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Kaltseis K, Hamann T, Gaul C, Broessner G. Is prednisone still a reasonable option in the treatment of withdrawal headache in patients with chronic migraine and medication overuse headache in the age of CGRP antibodies? A narrative review. Headache 2022; 62:1264-1271. [PMID: 36437611 PMCID: PMC10100419 DOI: 10.1111/head.14415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Along with the development of novel migraine therapies as the monoclonal antibodies against calcitonin gene-related peptide (CGRP) and its receptor, the question arises if the treatment of chronic migraine (CM) and medication overuse headache (MOH) must be reconsidered. Have previous therapeutic approaches, including glucocorticoids, lost their role in the management of this debilitating disorder? In this narrative review, we present an overview of the available treatment options in CM and MOH in light of CGRP antibodies as well as an evaluation of the role of glucocorticoids in withdrawal therapy. BACKGROUND Chronic migraine and medication overuse continues to be a difficult to treat condition. To date, potent treatment options are scarce and algorithms for advising patients with MOH are often still based on expert consensus rather than evidence-based medicine. For years and probably due to lack of effective alternatives, glucocorticoids have been used in MOH, especially to alleviate withdrawal symptoms caused by detoxification. Small case series report positive effects of steroids in this respective patient group; however, randomized controlled trials did not show a consistent benefit, although this may be due to methodological limitations. Because of these discrepancies, their role in MOH has been under debate ever since. METHODS We searched the electronic database PubMed for articles up to June 1, 2022 on the use of glucocorticoids in CM and MOH. CONCLUSION Despite popular use in clinical practice, there is currently still no scientific evidence for the efficacy of glucocorticoids in patients with CM and MOH. Treatment with monoclonal antibodies achieved high transition rates from medication overuse to non-overuse. However, further research is needed to evaluate the additional benefit of these new agents.
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Affiliation(s)
- Katharina Kaltseis
- Department of Neurology, Headache Outpatient Clinic, Innsbruck Medical University, Innsbruck, Austria
| | - Till Hamann
- Department of Neurology, Headache Center North-East, University Medical Center Rostock, Rostock, Germany
| | - Charly Gaul
- Headache Center Frankfurt, Frankfurt, Germany
| | - Gregor Broessner
- Department of Neurology, Headache Outpatient Clinic, Innsbruck Medical University, Innsbruck, Austria
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Silva MHR, Alencar Neto JFD, Ferreira Neto ODC, Alves Neto LB, Lemos NB, Lira AO, Rocha ML, Marques LFF, Pereira VE, Durand VR, Silva ACV, Bem Junior LS, Rocha Cirne de Azevedo Filho H. Impacts of the preempt protocol on chronic migraine: an integrative review. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2022.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Chronic migraine is an important cause of functional disability and quality of life deficits, affecting 12% of the world population. Therefore, more treatment alternatives that promote better pain control are needed. So, botulinum toxin type A presents itself as a therapeutic option for this purpose. This integrative review aimed to analyze the functionality of the PREEMPT protocol applied for the treatment of chronic migraine, analyzing the time of pain control, the frequency of repetition of the treatment and the possible subtypes of pain that benefit most from botulinum toxin. Data were collected from the National Library of Medicine and Lilacs databases, and the research concluded in July 2022. 31 articles were found, of which only 22 publications were considered eligible to compose this study, and those that contemplated the research objectives were selected. above. Botulinum toxin type A presents an effective, safe and well-tolerated preventive profile for patients with chronic migraine, increasing the patient's quality of life and works in pain control.
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Botox (OnabotulinumtoxinA) for Treatment of Migraine Symptoms: A Systematic Review. Pain Res Manag 2022; 2022:3284446. [PMID: 35401888 PMCID: PMC8989603 DOI: 10.1155/2022/3284446] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022]
Abstract
Background. Migraine is one of the most common types of headache, and it is the second most common cause of neurological disorders, with an annual prevalence of about 15% of the population. This study aimed to evaluate the effect of BoNT-A on the duration and intensity of migraine attacks. In addition, we investigated the effective injection sites. Methods. According to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, we searched online databases, including Web of Science, PubMed, EMBASE, Scopus, Cochrane Library, ProQuest, ClinicalTrials.gov, and Google Scholar from 2011 to 2021. Results. A total of 24 articles were included in the study. The use of BoNT-A in individuals suffering from chronic migraine (CM) decreases the frequency of migraine attacks per month, pain intensity, medication use, emergency visits, and migraine-related disabilities. The BoNT-A was well tolerated and leads to improved performance and better quality of life (QoL). Overall, treatment with BoNT-A in adults with CM is beneficial. In addition, the use of BoNT-A in individuals with vestibular migraine (VM) reduces the frequency of migraines and brings about the improvement of disability status caused by migraine headaches. Meanwhile, the use of BoNT-A reduces the frequency of migraine attacks per month among individuals with chronic refractory migraine (CRM). Conclusions. The use of BoNT-A is a low-cost option for the treatment of various kinds of migraines, including chronic, episodic, unilateral, and vestibular types. BoNT-A can reduce the frequency of migraine attacks per month and diminish the severity of pain.
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Sacco S, Russo A, Geppetti P, Grazzi L, Negro A, Tassorelli C, Tedeschi G, Martelletti P. What is changing in chronic migraine treatment? An algorithm for onabotulinumtoxinA treatment by the Italian chronic migraine group. Expert Rev Neurother 2020; 20:1275-1286. [PMID: 32990477 DOI: 10.1080/14737175.2020.1825077] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION OnabotulinumtoxinA (OBT-A) and monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway are two of the few treatments that ameliorate chronic migraine (CM) in randomized controlled trials and real-life studies. Separate clinical practice guidelines have been developed for the management of CM with OBT-A or CGRP-targeting mAbs. AREAS COVERED Considering the concomitant availability of OBT-A and CGRP-targeting mAbs as therapeutic treatment options, Italian migraine experts reviewed the evidence supporting the efficacy of OBT-A and CGRP-targeting mAbs in CM in order to rationalize the management of CM patients treated with OBT-A. Experts addressed everyday practice needs to shape the optimal pharmacological management by balancing adherence to regulatory indications, ethical considerations, and clinical expertise. Considering the remarkable challenge of improving the health and quality of life of patients with CM, even partial improvements may be clinically meaningful, particularly for those who are resistant or intolerant to oral migraine treatments. EXPERT OPINION In this collaborative effort, we propose a treatment algorithm that integrates the relevant aspects of managing patients with CM to provide ready-to-use practical guidance regarding the appropriate use of OBT-A.
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Affiliation(s)
- Simona Sacco
- Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila , L'Aquila, Italy
| | - Antonio Russo
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Pierangelo Geppetti
- Department of Health Sciences, Section of Clinical Pharmacology, Headache Center Careggi University Hospital, University of Florence , Florence, Italy
| | - Licia Grazzi
- Neuroalgology Unit, Headache Center, Neurological Institute "C. Besta" IRCCS Foundation , Milan, Italy
| | - Andrea Negro
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University , Rome, Italy
| | - Cristina Tassorelli
- Headache Science Centre, IRCCS Mondino Foundation , Pavia, PV, Italy.,Department of Brain and Behavioral Sciences, University of Pavia , Pavia, PV, Italy
| | - Gioacchino Tedeschi
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University , Rome, Italy
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Diener HC, Antonaci F, Braschinsky M, Evers S, Jensen R, Lainez M, Kristoffersen ES, Tassorelli C, Ryliskiene K, Petersen JA. European Academy of Neurology guideline on the management of medication‐overuse headache. Eur J Neurol 2020; 27:1102-1116. [DOI: 10.1111/ene.14268] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- H. C. Diener
- Institute for Medical Informatics, Biometry and Epidemiology Faculty of Medicine University Duisburg‐Essen Essen Germany
| | - F. Antonaci
- IRCCS C. Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - M. Braschinsky
- Headache Clinic Neurology Clinic Tartu University Hospital Tartu Estonia
| | - S. Evers
- Faculty of Medicine University of Münster MünsterGermany
- Krankenhaus Lindenbrunn Coppenbrügge Germany
| | - R. Jensen
- Danish Headache Center Neurological Clinic Rigshospitalet‐Glostrup University of Copenhagen Copenhagen Denmark
| | - M. Lainez
- Department of Neurology Hospital Clínico Universitario ValenciaSpain
- Department of Neurology Universidad Católica de Valencia Valencia Spain
| | - E. S. Kristoffersen
- Department of Neurology Akershus University Hospital OsloNorway
- Department of General Practice University of Oslo Oslo Norway
| | - C. Tassorelli
- IRCCS C. Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - K. Ryliskiene
- Department of Neurology Institute of Clinical Medicine Faculty of Medicine Vilnius University Vilnius Lithuania
| | - J. A. Petersen
- Department Of Neurology University Hospital Zurich Zurich Switzerland
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6
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News on the journal Neurological Sciences in 2017. Neurol Sci 2018; 39:15-21. [PMID: 29327225 DOI: 10.1007/s10072-017-3241-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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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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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