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Zhao C, Li C, Yu X, Dai X, Zou W. Effectiveness and safety of pharmacological prophylaxis for chronic migraine: a systematic review and network meta-analysis. J Neurol 2024:10.1007/s00415-024-12512-z. [PMID: 38910144 DOI: 10.1007/s00415-024-12512-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Chronic migraine (CM) significantly impacts both the physical and mental health of patients. Current studies on the safety and effectiveness of different pharmacological prophylaxis interventions for CM are limited. To address this gap, we conducted a network meta-analysis (NMA) to compare and rank the efficacy and safety of various drugs in preventing CM. METHODS Two independent researchers systematically searched four databases from their inception to August 1, 2023, to identify eligible randomized controlled trials (RCTs). Subsequently, they performed data extraction and assessed the risk of bias. A NMA was then performed. Continuous outcomes and binary outcomes were displayed as weighted mean difference (WMD) and risk ratio (RR), respectively, and corresponding 95% confidence intervals (CI) were reported. The surface under the cumulative ranking curve (SUCRA) was used to rank each intervention separately. RESULTS 24 RCTs involving 8789 patients were included. Compared to placebo, Botulinum toxin A demonstrated the most significant effect in reducing the monthly migraine days for CM patients (MD = 3.88, 95% CI 0.48, 7.28); in terms of improving the response rate by a 50% reduction in monthly migraine days, Topiramate (RR = 50.06, 95% CI 3.18, 787.30) was the most effective; there was no statistically significant difference between all preventive drugs and placebo in improving the migraine disability assessment (MIDAS) score; in terms of the incidence of adverse events, Eptinezumab (RR = 1.09, 95% CI 0.8, 1.54) exhibited the highest safety profile. CONCLUSION Among all the drugs for the preventive drugs for CM, Botulinum toxin A has the best efficacy and safety profile, closely followed by calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs).
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Affiliation(s)
- Chengqi Zhao
- First School of Clinical Medicine, Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China
| | - Changxin Li
- The Second Department of Rehabilitation, Heilongjiang Provincial Hospital of Traditional Chinese Medicine, Harbin, 150030, Heilongjiang, China
| | - Xueping Yu
- The Third Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, 26 Heping Road, Xiangfang District, Harbin, 150040, Heilongjiang, China
| | - Xiaohong Dai
- The Third Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, 26 Heping Road, Xiangfang District, Harbin, 150040, Heilongjiang, China
| | - Wei Zou
- The Third Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, 26 Heping Road, Xiangfang District, Harbin, 150040, Heilongjiang, China.
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ANAEIGOUDARI A, SEYEDI F, KOOSHKI R, PORAN M, ZAMYAD M, ABBASNEJAD M. Methyl Jasmonate Modulates Feeding Behaviors and Hypothalamic Expression of the Orexin 1 Receptor in Rats. Turk J Pharm Sci 2024; 20:374-379. [PMID: 38254344 PMCID: PMC10803927 DOI: 10.4274/tjps.galenos.2023.63833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
Objectives Active plant ingredients have been successfully used in modern medicine to control appetite and energy hemostasis. This study was designed to evaluate the efficacy of the phytohormone methyl jasmonate (MJ) on food-related behaviors in rats. Materials and Methods Adult male Wistar rats were randomly divided into different groups (7 rats) and infused intracerebroventricularly (i.c.v.) with MJ vehicle (DMSO) or MJ (2.5, 5 and 10 μg/rat). Then, the individual rats were placed in an automated open field-like apparatus to assess a 12-h food-related activity in light and dark times. After behavioral tests, immunofluorescence staining of the orexin 1 receptor (Orx1R) was studied in the hypothalamus of rats. Results MJ (2.5, 5, and 10 μg/rat) administration significantly decreased food intake in the light and dark phases compared with the control group. Moreover, all the MJ-treated groups exhibited a decrease in visits to food containers at the light and dark times (p < 0.001). In addition, rats infused with MJ at 5 μg and 10 μg spent less time in the ports of food containers in the light and dark phases in comparison with control rats. Time in zone-related to food and locomotor activity was significantly decreased in the MJ (5 μg) groups during the light time and in all MJ-injected groups in the dark time. Moreover, hypothalamic expression of Orx1R in rats treated with MJ (5 μg) was significantly lower as compared to the control group. Conclusion Overall, the results indicated the potential of MJ to modulate feeding-related behavior and Orx1R expression in the hypothalamus of rats.
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Affiliation(s)
- Akbar ANAEIGOUDARI
- Jiroft University of Medical Sciences School, of Medicine, Department of Physiology, Jiroft, Iran
| | - Fatemeh SEYEDI
- Jiroft University of Medical Sciences School, of Medicine, Department of Anatomy, Jiroft, Iran
| | - Razieh KOOSHKI
- Lorestan University Faculty of Sciences, Department of Biology, Khorramabad, Iran
| | - Mohadeseh PORAN
- Shahid Bahonar University of Kerman Faculty, of Sciences, Department of Biology, Kerman, Iran
| | - Mahnaz ZAMYAD
- Shahid Bahonar University of Kerman Faculty, of Sciences, Department of Biology, Kerman, Iran
| | - Mehdi ABBASNEJAD
- Shahid Bahonar University of Kerman Faculty, of Sciences, Department of Biology, Kerman, Iran
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Blumenfeld AM, Kaur G, Mahajan A, Shukla H, Sommer K, Tung A, Knievel KL. Effectiveness and Safety of Chronic Migraine Preventive Treatments: A Systematic Literature Review. Pain Ther 2023; 12:251-274. [PMID: 36417165 PMCID: PMC9845441 DOI: 10.1007/s40122-022-00452-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/21/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Numerous medications are used for the preventive treatment of chronic migraine (CM), including oral treatments, onabotulinumtoxinA (onabotA; BOTOX), and calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs). Despite substantial clinical trial evidence, less is published about the real-world experience of these treatments based on data routinely collected from a variety of sources. This systematic review assessed real-world evidence on the effectiveness and safety of preventive treatments for CM in adults. METHODS A systematic search of MEDLINE, Embase, and the Cochrane library with back-referencing and supplementary searches retrieved data published between January 2010 and February 2020. Publications were screened, extracted, and quality assessed. Data were narratively synthesized. Search criteria included preventive medications for CM. Evidence was available for topiramate, onabotulinumtoxinA, CGRP mAbs (erenumab, galcanezumab, and fremanezumab). OnabotulinumtoxinA was most commonly assessed (55 studies), followed by erenumab (six studies), multiple CGRP mAbs (one study), and topiramate (one study). Long-term data (> 1 year) were available for onabotulinumtoxinA only, with erenumab reported up 6 months, topiramate up to 3 months, and multiple CGRP mAbs up to 12 months. RESULTS Substantial data demonstrated that onabotulinumtoxinA reduces the number/frequency of headaches, concomitant acute medication use, and impact of headaches on well-being and daily activity. More limited evidence showed benefits for the same parameters with erenumab. Single studies suggested topiramate and multiple CGRP mAbs decrease the number/frequency of headaches and impact of headaches. To date, onabotulinumtoxinA is the only preventive treatment for CM that has long-term safety data in real-world settings reporting treatment-related adverse events of up to 3 years. CONCLUSION While substantial real-world evidence supports the long-term effectiveness and safety of onabotulinumtoxinA, real-world data on other preventive treatments of CM are currently limited to short term effectiveness due to their more recent approvals.
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Affiliation(s)
| | - Gavneet Kaur
- Bridge Medical Consulting Ltd, Richmond, London, UK
| | | | | | | | - Amy Tung
- AbbVie, 2525 Dupont Drive, Irvine, CA 92612 USA
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4
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Corbelli I, Verzina A, Leone De Magistris I, De Vanna G, Eusebi P, Mataluni G, Pisani A, Prudenzano AMP, Trojano M, Delussi M, De Tommaso M, Russo A, Silvestro M, Tedeschi G, Calabresi P, Sarchielli P. Sustained Efficacy, Safety and High Adherence Rate of Onabotulinum Toxin Type A in Chronic Migraine Patients: A Multicentric Prospective Real-Life Study. Toxins (Basel) 2022; 15:toxins15010034. [PMID: 36668854 PMCID: PMC9863104 DOI: 10.3390/toxins15010034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/08/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Guidelines regarding long-term use with onabotulinumtoxinA (onaBT-A) in chronic migraine (CM) prophylaxis are lacking. This multicentric prospective real-life study aimed to assess the efficacy and safety of a long-term treatment. A total of 195 chronic migraine patients were treated with onaBT-A, every 3 months for 5 cycles (Phase 1). In the Phase 2 of the study, depending on response rate, patients were divided into "responders" (R), "partially responders" (PR) and "non-responders" (NR). Then, we proposed to R and PR patients to continue with an additional 12 months of treatment (additional 4 sessions). Response to treatment and adverse events were collected for the entire duration of the study. Of the 195 patients included (females 82.1%, mean age 47.4 ± 12.4), at the end of Phase 1 there were 52.3% of R patients, 17.9% of PR patients, 15.4% of NR patients and 14.4% drop-outs. During Phase 2 of treatment, R patients presented a maintenance of the improvement achieved during the first year of treatment, as well as PR patients. Except for three serious adverse events not related to treatment, all other adverse events were mild or moderate in severity and resolved without sequelae. In the literature, adherence to oral migraine-preventive medications among patients with CM was found to be less than 25%. The results of this prospective real-life multicenter study show efficacy, safety and adherence to a long-term treatment with onaBT-A.
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Affiliation(s)
- Ilenia Corbelli
- Neurological Clinic, S. Maria Misericordia Hospital, Department of Medicine, University of Perugia, 06129 Perugia, Italy
- Correspondence: ; Tel.: +39-075-578-4228; Fax: +39-075-578-4229
| | - Angela Verzina
- Neurological Clinic, S. Maria Misericordia Hospital, Department of Medicine, University of Perugia, 06129 Perugia, Italy
| | - Ilaria Leone De Magistris
- Neurological Clinic, S. Maria Misericordia Hospital, Department of Medicine, University of Perugia, 06129 Perugia, Italy
| | - Gioacchino De Vanna
- Neurological Clinic, S. Maria Misericordia Hospital, Department of Medicine, University of Perugia, 06129 Perugia, Italy
| | - Paolo Eusebi
- Neurological Clinic, S. Maria Misericordia Hospital, Department of Medicine, University of Perugia, 06129 Perugia, Italy
| | - Giorgia Mataluni
- Neurology Unit, Department of Systems Medicine, University of Tor Vergata, 00133 Rome, Italy
| | - Antonio Pisani
- Neurology Unit, Department of Systems Medicine, University of Tor Vergata, 00133 Rome, Italy
| | - Addolorata Maria Pia Prudenzano
- Headache Center, Neurological Clinic “L. Amaducci”, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, 70121 Bari, Italy
| | - Maria Trojano
- Headache Center, Neurological Clinic “L. Amaducci”, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, 70121 Bari, Italy
| | - Marianna Delussi
- Applied Neurophysiology and Pain (ANP) Unit, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Marina De Tommaso
- Applied Neurophysiology and Pain (ANP) Unit, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Antonio Russo
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Marcello Silvestro
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Paolo Calabresi
- The Institute of Neurology, Agostino Gemelli University Policlinic IRCCS, 00168 Rome, Italy
- Department of Neurosciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Paola Sarchielli
- Neurological Clinic, S. Maria Misericordia Hospital, Department of Medicine, University of Perugia, 06129 Perugia, Italy
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Abstract
Chronic migraine is a neurologic disorder associated with considerable disability, lost productivity, and a profound economic burden worldwide. The past five years have seen a dramatic expansion in new treatments for this often challenging condition, among them calcitonin gene related peptide antagonists and neuromodulatory devices. This review outlines the epidemiology of and diagnostic criteria and risk factors for chronic migraine. It discusses evidence based drug and non-drug treatments, their advantages and disadvantages, and the principles of patient centered care for adults with chronic migraine, with attention to differential diagnosis and comorbidities, clinical reasoning, initiation and monitoring, cost, and availability. It discusses the international guidelines on drug treatment for chronic migraine and evaluates non-drug treatments including behavioral and complementary therapies and lifestyle modifications. Finally, it discusses the management of chronic migraine in special populations, including pediatrics, pregnancy, and older people, and considers future questions and emerging research in the field.
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Affiliation(s)
| | - Julie Roth
- Warren Alpert Medical School of Brown University, Brown University, Providence, RI, USA
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Marynissen H, Buntinx L, Bamps D, Depre M, Ampe E, Van Hecken A, Gabriel K, Sands S, Vargas G, de Hoon J. First-in-human development of a pharmacodynamic biomarker for PAC 1 receptor antagonists using intradermal injections of maxadilan. Clin Transl Sci 2022; 15:1968-1977. [PMID: 35621246 PMCID: PMC9372410 DOI: 10.1111/cts.13309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 11/28/2022] Open
Abstract
Maxadilan, a potent vasodilator peptide, selectively activates the PAC1 receptor, a promising target for migraine therapy. Therefore, maxadilan has been suggested as a tool to study the pharmacodynamics (PDs) of PAC1 receptor antagonists. The objectives of this first-in-human study were to: (1) determine the safety, tolerability, dose response, and time course of the dermal blood flow (DBF) changes after intradermal (i.d.) injections of maxadilan in the human forearm, and (2) assess the inter-arm and inter-period reproducibility of this response. This was a single-center, open-label study in healthy subjects, comprising three parts: (1) dose-response (n = 25), (2) response duration (n = 10), and (3) reproducibility (n = 15). DBF measurements were performed using laser Doppler imaging (LDI) up to 60 min postinjection, or up to 5 days for the response duration assessments. To assess reproducibility, the intraclass correlation coefficient (ICC) and sample sizes were calculated. The i.d. maxadilan (0.001, 0.01, 0.1, 0.9, 3, and 10 ng) produced a well-tolerated, dose-dependent increase in DBF, with a half-maximal effective concentration fitted at 0.0098 ng. The DBF response to 0.9 ng maxadilan was quantifiable with LDI up to 72 h postinjection. The inter-period reproducibility of the DBF response was better upon 0.9 ng (ICC > 0.6) compared to 0.01 ng (ICC < 0.4) maxadilan. However, irrespective of the study design or maxadilan dose, a sample size of 11 subjects is sufficient to detect a 30% difference in DBF response with 80% power. In conclusion, intradermal maxadilan provides a safe, well-tolerated, and reproducible PD biomarker for PAC1 receptor antagonists in vivo in humans.
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Affiliation(s)
- Heleen Marynissen
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Dorien Bamps
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Marleen Depre
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Els Ampe
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Anne Van Hecken
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Kristin Gabriel
- Spark Therapeutics, Member of the Roche Group, Philadelphia, Pennsylvania, USA
| | | | | | - Jan de Hoon
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Entonen AH, Suominen SB, Sillanmäki LH, Rautava PT, Kauniskangas K, Mäntyselkä PT, Sumanen M, Koskenvuo MJ. Prevalent migraine as a predictor of incident hypertension. Eur J Public Health 2022; 32:297-301. [PMID: 35021188 PMCID: PMC8975527 DOI: 10.1093/eurpub/ckab219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Migraine has been associated with several diseases. This population-based prospective Finnish postal survey Health and Social Support Study explored whether self-reported migraine predicted incident hypertension independently in a working-age population by utilizing two data sources: the baseline survey from the year 1998 in combination with the follow-up survey data from the years 2003 and 2012 with linkage to the national Social Insurance Institution registry data of the special reimbursement medication for hypertension from 1999 to 2013. The survey follow-up reached until the second follow-up in the year 2012. The register follow-up also included the year 2013. Methods The present population-based prospective cohort study, utilizing two different data sources, included 8593 respondents (22.7% response rate) who participated in 1998, 2003, and 2012 but who did not report hypertension at the baseline in 1998, and whose responses could be linked with the Social Insurance Institution registry data from the beginning of 1999 to the end of 2013. The multivariable logistic regression analysis was based on the combined two data sets. Results A significant association of self-reported migraine and incident hypertension (odds ratio 1.37; 95% confidence interval 1.20–1.57) prevailed in the multiple logistic regression analysis adjusted for central socio-demographic and health behaviour variables. Conclusion Extra attention should be paid to prevention and control of hypertension in working-age migraine patients.
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Affiliation(s)
- Anitta H Entonen
- Department of Public Health, Faculty of Medicine, University of Turku, Turku, Finland
| | - Sakari B Suominen
- Department of Public Health, Faculty of Medicine, University of Turku, Turku, Finland.,School of Health Sciences, University of Skövde, Sweden.,Research Services, Turku University Hospital, Turku, Finland
| | - Lauri H Sillanmäki
- Department of Public Health, Faculty of Medicine, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Päivi T Rautava
- Department of Public Health, Faculty of Medicine, University of Turku, Turku, Finland.,Research Services, Turku University Hospital, Turku, Finland
| | - Katariina Kauniskangas
- Department of Public Health, Faculty of Medicine, University of Turku, Turku, Finland.,Healthcare Services, City of Turku, Section of Welfare, Turku, Finland
| | - Pekka T Mäntyselkä
- Institute of Public Health and Clinical Nutrition,University of Eastern Finland and Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Markku Sumanen
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Markku J Koskenvuo
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Efficacy and Safety of Chuanxiong Qingnao Granule in Patients with Migraine: A Randomized, Double-Blind, Placebo-Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2021:6203999. [PMID: 34976097 PMCID: PMC8716194 DOI: 10.1155/2021/6203999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/01/2021] [Accepted: 12/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of Chuanxiong Qingnao Granule (CQG) to treat migraine. METHOD This study was a randomized, double-blind, placebo-controlled trial. All migraineurs were recruited and randomly assigned into a treatment group treated with CQG and a control group treated with a placebo. The whole research process included a 4-week baseline, 12-week intervention, and 12-week follow-up. The primary outcome was responder rate, defined as the percentage of migraineurs with 50% or more reduction in the frequency of migraine attack during treatment and posttreatment period compared with the baseline. The secondary outcomes were the number of migraine days, migraine attack frequency, visual analogue scale (VAS), Fatigue Severity Scale (FSS), Hamilton Depression Scale (HAMD), and Migraine Disability Assessment (MIDAS). RESULTS A total of 346 migraineurs completed the research and were included in the intention-treatment analyses. The response rates differed significantly between the treatment group and the control group (71.5% vs. 12.1% at week 12 and 83.1% vs. 3.4% at week 24). Attack frequency, days of headache attack, VAS, FSS, HAMD, and MIDAS decreased at week 12 in both groups with more reduction in the treatment group (P < 0.001). No severe adverse events were observed in this trial. CONCLUSION Chuanxiong Qingnao Granule can significantly improve headache symptoms in patients with migraine while improving disability, fatigue, and depression with a good safety profile.
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Tanaka M, Török N, Vécsei L. Are 5-HT 1 receptor agonists effective anti-migraine drugs? Expert Opin Pharmacother 2021; 22:1221-1225. [PMID: 33843394 DOI: 10.1080/14656566.2021.1910235] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Masaru Tanaka
- MTA-SZTE, Neuroscience Research Group, Szeged, Hungary.,Department of Neurology, Interdisciplinary Excellence Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Nóra Török
- MTA-SZTE, Neuroscience Research Group, Szeged, Hungary.,Department of Neurology, Interdisciplinary Excellence Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - László Vécsei
- MTA-SZTE, Neuroscience Research Group, Szeged, Hungary.,Department of Neurology, Interdisciplinary Excellence Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary
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Baranowsky A, Appelt J, Kleber C, Lange T, Ludewig P, Jahn D, Pandey P, Keller D, Rose T, Schetler D, Braumüller S, Huber-Lang M, Tsitsilonis S, Yorgan T, Frosch KH, Amling M, Schinke T, Keller J. Procalcitonin Exerts a Mediator Role in Septic Shock Through the Calcitonin Gene-Related Peptide Receptor. Crit Care Med 2021; 49:e41-e52. [PMID: 33196529 DOI: 10.1097/ccm.0000000000004731] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Clinically, procalcitonin represents the most widely used biomarker of sepsis worldwide with unclear pathophysiologic significance to date. Pharmacologically, procalcitonin was shown to signal through both calcitonin receptor and calcitonin gene-related peptide receptor in vitro, yet the identity of its biologically relevant receptor remains unknown. DESIGN Prospective randomized animal investigations and in vitro human blood studies. SETTING Research laboratory of a university hospital. SUBJECTS C57BL/6J mice and patients with post-traumatic sepsis. INTERVENTIONS Procalcitonin-deficient mice were used to decipher a potential mediator role in experimental septic shock and identify the relevant receptor for procalcitonin. Cecal ligation and puncture and endotoxemia models were employed to investigate septic shock. Disease progression was evaluated through survival analysis, histology, proteome profiling, gene expression, and flow cytometry. Mechanistic studies were performed with cultured macrophages, dendritic cells, and gamma delta T cells. Main findings were confirmed in serum samples of patients with post-traumatic sepsis. MEASUREMENTS AND MAIN RESULTS Procalcitonin-deficient mice are protected from septic shock and show decreased pulmonary inflammation. Mechanistically, procalcitonin potentiates proinflammatory cytokine expression in innate immune cells, required for interleukin-17A expression in gamma delta T cells. In patients with post-traumatic sepsis, procalcitonin positively correlates with systemic interleukin-17A levels. In mice with endotoxemia, immunoneutralization of interleukin-17A inhibits the deleterious effect of procalcitonin on disease outcome. Although calcitonin receptor expression is irrelevant for disease progression, the nonpeptide calcitonin gene-related peptide receptor antagonist olcegepant, a prototype of currently introduced antimigraine drugs, inhibits procalcitonin signaling and increases survival time in septic shock. CONCLUSIONS Our experimental data suggest that procalcitonin exerts a moderate but harmful effect on disease progression in experimental septic shock. In addition, the study points towards the calcitonin gene-related peptide receptor as relevant for procalcitonin signaling and suggests a potential therapeutic application for calcitonin gene-related peptide receptor inhibitors in sepsis, which warrants further clinical investigation.
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Affiliation(s)
- Anke Baranowsky
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jessika Appelt
- Julius Wolff Institut for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Kleber
- University Center of Orthopaedics and Traumatology, University Hospital Dresden, Dresden, Germany
| | - Tobias Lange
- Institute of Anatomy and Experimental Morphology, University Cancer Center Hamburg, Hamburg, Germany
| | - Peter Ludewig
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Denise Jahn
- Julius Wolff Institut for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Puja Pandey
- Julius Wolff Institut for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Daniela Keller
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Rose
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Daniela Schetler
- Institute of Anatomy and Experimental Morphology, University Cancer Center Hamburg, Hamburg, Germany
| | - Sonja Braumüller
- Department of Traumatology, Center of Surgery, University of Ulm, Ulm, Germany
| | - Markus Huber-Lang
- Department of Traumatology, Center of Surgery, University of Ulm, Ulm, Germany
| | - Serafeim Tsitsilonis
- Julius Wolff Institut for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Timur Yorgan
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Schinke
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Keller
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
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Urits I, Gress K, Charipova K, Zamarripa AM, Patel PM, Lassiter G, Jung JW, Kaye AD, Viswanath O. Pharmacological options for the treatment of chronic migraine pain. Best Pract Res Clin Anaesthesiol 2020; 34:383-407. [PMID: 33004155 DOI: 10.1016/j.bpa.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 12/29/2022]
Abstract
Migraine is a debilitating neurological condition with symptoms typically consisting of unilateral and pulsating headache, sensitivity to sensory stimuli, nausea, and vomiting. The World Health Organization (WHO) reports that migraine is the third most prevalent medical disorder and second most disabling neurological condition in the world. There are several options for preventive migraine treatments that include, but are not limited to, anticonvulsants, antidepressants, beta blockers, calcium channel blockers, botulinum toxins, NSAIDs, riboflavin, and magnesium. Patients may also benefit from adjunct nonpharmacological options in the comprehensive prevention of migraines, such as cognitive behavior therapy, relaxation therapies, biofeedback, lifestyle guidance, and education. Preventative therapies are an essential component of the overall approach to the pharmacological treatment of migraine. Comparative studies of newer therapies are needed to help patients receive the best treatment option for chronic migraine pain.
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Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
| | - Kyle Gress
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Alec M Zamarripa
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Parth M Patel
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Grace Lassiter
- Georgetown University School of Medicine, Washington, DC, USA
| | - Jai Won Jung
- Georgetown University School of Medicine, Washington, DC, USA
| | - Alan D Kaye
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Omar Viswanath
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA; Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA
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12
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Verkest C, Häfner S, Ávalos Prado P, Baron A, Sandoz G. Migraine and Two-Pore-Domain Potassium Channels. Neuroscientist 2020; 27:268-284. [PMID: 32715910 DOI: 10.1177/1073858420940949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Migraine is a common, disabling neurological disorder with a genetic, environmental, and hormonal component with an annual prevalence estimated at ~15%. It is characterized by attacks of severe, usually unilateral and throbbing headache, and can be accompanied by nausea, vomiting, and photophobia. Migraine is clinically divided into two main subtypes: migraine with aura, when it is preceded by transient neurological disturbances due to cortical spreading depression (CSD), and migraine without aura. Activation and sensitization of trigeminal sensory neurons, leading to the release of pro-inflammatory peptides, is likely a key component in headache pain initiation and transmission in migraine. In the present review, we will focus on the function of two-pore-domain potassium (K2P) channels, which control trigeminal sensory neuron excitability and their potential interest for developing new drugs to treat migraine.
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Affiliation(s)
- Clément Verkest
- CNRS, INSERM, iBV, Université Cote d'Azur, Nice, France.,Laboratories of Excellence, Ion Channel Science and Therapeutics Nice, France.,Université Cote d'Azur, CNRS, INSERM, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France
| | - Stephanie Häfner
- CNRS, INSERM, iBV, Université Cote d'Azur, Nice, France.,Laboratories of Excellence, Ion Channel Science and Therapeutics Nice, France
| | - Pablo Ávalos Prado
- CNRS, INSERM, iBV, Université Cote d'Azur, Nice, France.,Laboratories of Excellence, Ion Channel Science and Therapeutics Nice, France
| | - Anne Baron
- Laboratories of Excellence, Ion Channel Science and Therapeutics Nice, France.,Université Cote d'Azur, CNRS, INSERM, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France
| | - Guillaume Sandoz
- CNRS, INSERM, iBV, Université Cote d'Azur, Nice, France.,Laboratories of Excellence, Ion Channel Science and Therapeutics Nice, France
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Leung A. Addressing chronic persistent headaches after MTBI as a neuropathic pain state. J Headache Pain 2020; 21:77. [PMID: 32560626 PMCID: PMC7304149 DOI: 10.1186/s10194-020-01133-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/25/2020] [Indexed: 12/15/2022] Open
Abstract
An increasing number of patients with chronic persistent post-traumatic headache (PPTH) after mild traumatic brain injury (MTBI) are being referred to headache or pain specialists as conventional treatment options for primary headache disorders have not been able to adequately alleviate their debilitating headache symptoms. Evolving clinical and mechanistic evidences support the notation that chronic persistent MTBI related headaches (MTBI-HA) carry the hallmark characteristics of neuropathic pain. Thus, in addition to conventional treatment options applicable to non-traumatic primary headache disorders, other available treatment modalities for neuropathic pain should be considered. In this comprehensive review article, the author reveals the prevalence of MTBI-HA and its clinical manifestation, discusses existing clinical and mechanistic evidence supporting the classification of chronic persistent MTBI-HA as a neuropathic pain state, and explores current available treatment options and future directions of therapeutic research related to MTBI-HA.
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Affiliation(s)
- Albert Leung
- Department of Anesthesiology, Center for Pain Medicine, UCSD School of Medicine, La Jolla, USA.
- Center for Pain and Headache Research, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92126, USA.
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