period <20 months, more than five cycles of onabotulinumtoxinA, >50% improvement in pain intensity and topiramate as an initial treatment were predictors of a reduction in oral prophylactics (area under the curve, 70.3%; P < 0.001). CONCLUSIONS Our study demonstrated the efficacy and safety of onabotulinumtoxinA. This treatment reduced the use of oral prophylactics. Withdrawal of oral prophylactics was most likely to occur after five cycles of treatment.
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Affiliation(s)
- A Alpuente
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona.,Headache and Neurological Pain Research Group, Departament de Medicina, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona
| | - V J Gallardo
- Headache and Neurological Pain Research Group, Departament de Medicina, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona
| | - M Torres-Ferrús
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona.,Headache and Neurological Pain Research Group, Departament de Medicina, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona
| | - S Santos-Lasaosa
- Headache Unit, Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza
| | - A L Guerrero
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid
| | - J M Laínez
- Department of Neurology, Hospital Clínico Universitario, Universidad Católica de Valencia, Valencia
| | - J Viguera
- Headache Unit, Neuroscience Department, Hospital Universitario Virgen Macarena, Sevilla
| | - A Gago-Veiga
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa, Madrid
| | - P Irimia
- Neurology Department, Clínica Universidad de Navarra, Pamplona
| | | | - P Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona.,Headache and Neurological Pain Research Group, Departament de Medicina, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona
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