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Tassorelli C, Diener HC, Dodick DW, Silberstein SD, Lipton RB, Ashina M, Becker WJ, Ferrari MD, Goadsby PJ, Pozo-Rosich P, Wang SJ. Guidelines of the International Headache Society for controlled trials of preventive treatment of chronic migraine in adults. Cephalalgia 2018; 38:815-832. [DOI: 10.1177/0333102418758283] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Quality clinical trials form an essential part of the evidence base for the treatment of headache disorders. In 1991, the International Headache Society Clinical Trials Standing Committee developed and published the first edition of the Guidelines for Controlled Trials of Drugs in Migraine. In 2008, the Committee published the first specific guidelines on chronic migraine. Subsequent advances in drug, device, and biologicals development, as well as novel trial designs, have created a need for a revision of the chronic migraine guidelines. Objective The present update is intended to optimize the design of controlled trials of preventive treatment of chronic migraine in adults, and its recommendations do not apply to trials in children or adolescents.
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Affiliation(s)
- Cristina Tassorelli
- Headache Science Center, C. Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | | | | | - Richard B Lipton
- Montefiore Headache Center, Department of Neurology and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Werner J Becker
- Dept of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Peter J Goadsby
- National Institute for Health Research-Wellcome Trust King’s Clinical Research Facility, King’s College Hospital, London, England
| | - Patricia Pozo-Rosich
- Headache Research Group, VHIR, Universitat Autònoma de Barcelona, Barcelona Spain
- Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain
| | - Shuu-Jiun Wang
- Neurological Institute, Taipei Veterans General Hospital and Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Tassorelli C, Tedeschi G, Sarchielli P, Pini LA, Grazzi L, Geppetti P, De Tommaso M, Aguggia M, Cortelli P, Martelletti P. Optimizing the long-term management of chronic migraine with onabotulinumtoxinA in real life. Expert Rev Neurother 2017; 18:167-176. [PMID: 29280408 DOI: 10.1080/14737175.2018.1419867] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Management of chronic migraine is challenging. OnabotulinumtoxinA (OBT-A) is the only medication licensed for prevention of chronic migraine, and has been widely adopted in clinical practice. Limited data is available on its long-term use. Areas covered: Data from controlled trials are combined with available data on the long-term use of OBT-A in real-life studies, with information obtained in a recent survey among Italian headache centers, and the clinical experience of the authors. Six areas were identified as relevant to patients with chronic migraine: 1) definition of responders to OBT-A; 2) management of responders to OBT-A; 3) optimal timing of prophylaxis with OBT-A; 4) position of OBT-A in prevention of chronic migraine; 5) management of medication overuse, and 6) patient education. Expert commentary: This review provides an update on the latest evidence regarding the long-term use of OBT-A in chronic migraine and analyzes the critical issues in the decision-making process that emerge from the analysis of the literature and routine practice. A treatment algorithm is proposed for the adoption in the daily practice.
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Affiliation(s)
- Cristina Tassorelli
- a Headache Science Center , National Neurological Institute C. Mondino , Pavia , Italy.,b Department of Brain and Behavioral Sciences , University of Pavia , Pavia , Italy
| | - Gioacchino Tedeschi
- c Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - P Sarchielli
- d Neurology Clinic , University Hospital of Perugia , Perugia , Italy
| | - Luigi Alberto Pini
- e Center for Neuroscience and Neurotechnology, Polyclinic Hospital , University of Modena and Reggio Emilia , Modena , Italy
| | - Licia Grazzi
- f Headache and Neuroalgology Unit , Neurological Institute "C. Besta" IRCCS Foundation , Milan , Italy
| | - Pierangelo Geppetti
- g Headache Center, Department of Health Sciences , University of Florence , Florence , Italy
| | - Marina De Tommaso
- h Applied Neurophysiology and Pain Unit, SMBNOS Department, Polyclinic General Hospital , Bari Aldo Moro University , Bari , Italy
| | - Marco Aguggia
- i Headache Center, Neurology Department , Asti Hospital , Asti , Italy
| | - P Cortelli
- j Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy.,k IRCCS Institute of Neurological Sciences of Bologna , Bellaria Hospital , Bologna , Italy
| | - Paolo Martelletti
- l Department of Clinical and Molecular Medicine, Sapienza University of Rome and Regional Referral Headache Center , Sant'Andrea Hospital , Rome , Italy
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Chiang CC, Starling AJ. OnabotulinumtoxinA in the treatment of patients with chronic migraine: clinical evidence and experience. Ther Adv Neurol Disord 2017; 10:397-406. [PMID: 29204191 PMCID: PMC5703105 DOI: 10.1177/1756285617731521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 08/13/2017] [Indexed: 12/16/2022] Open
Abstract
Chronic migraine is a debilitating neurobiological disorder that affects approximately 1.4–2.2% of the population worldwide. Patients with chronic migraine have 15 or more headache days per month, with at least 8 days per month that meet the criteria for migraine. Injection of onabotulinumtoxinA, using a standardized injection protocol, was approved by the US Food and Drug Administration in 2010 for the treatment of chronic migraine. The approval was made based on results from two large, randomized, double-blind placebo-controlled trials: the Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials. Since then, numerous studies have been performed investigating the short-term and long-term benefits, risks and complications of the use of onabotulinumtoxinA injections for the treatment of chronic migraine. The purpose of this narrative review is to describe the currently available clinical evidence for the use of onabotulinumtoxinA injections for treating patients with chronic migraine.
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Affiliation(s)
| | - Amaal J Starling
- Department of Neurology, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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Tassorelli C, Aguggia M, De Tommaso M, Geppetti P, Grazzi L, Pini LA, Sarchielli P, Tedeschi G, Martelletti P, Cortelli P. Onabotulinumtoxin A for the management of chronic migraine in current clinical practice: results of a survey of sixty-three Italian headache centers. J Headache Pain 2017; 18:66. [PMID: 28667550 PMCID: PMC5493599 DOI: 10.1186/s10194-017-0773-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/17/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Chronic migraine is a complex clinical condition often undertreated. Onabotulinumtoxin A (OBT-A) was approved in Italy in 2013 for symptom relief in patients with chronic migraine who have failed, or do not tolerate, oral prophylactic treatments. However, the impact of OBT-A in clinical practice remains to be defined. METHODS To investigate the current management of chronic migraine with OBT-A in clinical practice, a web-based survey was conducted among clinicians working in third-level headache centers across Italy. A 26-item questionnaire was designed and developed by a group of 10 Italian headache specialists to address the following issues: treatment paradigm and OBT-A injection intervals, frequency of treatment and retreatment, definition of responders/non-responders, satisfaction with treatment potential impact of early treatment with OBT-A. Ninety-six headache centers were selected and contacted via e-mail. The online survey was anonymous and carried out using a secure website. RESULTS Overall, 64 of the 96 centers (66.7%) completed the questionnaire. Most centers (98.4%) had been using OBT-A for >1 year. OBT-A was administered according to the PREEMPT paradigm in most centers (88.9%). While during the first year of prophylaxis with OBT-A most clinicians (93.6%) repeated OBT-A treatment every 3 months, as recommended, in the following years interval duration was variable. Response to OBT-A was defined as a ≥ 50% reduction in the headache days by 58.7% of the clinicians, and as a ≥ 30% reduction by 25.4% of them. Almost 60% of the clinicians considered OBT-A as a long-lasting therapy, while for one-third of them treatment could be discontinued in patients showing a benefit for ≥6 months. According to 80% of the clinicians, early administration of OBT-A after the onset of chronic migraine was associated with better outcomes, and 47.6% felt that OBT-A should be recommended as a first-line option. CONCLUSIONS This survey indicates that in third-level headache centers in Italy OBT-A is used in good compliance with current recommendations. There is agreement about the definition of response as a reduction in headache days by 30% to 50%. Additional effort is required to define response to OBT-A and to establish optimal treatment duration.
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Affiliation(s)
- Cristina Tassorelli
- Headache Science Center, National Neurological Institute C. Mondino, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Via Mondino 2, 27100 Pavia, Italy
| | - Marco Aguggia
- Headache Center, Neurology Department, Asti Hospital, Asti, Italy
| | - Marina De Tommaso
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Polyclinic General Hospital, Bari Aldo Moro University, Bari, Italy
| | - Pierangelo Geppetti
- Headache Center, Department of Health Sciences, University of Florence, Florence, Italy
| | - Licia Grazzi
- Headache and Neuroalgology Unit, Neurological Institute “C. Besta” IRCCS Foundation, Milan, Italy
| | - Luigi Alberto Pini
- Center for Neuroscience and Neurotechnology, Polyclinic Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Sarchielli
- Neurology Clinic, University Hospital of Perugia, Perugia, Italy
| | - Gioacchino Tedeschi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome and Regional Referral Headache Center, Sant’Andrea Hospital, Rome, Italy
| | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
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Dahri M, Hashemilar M, Asghari-Jafarabadi M, Tarighat-Esfanjani A. Efficacy of coenzyme Q10 for the prevention of migraine in women: A randomized, double-blind, placebo-controlled study. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Evidence and experience with onabotulinumtoxinA in chronic migraine: Recommendations for daily clinical practice. Neurologia 2017; 34:408-417. [PMID: 29169810 DOI: 10.1016/j.nrl.2017.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/07/2017] [Indexed: 12/12/2022] Open
Abstract
OnabotulinumtoxinA has been demonstrated to be effective as a preventive treatment in patients with chronic migraine (CM). Five years after the approval of onabotulinumtoxinA in Spain, the Headache Study Group of the Spanish Society of Neurology considered it worthwhile to gather a group of experts in treating patients with CM in order to draw up, based on current evidence and our own experience, a series of guidelines aimed at facilitating the use of the drug in daily clinical practice. For this purpose, we posed 12 questions that we ask ourselves as doctors, and which we are also asked by our patients. Each author responded to one question, and the document was then reviewed by everyone. We hope that this review will constitute a practical tool to help neurologists treating patients with CM.
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Guerzoni S, Pellesi L, Baraldi C, Cainazzo MM, Negro A, Martelletti P, Pini LA. Long-term Treatment Benefits and Prolonged Efficacy of OnabotulinumtoxinA in Patients Affected by Chronic Migraine and Medication Overuse Headache over 3 Years of Therapy. Front Neurol 2017; 8:586. [PMID: 29163347 PMCID: PMC5676047 DOI: 10.3389/fneur.2017.00586] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/19/2017] [Indexed: 01/03/2023] Open
Abstract
Background Chronic migraine (CM) affects about the 2% of the general population and it has been recognized as one of the most-disabling conditions worldwide by the World Health Organization. CM is often associated with the overuse of abortive medication, which determines the worsening of headache itself and the development of a secondary headache called medication overuse headache. The management of these associated conditions is difficult, but a growing amount of evidence is pointing out the effectiveness and the good safety profile of OnabotulinumtoxinA (OnabotA). Despite this, data on OnabotA effects and safety in long-term use lack. The purpose of the present article is to retrospectively assess the efficacy and safety of OnabotA in a cohort of chronic migraineurs with drug overuse from the 18th month of treatment until the third year. Materials and methods 90 chronic migraineurs with medication overuse were enrolled between January 2013 and February 2017. All patients were treated with OnabotA according to PREEMPT dictates. Before every injection session the headache index, the analgesic consumption, the visual analog scale for pain score, the 36-items short form health survey questionnaire score, the 6-items headache impact test (HIT-6) score and the Zung self-rating anxiety and depression scale scores were collected. Adverse events were carefully registered. A simple linear regression was performed to explore the mean changes in the abovementioned parameters for a single injection session and mean comparison tests were performed using the one-way analysis of variance followed by Tukey–Kramer post-hoc test. Results A significantly improvement for a single injection was registered for all the above-mentioned parameters. Headache index, analgesic consumption, visual analog pain scale, and 6-items HIT-6 scores were significantly lower than baseline from the 18th month of treatment onwards. The 36-items short form health survey questionnaire scores were significantly higher than baseline at every injections session from the 18th months onwards. Zung scales did not change. No serious adverse events were assessed and no adverse events-related drop-outs were seen. Conclusion OnabotA effectiveness and safety last until 3 years of therapy, raising the possibility of the use of this therapy even for many years in CM prevention.
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Affiliation(s)
- Simona Guerzoni
- Headache and Drug Abuse Research Centre, Policlinico Hospital, Department of Diagnostic Medicine, Clinical and Public Health, University of Modena e Reggio Emilia, Modena, Italy
| | - Lanfranco Pellesi
- Headache and Drug Abuse Research Centre, Policlinico Hospital, Department of Diagnostic Medicine, Clinical and Public Health, University of Modena e Reggio Emilia, Modena, Italy
| | - Carlo Baraldi
- Headache and Drug Abuse Research Centre, Policlinico Hospital, Department of Diagnostic Medicine, Clinical and Public Health, University of Modena e Reggio Emilia, Modena, Italy
| | - Michela Maria Cainazzo
- Headache and Drug Abuse Research Centre, Policlinico Hospital, Department of Diagnostic Medicine, Clinical and Public Health, University of Modena e Reggio Emilia, Modena, Italy
| | - Andrea Negro
- Regional Referral Headache Centre, Sant'Andrea Hospital, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Paolo Martelletti
- Regional Referral Headache Centre, Sant'Andrea Hospital, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Luigi Alberto Pini
- Headache and Drug Abuse Research Centre, Policlinico Hospital, Department of Diagnostic Medicine, Clinical and Public Health, University of Modena e Reggio Emilia, Modena, Italy.,Center for Neuroscience and Neurotechnology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena e Reggio Emilia, Modena, Italy
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Barbanti P, Ferroni P. Onabotulinum toxin A in the treatment of chronic migraine: patient selection and special considerations. J Pain Res 2017; 10:2319-2329. [PMID: 29033605 PMCID: PMC5628659 DOI: 10.2147/jpr.s113614] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Discovered by serendipity, onabotulinum toxin A (BoNT-A) is the only US Food and Drug Administration-approved treatment for the prevention of chronic migraine (CM), one of the most disabling and burdensome human conditions. Its efficacy, safety and tolerability, proved by the largest and longest migraine therapeutic trial (the Phase III Research Evaluating Migraine Prophylaxis Therapy program [PREEMPT]), have been replicated by various real-life studies also in the presence of medication overuse. The benefit of BoNT-A prophylaxis is likely due to its ability to counteract peripheral and central nociceptive sensitization through reversible chemical denervation of pericranial sensitive afferents. Its efficacy increases considerably over time during long-term treatments, significantly varying among patients. The present review focuses on the state-of-the art of current knowledge on putative instrumental, biochemical and clinical predictors of BoNT-A responsiveness, outlining the need for a thorough characterization of the full phenotypic migraine picture when trying to predict good responders. Available evidence suggests that disentangling the BoNT-A responsiveness puzzle requires 1) a reappraisal of easy-obtainable clinical details (eg, site and quality of pain, presence of cranial autonomic symptoms), 2) a proper stratification of patients with CM according to their headache frequency, 3) the evaluation of potential synergistic effects of concomitant prophylaxis/treatment and 4) a detailed assessment of modifiable risk factors evolution during treatment.
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Affiliation(s)
- Piero Barbanti
- Headache and Pain Unit, Department of Neurological, Motor and Sensorial Sciences
| | - Patrizia Ferroni
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, IRCCS San Raffaele Pisana, Rome, Italy
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Ashina M, Dodick D, Goadsby PJ, Reuter U, Silberstein S, Zhang F, Gage JR, Cheng S, Mikol DD, Lenz RA. Erenumab (AMG 334) in episodic migraine: Interim analysis of an ongoing open-label study. Neurology 2017; 89:1237-1243. [PMID: 28835404 DOI: 10.1212/wnl.0000000000004391] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/29/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess long-term safety and efficacy of anti-calcitonin gene-related peptide receptor erenumab in patients with episodic migraine (EM). METHODS Patients enrolled in a 12-week, double-blind, placebo-controlled clinical trial (NCT01952574) who continued in an open-label extension (OLE) study will receive erenumab 70 mg every 4 weeks for up to 5 years. This preplanned interim analysis, conducted after all participants had completed the 1-year open-label follow-up, evaluated changes in monthly migraine days (MMD), achievement of ≥50%, ≥75%, and 100% reductions, Headache Impact Test (HIT-6) score, Migraine-Specific Quality of Life (MSQ), Migraine Disability Assessment (MIDAS), and safety. Data reported as observed without imputation for missing data. RESULTS Of 472 patients enrolled in the parent study, 383 continued in the OLE with a median exposure to erenumab of 575 days (range 28-822 days). Mean (SD) MMD were 8.8 (2.6) at parent study baseline, 6.3 (4.2) at week 12 (beginning of OLE), and 3.7 (4.0) at week 64 (mean change from baseline [reduction] of 5.0 days). At week 64, 65%, 42%, and 26% achieved ≥50%, ≥75%, and 100% reduction in MMD, respectively. Mean HIT-6 scores were 60.2 (6.3) at baseline and 51.7 (9.2) at week 64. MSQ and MIDAS improvements from baseline were maintained through week 64. Safety profiles during the OLE were similar to those in the double-blind phase, which overall were similar to placebo. CONCLUSIONS One-year efficacy, supported by functional improvements and favorable safety and tolerability profiles, supports further investigation of erenumab as a preventive treatment in patients with EM. CLINICALTRIALSGOV IDENTIFIER NCT01952574. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with episodic migraine, erenumab reduces long-term MMD and improves headache-related disability and migraine-specific quality of life.
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Affiliation(s)
- Messoud Ashina
- From the Department of Neurology (M.A.), Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Neurology (D.D.), Mayo Clinic, Scottsdale, AZ; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), Kings College London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Jefferson Headache Center (S.S.), Thomas Jefferson University, Philadelphia, PA; Amgen Inc. (F.Z., S.C., D.D.M., R.A.L.), Thousand Oaks; and Gage Medical Writing, LLC (J.R.G.), Moorpark, CA.
| | - David Dodick
- From the Department of Neurology (M.A.), Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Neurology (D.D.), Mayo Clinic, Scottsdale, AZ; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), Kings College London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Jefferson Headache Center (S.S.), Thomas Jefferson University, Philadelphia, PA; Amgen Inc. (F.Z., S.C., D.D.M., R.A.L.), Thousand Oaks; and Gage Medical Writing, LLC (J.R.G.), Moorpark, CA
| | - Peter J Goadsby
- From the Department of Neurology (M.A.), Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Neurology (D.D.), Mayo Clinic, Scottsdale, AZ; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), Kings College London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Jefferson Headache Center (S.S.), Thomas Jefferson University, Philadelphia, PA; Amgen Inc. (F.Z., S.C., D.D.M., R.A.L.), Thousand Oaks; and Gage Medical Writing, LLC (J.R.G.), Moorpark, CA
| | - Uwe Reuter
- From the Department of Neurology (M.A.), Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Neurology (D.D.), Mayo Clinic, Scottsdale, AZ; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), Kings College London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Jefferson Headache Center (S.S.), Thomas Jefferson University, Philadelphia, PA; Amgen Inc. (F.Z., S.C., D.D.M., R.A.L.), Thousand Oaks; and Gage Medical Writing, LLC (J.R.G.), Moorpark, CA
| | - Stephen Silberstein
- From the Department of Neurology (M.A.), Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Neurology (D.D.), Mayo Clinic, Scottsdale, AZ; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), Kings College London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Jefferson Headache Center (S.S.), Thomas Jefferson University, Philadelphia, PA; Amgen Inc. (F.Z., S.C., D.D.M., R.A.L.), Thousand Oaks; and Gage Medical Writing, LLC (J.R.G.), Moorpark, CA
| | - Feng Zhang
- From the Department of Neurology (M.A.), Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Neurology (D.D.), Mayo Clinic, Scottsdale, AZ; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), Kings College London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Jefferson Headache Center (S.S.), Thomas Jefferson University, Philadelphia, PA; Amgen Inc. (F.Z., S.C., D.D.M., R.A.L.), Thousand Oaks; and Gage Medical Writing, LLC (J.R.G.), Moorpark, CA
| | - Julia R Gage
- From the Department of Neurology (M.A.), Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Neurology (D.D.), Mayo Clinic, Scottsdale, AZ; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), Kings College London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Jefferson Headache Center (S.S.), Thomas Jefferson University, Philadelphia, PA; Amgen Inc. (F.Z., S.C., D.D.M., R.A.L.), Thousand Oaks; and Gage Medical Writing, LLC (J.R.G.), Moorpark, CA
| | - Sunfa Cheng
- From the Department of Neurology (M.A.), Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Neurology (D.D.), Mayo Clinic, Scottsdale, AZ; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), Kings College London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Jefferson Headache Center (S.S.), Thomas Jefferson University, Philadelphia, PA; Amgen Inc. (F.Z., S.C., D.D.M., R.A.L.), Thousand Oaks; and Gage Medical Writing, LLC (J.R.G.), Moorpark, CA
| | - Daniel D Mikol
- From the Department of Neurology (M.A.), Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Neurology (D.D.), Mayo Clinic, Scottsdale, AZ; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), Kings College London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Jefferson Headache Center (S.S.), Thomas Jefferson University, Philadelphia, PA; Amgen Inc. (F.Z., S.C., D.D.M., R.A.L.), Thousand Oaks; and Gage Medical Writing, LLC (J.R.G.), Moorpark, CA
| | - Robert A Lenz
- From the Department of Neurology (M.A.), Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Neurology (D.D.), Mayo Clinic, Scottsdale, AZ; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), Kings College London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Jefferson Headache Center (S.S.), Thomas Jefferson University, Philadelphia, PA; Amgen Inc. (F.Z., S.C., D.D.M., R.A.L.), Thousand Oaks; and Gage Medical Writing, LLC (J.R.G.), Moorpark, CA
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Escher CM, Paracka L, Dressler D, Kollewe K. Botulinum toxin in the management of chronic migraine: clinical evidence and experience. Ther Adv Neurol Disord 2017; 10:127-135. [PMID: 28382110 PMCID: PMC5367647 DOI: 10.1177/1756285616677005] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chronic migraine (CM) is a severely disabling neurological condition characterized by episodes of pulsating unilateral or bilateral headache. The United States Food and Drug Administration (FDA) approved onabotulinumtoxinA (Botox®) for the prophylactic treatment of CM in 2010. It has been shown that onabotulinumtoxinA is effective in the reduction of headache frequency and severity in patients with CM. Treatment is well tolerated by the patients. This review reports on the history of botulinum neurotoxin (BoNT) in CM and presents the current clinical evidence for the use of onabotulinumtoxinA in the treatment of CM.
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Affiliation(s)
- Claus M Escher
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Lejla Paracka
- Department of Neurology, Movement Disorder Section, Hannover Medical School, Hannover, Germany
| | - Dirk Dressler
- Department of Neurology, Movement Disorder Section, Hannover Medical School, Hannover, Germany
| | - Katja Kollewe
- Department of Neurology, Movement Disorder Section, Hannover Medical School, Carl-Neuberg Str. 1, D-30625 Hannover, Germany
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Bezerra MER, Rocha-Filho PAS. Headache Attributed to Craniocervical Dystonia - A Little Known Headache. Headache 2016; 57:336-343. [DOI: 10.1111/head.12996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/14/2016] [Indexed: 01/03/2023]
Affiliation(s)
| | - Pedro Augusto Sampaio Rocha-Filho
- Department of Neuropsychiatry; Universidade Federal de Pernambuco (UFPE), Recife, Brazil and Headache Clinic, Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE); Recife Brazil
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Lauritsen C, Mazuera S, Lipton RB, Ashina S. Intravenous ketamine for subacute treatment of refractory chronic migraine: a case series. J Headache Pain 2016; 17:106. [PMID: 27878523 PMCID: PMC5120050 DOI: 10.1186/s10194-016-0700-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/17/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Refractory migraine is a challenging condition with great impact on health related quality of life. Intravenous (IV) ketamine has been previously used to treat various refractory pain conditions. We present a series of patients with refractory migraine treated with intravenous ketamine in the hospital setting. METHODS Based on retrospective chart review, we identified six patients with refractory migraine admitted from 2010 through 2014 for treatment with intravenous ketamine. Ketamine was administered using a standard protocol starting with a dose of 0.1 mg/kg/hr and increased by 0.1 mg/kg/hr every 3 to 4 h as tolerated until the target pain score of 3/10 was achieved and maintained for at least 8 h. Visual Analogue Scale (VAS) scores at time of hospital admission were obtained as well as average baseline VAS scores prior to ketamine infusion. A phone interview was conducted for follow-up of migraine response in the 3 to 6 months following ketamine infusion. RESULTS The study sample had a median age of 36.5 years (range 29-54) and 83% were women. Pre-treatment pain scores ranged from 9 to 10. All patients achieved a target pain level of 3 or less for 8 h; the average ketamine infusion rate at target was 0.34 mg/kg/hour (range 0.12-0.42 mg/kg/hr). One patient reported a transient out-of-body hallucination following an increase in the infusion rate, which resolved after decreasing the rate. There were no other significant side effects. CONCLUSION IV ketamine was safely administered in the hospital setting to patients with refractory chronic migraine. Treatment was associated with short term improvement in pain severity in 6 of 6 patients with refractory chronic migraine. Prospective placebo-controlled trials are needed to assess short term and long-term efficacy of IV ketamine in refractory chronic migraine.
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Affiliation(s)
- Clinton Lauritsen
- Department of Neurology, Thomas Jefferson University, Jefferson Headache Center, Philadelphia, PA, USA.
| | - Santiago Mazuera
- Department of Neurology, Thomas Jefferson University, Jefferson Headache Center, Philadelphia, PA, USA
| | - Richard B Lipton
- Department of Neurology, Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sait Ashina
- Department of Neurology, New York University School of Medicine, NYU Langone Medical Center, NYU Lutheran Headache Center, New York, NY, USA
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Hubbard CS, Becerra L, Smith JH, DeLange JM, Smith RM, Black DF, Welker KM, Burstein R, Cutrer FM, Borsook D. Brain Changes in Responders vs. Non-Responders in Chronic Migraine: Markers of Disease Reversal. Front Hum Neurosci 2016; 10:497. [PMID: 27766076 PMCID: PMC5052273 DOI: 10.3389/fnhum.2016.00497] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/21/2016] [Indexed: 01/21/2023] Open
Abstract
The aim of this study was to identify structural and functional brain changes that accompanied the transition from chronic (CM; ≥15 headache days/month) to episodic (EM; <15 headache days/month) migraine following prophylactic treatment with onabotulinumtoxinA (BoNT-A). Specifically, we examined whether CM patients responsive to prophylaxis (responders; n = 11), as evidenced by a reversal in disease status (defined by at least a 50% reduction in migraine frequency and <15 headache days/month), compared to CM patients whose migraine frequency remained unchanged (non-responders; n = 12), showed differences in cortical thickness using surface-based morphometry. We also investigated whether areas showing group differences in cortical thickness displayed altered resting-state functional connectivity (RS-FC) using seed-to-voxel analyses. Migraine characteristics measured across groups included disease duration, pain intensity and headache frequency. Patient reports of headache frequency over the 4 weeks prior to (pre-treatment) and following (post-treatment) prophylaxis were compared (post minus pre) and this measure served as the clinical endpoint that determined group assignment. All patients were scanned within 2 weeks of the post-treatment visit. Results revealed that responders showed significant cortical thickening in the right primary somatosensory cortex (SI) and anterior insula (aINS), and left superior temporal gyrus (STG) and pars opercularis (ParsOp) compared to non-responders. In addition, disease duration was negatively correlated with cortical thickness in fronto-parietal and temporo-occipital regions in responders but not non-responders, with the exception of the primary motor cortex (MI) that showed the opposite pattern; disease duration was positively associated with MI cortical thickness in responders versus non-responders. Our seed-based RS-FC analyses revealed anti-correlations between the SI seed and lateral occipital (LOC) and dorsomedial prefrontal cortices (DMPFC) in responders, whereas non-responders showed increased connectivity between the ParsOp seed and LOC. Overall, our findings revealed distinct morphometric and functional brain changes in CM patients that reverted to EM following prophylactic treatment compared to CM patients that showed no change in disease status. Elucidating the CNS changes involved in disease reversal may be critical to discovering interventions that prevent or slow the progression of CM. Such changes may aid in the evaluation of treatments as well as provide markers for disease “de-chronification”.
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Affiliation(s)
- Catherine S Hubbard
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's HospitalBoston, MA, USA; Department of Anaesthesia, Harvard Medical SchoolBoston, MA, USA
| | - Lino Becerra
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's HospitalBoston, MA, USA; Department of Anaesthesia, Harvard Medical SchoolBoston, MA, USA
| | | | | | - Ryan M Smith
- Department of Neurology, Mayo Clinic Rochester, MN, USA
| | - David F Black
- Department of Neurology, Mayo Clinic Rochester, MN, USA
| | - Kirk M Welker
- Department of Neurology, Mayo Clinic Rochester, MN, USA
| | - Rami Burstein
- Department of Anaesthesia, Harvard Medical SchoolBoston, MA, USA; Department of Anaesthesia, Beth Israel Deaconess Medical CenterBoston, MA, USA
| | - Fred M Cutrer
- Department of Neurology, Mayo Clinic Rochester, MN, USA
| | - David Borsook
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's HospitalBoston, MA, USA; Department of Anaesthesia, Harvard Medical SchoolBoston, MA, USA
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