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Belvís R, Irimia P, González N, García-Ull J, Pozo-Rosich P, López-Bravo A, Morollón N, Quintas S, Plana A, Baz PG, Tentor A, Gallego Artiles N, León FJ, Pérez Martín M, Rivera I, Ramírez R, Colomina I, Lainez JM, Pascual J. Migraine treatment consensus document of the Spanish Society of Neurology (SEN), Spanish Society of Family and Community Medicine (SEMFYC), Society of Primary Care Medicine (SEMERGEN) and Spanish Association of Migraine and Headache (AEMICE) on migraine treatment. Med Clin (Barc) 2024:S0025-7753(24)00137-4. [PMID: 38643025 DOI: 10.1016/j.medcli.2024.02.006] [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: 09/28/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 04/22/2024]
Abstract
Migraine is a disease with a high prevalence and incidence, in addition to being highly disabling, causing a great impact on the patient's quality of life at a personal, family and work level, but also social, given its high expense due to its direct (care) and indirect (presenteeism and work absenteeism) costs. The multiple and recent developments in its pathophysiological knowledge and in its therapy require updating and, therefore, in this article the Spanish scientific societies most involved in its study and treatment (SEN, SEMFYC and SEMERGEN), together with the Association Spanish Association for Patients with Migraine and other Headaches (AEMICE), we have developed these updated care recommendations. We reviewed the treatment of migraine attacks, which consisted mainly of the use of NSAIDs and triptans, to which ditans and gepants have been added. We also discuss preventive treatment consisting of oral preventive drugs, botulinum toxin, and treatments that block the action of calcitonin-related peptide (CGRP). Finally, we emphasize that pharmacological treatments must be complementary to carrying out general measures consisting of identifying and managing/deletion the precipitating factors of the attacks and the chronicizing factors, controlling the comorbidities of migraine and eliminating analgesic overuse.
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Affiliation(s)
- Robert Belvís
- Unidad de Cefaleas y Neuralgias, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau. Grupo de Estudio de Cefaleas de la SEN, Barcelona, España.
| | - Pablo Irimia
- Servicio de Neurología, Clínica Universidad de Navarra. Grupo de Estudio de Cefaleas de la SEN, Pamplona, España
| | - Nuria González
- Servicio de Neurología, Hospital Universitario San Carlos. Grupo de Estudio de Cefaleas de la SEN, Madrid, España
| | - Jésica García-Ull
- Servicio de Neurología, Hospital Clínico. Grupo de Estudio de Cefaleas de la SEN, Valencia, España
| | - Patricia Pozo-Rosich
- Unidad de Cefalea y Grupo de Investigación en Cefalea, Servicio de Neurología, Hospital Vall d'Hebron y Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona. Grupo de Estudio de Cefaleas de la SEN, Barcelona, España
| | - Alba López-Bravo
- Unidad de Cefaleas, Sección de Neurología, Hospital Reina Sofía. Instituto de Investigación Sanitaria de Aragón (IIS-A). Grupo de Estudio de Cefaleas de la SEN, Tudela, Navarra, España
| | - Noemí Morollón
- Unidad de Cefaleas y Neuralgias, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau. Grupo de Estudio de Cefaleas de la SEN, Barcelona, España
| | - Sonia Quintas
- Servicio de Neurología, Hospital de La Princesa. Grupo de Estudio de Cefaleas de la SEN, Madrid, España
| | - Antoni Plana
- ABS Balàfia-Pardinyes-Secà de Sant Pere de Lleida, Àmbit Lleida. Institut Català de la Salut (ICS). Grupo de Trabajo de Neurología SEMFYC, Lleida, España
| | | | | | | | - Francisco Javier León
- Centro de Salut Dúrcal, Distrito Sanitario Granada Metropolitano. Grupo de Trabajo de Neurología SEMFYC, Granada, España
| | | | - Inés Rivera
- C.S. Barranco Grande, Santa Cruz de Tenerife, España
| | - Raquel Ramírez
- Servicio de Medicina de Familia, Clínica Universitaria de Navarra, Madrid, España
| | | | - José Miguel Lainez
- Servicio de Neurología, Hospital Clínico. Grupo de Estudio de Cefaleas de la SEN, Valencia, España
| | - Julio Pascual
- Servicio de Neurología, Hospital Marqués de Valdecilla, Universidad de Cantabria e IDIVAL. Grupo de Estudio de Cefaleas de la SEN, Santander, España
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Robblee J. Breaking the cycle: unraveling the diagnostic, pathophysiological and treatment challenges of refractory migraine. Front Neurol 2023; 14:1263535. [PMID: 37830088 PMCID: PMC10565861 DOI: 10.3389/fneur.2023.1263535] [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: 07/19/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
Background Refractory migraine is a poorly described complication of migraine in which migraine has chronified and become resistant to standard treatments. The true prevalence is unknown, but medication resistance is common in headache clinic patient populations. Given the lack of response to treatment, this patient population is extremely difficult to treat with limited guidance in the literature. Objective To review the diagnostic, pathophysiological, and management challenges in the refractory migraine population. Discussion There are no accepted, or even ICHD-3 appendix, diagnostic criteria for refractory migraine though several proposed criteria exist. Current proposed criteria often have low bars for refractoriness while also not meeting the needs of pediatrics, lower socioeconomic status, and developing nations. Pathophysiology is unknown but can be hypothesized as a persistent "on" state as a progression from chronic migraine with increasing central sensitization, but there may be heterogeneity in the underlying pathophysiology. No guidelines exist for treatment of refractory migraine; once all guideline-based treatments are tried, treatment consists of n-of-1 treatment trials paired with non-pharmacologic management. Conclusion Refractory migraine is poorly described diagnostically, its pathophysiology can only be guessed at by extension of chronic migraine, and treatment is more the art than science of medicine. Navigating care of this refractory population will require multidisciplinary care models and an emphasis on future research to answer these unknowns.
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Affiliation(s)
- Jennifer Robblee
- Department of Neurology, Dignity Health, St Joseph’s Hospital and Medical Center, Lewis Headache Clinic, Barrow Neurological Institute, Phoenix, AZ, United States
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Alharbi AS, Alharbi OF, Qutub FL, Albogami WM, Aljuhnie MA, Alharbi AE, Alqahtani WN, Babateen O. Assessment of the Prevalence and Level of Awareness of Medication Overuse Headache Among the General Population in Makkah City, Saudi Arabia. Cureus 2023; 15:e37985. [PMID: 37223197 PMCID: PMC10202447 DOI: 10.7759/cureus.37985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Medication overuse headache (MOH) is a secondary headache condition caused by consistently using more medication than necessary to treat headache symptoms. MOH is defined as a headache that occurs for 15 or more days per month in a patient with a pre-existing primary headache, and it develops as a result of regular overuse of symptomatic headache medication for more than three months. Patients with headaches often use simple pain medication for 15 or more days per month (e.g., non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol) and 10 or more days per month of opioids, triptans, and combination analgesics, but when there is no relief from these medications, the headache progression can lead to a cycle of consuming more medication with increased pain, which can lead to MOH. OBJECTIVE This study aimed to assess the prevalence and awareness of MOH among the general population of Makkah, Saudi Arabia. METHODS A cross-sectional study was conducted between December 2022 and March 2023 using a self-administered online questionnaire disseminated through social media. Data were collected from females and males 18 years of age and older living in Makkah, Saudi Arabia. RESULTS Overall, 715 individuals completed the questionnaire, 497 of whom were female (69.5%). The average age of the participants was 32.9 years (±13.3 years). The prevalence of MOH among those who reported having experienced headaches throughout their lifetimes was estimated to be 4.5%. Only 134 people (18.7%) were determined to be aware of MOH. CONCLUSION This study demonstrated that the general population of Makkah has a high prevalence of MOH and low levels of MOH awareness.
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Affiliation(s)
- Abdullah S Alharbi
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Omar F Alharbi
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Fadi L Qutub
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Warif M Albogami
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Mohammed A Aljuhnie
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Abdullah E Alharbi
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Wed N Alqahtani
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Omar Babateen
- Department of Physiology, College of Medicine, Umm Al-Qura University, Makkah, SAU
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Artemenko AR, Abramov VG, Bozhenkina TV, Konovalova ZN, Korenko AN, Krasavina DA, Kurenkov AL, Latysheva NV, Naprienko MV, Orlova OR, Filatova EG, Shevchenko VS, Iakovleva PN. [Botulinum toxin type A (Relatox) in transition from medication overuse to non-overuse status in patients with chronic migraine: a subgroup analysis of phase IIIb randomized single-blind multicenter active-controlled parallel-group trial]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:64-74. [PMID: 37994890 DOI: 10.17116/jnevro202312311164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To access the effect of Relatox, the first Russian botulinum toxin type A, in patients with chronic migraine (CM) and medication overuse (MO). MATERIAL AND METHODS In phase IIIb single-blind randomized multicenter active-controlled parallel-group study, patients with CM were randomized to once intramuscular injections of Relatox (n=101) or onabotulinumtoxin A injections - Botox (n=108). This subgroup analysis evaluated the percentage of patients who transition from medication overuse to non overuse status from baseline; mean changes in the number of headache days, migraine headache days, acute headache medication intakes days, headache intensity, proportion of patients who had a ≥50% reduction in headache days, proportion of the patients with severe (≥60) Headache Impact Test-6 score and with a severe (≥21) MIDAS score in a 28-day periods in each treatment among patients with baseline acute medication overuse via repeated measures. RESULTS Of 209 patients with CM, 100% met medication overuse criteria. Relatox and Botox demonstrated significant improvement for overall least squares mean change in headache days, migraine headache days, headache intensity; and headache-related disability and quality of life in CM patients with baseline MO, without differences between the groups. 75% and 70% patients in the Relatox and Botox groups, respectively, achieved ≥50% reduction in headache days from baseline (OR 1.58, CI 95% 0.84; 3.02, p=0.155). Furthermore, Relatox and Botox significant reduced average medication overuse rates in patient with CM and MO at baseline. 62% of patients in the Relatox group and 48% of patients in the Botox group transitioned from medication overuse to non overuse status compared from baseline (OR 2.07, CI 95% 0.91; 4.62, p=0.044). Relatox group had greater reductions than the Botox group in the percentage of patients with acute migraine-specific medication (triptan) overuse (p=0.050). CONCLUSION The results demonstrate highly prevalent of medication overuse among individuals with CM. This analysis provides evidence that the Russian botulinum toxin type A Relatox significantly improves measures of headache symptoms, quality of life and headache-related disability, and also significantly greater, compared to Botox, reduces migraine-specific medication consumption in patients with chronic migraine who overuse acute medications.
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Affiliation(s)
- A R Artemenko
- Sechenov First Moscow State Medical University of (Sechenov University), Moscow, Russia
- LLC «Medical Center «Practical Neurology», Moscow, Russia
| | - V G Abramov
- Federal Siberian Scientific and Clinical Center, Krasnoyarsk, Russia
| | - T V Bozhenkina
- Federal Siberian Scientific and Clinical Center, Krasnoyarsk, Russia
| | - Z N Konovalova
- LLC «Central Institute of Botulinotherapy and Actual Neurology», Moscow, Russia
| | - A N Korenko
- LLC «Professorial Clinic «Oda», St. Petersburg, Russia
- Academian I.P. Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - D A Krasavina
- LLC «Professorial Clinic «Oda», St. Petersburg, Russia
- Staint Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - A L Kurenkov
- LLC «Medical Center «Practical Neurology», Moscow, Russia
- National Medical Research Center for Children's Health, Moscow, Russia
| | - N V Latysheva
- Sechenov First Moscow State Medical University of (Sechenov University), Moscow, Russia
- LLC «Cephalgologist», Moscow, Russia
| | - M V Naprienko
- Sechenov First Moscow State Medical University of (Sechenov University), Moscow, Russia
- LLC «Cephalgologist», Moscow, Russia
| | - O R Orlova
- Sechenov First Moscow State Medical University of (Sechenov University), Moscow, Russia
- LLC «Central Institute of Botulinotherapy and Actual Neurology», Moscow, Russia
| | - E G Filatova
- Sechenov First Moscow State Medical University of (Sechenov University), Moscow, Russia
- LLC «Cephalgologist», Moscow, Russia
| | - V S Shevchenko
- LLC «Medical Center «Practical Neurology», Moscow, Russia
- Treatment and Rehabilitation Center, Moscow, Russia
| | - P N Iakovleva
- LLC «Central Institute of Botulinotherapy and Actual Neurology», Moscow, Russia
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Corand V, Moisset X, Radat F, Lucas C. Medication overuse headache: Updating of the French recommendations regarding the treatments strategies. Rev Neurol (Paris) 2021; 177:760-764. [PMID: 34332779 DOI: 10.1016/j.neurol.2021.07.003] [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: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
Regular and frequent use of analgesics and acute antimigraine drugs can increase the frequency of headache, and induce the transition from episodic to chronic migraine or medication-overuse headache (MOH). The one-year prevalence of this condition is between 1% and 2% in Europe, provoking substantial burden. MOH is more prevalent in people with comorbid depression, anxiety, and other chronic pain conditions. This paper aims at presenting an updating of French recommendations regarding treatments strategies. Prior French recommendations, published in 2014, were written in French. A literature search in the major medical databases including the terms "medication overuse headache", "symptomatic medication overuse", published between 2010 and 2020 was carried out. Three main strategies can be recommended and conducted in parallel: education and explanations about the negative consequences of overusing acute antimigraine drugs, discontinuation of the overused medication, and finally, preventive drug therapy and non-pharmacological prevention. Medication overuse headache remains a debated problem and evidence for the most effective treatment strategy is needed.
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Affiliation(s)
- V Corand
- Centre d'Etude et de Traitement de la Douleur, hôpital Pellegrin, CHU de Bordeaux, place Amélie Raba Léon, 33076 Bordeaux cedex, France
| | | | - X Moisset
- Université Clermont Auvergne, Inserm U-1107, Neuro-Dol, 63000 Clermont-Ferrand, France
| | - F Radat
- 107, rue Judaïque, 33000 Bordeaux, France
| | - C Lucas
- Centre d'Evaluation et de Traitement de la Douleur, Service de Neurochirurgie, hôpital Salengro, CHU de Lille, 2, avenue Oscar Lambret, 59037 Lille cedex, France.
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Effectiveness of Exercise and Manual Therapy as Treatment for Patients with Migraine, Tension-Type Headache or Cervicogenic Headache: An Umbrella and Mapping Review with Meta-Meta-Analysis. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11156856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The aim of the study was to perform a mapping and umbrella review with meta-meta-analysis (MMA) to synthesise and critically evaluate the effectiveness of manual therapy (MT) and aerobic exercise (AE) in relation to pain intensity, frequency, disability and quality of life in patients with migraines, tension-type headaches (TTH) and cervicogenic headaches (CGH). A systematic search was conducted in PubMed, PEDro, Scielo and Google Scholar up to December 2020. A total of 18 articles met the inclusion criteria, and only 8 were included in the quantitative analysis. The MMA showed results in favour of the interventions in terms of pain intensity and quality of life in migraine, TTH and CCH. Data were also in favour of the intervention in terms of pain frequency in migraine and in terms of disability in TTH. However, there were no significant effects on pain frequency in TTH and CGH. The results showed moderate evidence to suggest that AE reduces pain intensity in patients with migraine. In addition, the evidence in favour of MT or a mixed intervention (including therapeutic exercise) was also moderate in terms of reducing pain intensity in patients with TTH.
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