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Basedau H, Ornello R, Matteis ED, Davaasuren B, Kadyrova B, Vuralli D, Bozhenko M, Azizova I, Bitsadze N, Eralieva E, Ashina M, Mitsikostas D, Puledda F. Placebo and nocebo in the treatment of migraine: How much does real world effectiveness depend on contextual effects? Cephalalgia 2023; 43:3331024231218392. [PMID: 38041833 DOI: 10.1177/03331024231218392] [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: 12/04/2023]
Abstract
PURPOSE Treatments in medicine impact individuals beyond their intended effects, due to phenomena such as the placebo and nocebo effects. The placebo effect arises from the positive expectation of a treatment being beneficial, while the nocebo effect stems from the negative expectation of a treatment causing harm. Both in real-world practice and clinical trials, treatments can lead to outcomes unrelated to their intended mechanism of action, which we categorize as placebo and nocebo responses. These responses, combined with the inherent fluctuation in a condition's natural progression, regression to the mean, and random comorbidities, make up a significant part of the therapeutic experience. Particularly in pain management, placebo and nocebo effects play a substantial role. By addressing modifiable contextual factors such as patient expectations, lifestyle choices, and the therapeutic relationship, healthcare providers can enhance the effectiveness of migraine treatments, paving the way for a more comprehensive, individualized approach to patient care. We must also consider non-modifiable factors like personal experiences, beliefs, and information from social media and the internet. CONCLUSION This review offers a summary of our current understanding of the placebo and nocebo effects in migraine management.
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Affiliation(s)
- Hauke Basedau
- Department of Systems Neuroscience, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Eleonora De Matteis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Begimai Kadyrova
- Department of Special Clinical Disciplines, International School of Medicine of International University of Kyrgyzstan, Bishkek, Kyrgyzstan
| | - Doga Vuralli
- Department of Neurology and Algology, Neuropsychiatry Center, Neuroscience and Neurotechnology Center of Excellence (NÖROM), Gazi University, Ankara, Turkey
| | - Myroslav Bozhenko
- Department of Neurology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Ilaha Azizova
- Neurological Clinic "New Medical Technologies", Baku, Azerbaijan
| | | | | | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Dimos Mitsikostas
- Department of Neurology Α, Aegintion Hospital, National and Kapidistrian University of Athens, Athens, Greece
| | - Francesca Puledda
- Headache Group, Wolfson SPaRC, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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May A, Evers S, Goadsby PJ, Leone M, Manzoni GC, Pascual J, Carvalho V, Romoli M, Aleksovska K, Pozo-Rosich P, Jensen RH. European Academy of Neurology guidelines on the treatment of cluster headache. Eur J Neurol 2023; 30:2955-2979. [PMID: 37515405 DOI: 10.1111/ene.15956] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND AND PURPOSE Cluster headache is a relatively rare, disabling primary headache disorder with a major impact on patients' quality of life. This work presents evidence-based recommendations for the treatment of cluster headache derived from a systematic review of the literature and consensus among a panel of experts. METHODS The databases PubMed (Medline), Science Citation Index, and Cochrane Library were screened for studies on the efficacy of interventions (last access July 2022). The findings in these studies were evaluated according to the recommendations of the European Academy of Neurology, and the level of evidence was established using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). RECOMMENDATIONS For the acute treatment of cluster headache attacks, there is a strong recommendation for oxygen (100%) with a flow of at least 12 L/min over 15 min and 6 mg subcutaneous sumatriptan. Prophylaxis of cluster headache attacks with verapamil at a daily dose of at least 240 mg (maximum dose depends on efficacy and tolerability) is recommended. Corticosteroids are efficacious in cluster headache. To reach an effect, the use of at least 100 mg prednisone (or equivalent corticosteroid) given orally or at up to 500 mg iv per day over 5 days is recommended. Lithium, topiramate, and galcanezumab (only for episodic cluster headache) are recommended as alternative treatments. Noninvasive vagus nerve stimulation is efficacious in episodic but not chronic cluster headache. Greater occipital nerve block is recommended, but electrical stimulation of the greater occipital nerve is not recommended due to the side effect profile.
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Affiliation(s)
- Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Stefan Evers
- Department of Neurology, Lindenbrunn Hospital, Coppenbrügge, Germany
- Faculty of Medicine, University of Münster, Münster, Germany
| | - Peter J Goadsby
- NIHR King's CRF, SLaM Biomedical Research Centre, King's College London, London, UK
| | - Massimo Leone
- Neuroalgology Department, Foundation of the Carlo Besta Neurological Institute, IRCCS, Milan, Italy
| | | | - Julio Pascual
- Service of Neurology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain
| | - Vanessa Carvalho
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Michele Romoli
- Neurology and Stroke Unit, Bufalini Hospital, Cesena, Italy
| | | | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rigmor H Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
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3
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Diener HC, Tassorelli C, Dodick DW. Management of Trigeminal Autonomic Cephalalgias Including Chronic Cluster: A Review. JAMA Neurol 2023; 80:308-319. [PMID: 36648786 DOI: 10.1001/jamaneurol.2022.4804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Importance Trigeminal autonomic cephalalgias (TACs) comprise a unique collection of primary headache disorders characterized by moderate or severe unilateral pain, localized in in the area of distribution of the first branch of the trigeminal nerve, accompanied by cranial autonomic symptoms and signs. Most TACs are rare diseases, which hampers the possibility of performing randomized clinical trials and large studies. Therefore, knowledge of treatment efficacy must be based only on observational studies, rare disease registries, and case reports, where real-world data and evidence play an important role in health care decisions. Observations Chronic cluster headache is the most common of these disorders, and the literature offers some evidence from randomized clinical trials to support the use of pharmacologic and neurostimulation treatments. Galcanezumab, a monoclonal antibody targeting the calcitonin gene-related peptide, was not effective at 3 months in a randomized clinical trial but showed efficacy at 12 months in a large case series. For the other TACs (ie, paroxysmal hemicrania, hemicrania continua, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms), only case reports and case series are available to guide physicians in everyday management. Conclusions and Relevance The accumulation of epidemiologic, pathophysiologic, natural history knowledge, and data from case series and small controlled trials, especially over the past 20 years from investigators around the world, has added to the previously limited evidence and has helped advance and inform the treatment approach to rare TACs, which can be extremely challenging for clinicians.
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Affiliation(s)
- Hans Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Department of Neuroepidemiology, University Duisburg-Essen, Essen, Germany
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science & Neurorehabilitation Centre, IRCCS C., Mondino Foundation, Pavia, Italy
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Phoenix, Arizona
- Atria Institute, New York, New York
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Abstract
Cluster headache belongs to the group of trigeminal autonomic headaches. This review summarizes drug therapy of cluster attacks and prophylactic treatment. Neurostimulation methods are not addressed. The therapy for acute cluster attacks includes inhalation of 100% oxygen, subcutaneous administration of sumatriptan, and intranasal application of sumatriptan or zolmitriptan. Bridging therapy, which is used until oral prophylactic therapy is effective, is performed either with oral prednisolone or with a pharmacological block of the major occipital nerves. Best documented drugs for preventive treatment of cluster headache are verapamil and lithium, and possibly effective drugs are gabapentin, topiramate, divalproex sodium, and melatonin. The efficacy of monoclonal antibodies to the calcitonin gene-related peptide so far has been only demonstrated for episodic cluster headache. Several drug therapies are being investigated including ketamine, onabotulinumtoxinA, lysergic acid, and sodium oxybate.
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Affiliation(s)
- Hans Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Medical Faculty of the University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Arne May
- Department of Systems Neuroscience, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
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5
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Cluster headache pathophysiology - insights from current and emerging treatments. Nat Rev Neurol 2021; 17:308-324. [PMID: 33782592 DOI: 10.1038/s41582-021-00477-w] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 02/01/2023]
Abstract
Cluster headache is a debilitating primary headache disorder that affects approximately 0.1% of the population worldwide. Cluster headache attacks involve severe unilateral pain in the trigeminal distribution together with ipsilateral cranial autonomic features and a sense of agitation. Acute treatments are available and are effective in just over half of the patients. Until recently, preventive medications were borrowed from non-headache indications, so management of cluster headache is challenging. However, as our understanding of cluster headache pathophysiology has evolved on the basis of key bench and neuroimaging studies, crucial neuropeptides and brain structures have been identified as emerging treatment targets. In this Review, we provide an overview of what is known about the pathophysiology of cluster headache and discuss the existing treatment options and their mechanisms of action. Existing acute treatments include triptans and high-flow oxygen, interim treatment options include corticosteroids in oral form or for greater occipital nerve block, and preventive treatments include verapamil, lithium, melatonin and topiramate. We also consider emerging treatment options, including calcitonin gene-related peptide antibodies, non-invasive vagus nerve stimulation, sphenopalatine ganglion stimulation and somatostatin receptor agonists, discuss how evidence from trials of these emerging treatments provides insights into the pathophysiology of cluster headache and highlight areas for future research.
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6
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Courault P, Demarquay G, Zimmer L, Lancelot S. Cluster headache: state of the art of pharmacological treatments and therapeutic perspectives. Fundam Clin Pharmacol 2020; 35:595-619. [DOI: 10.1111/fcp.12636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/13/2020] [Accepted: 12/03/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Pierre Courault
- Lyon Neuroscience Research Center (CRNL) Université de LyonCNRSINSERM Lyon France
- Hospices Civils de Lyon (HCL) Lyon France
| | | | - Luc Zimmer
- Lyon Neuroscience Research Center (CRNL) Université de LyonCNRSINSERM Lyon France
- Hospices Civils de Lyon (HCL) Lyon France
- CERMEP‐Imaging Platform Groupement Hospitalier Est Bron France
- National Institute for Nuclear Science and Technology (INSTN) CEA Saclay France
| | - Sophie Lancelot
- Lyon Neuroscience Research Center (CRNL) Université de LyonCNRSINSERM Lyon France
- Hospices Civils de Lyon (HCL) Lyon France
- CERMEP‐Imaging Platform Groupement Hospitalier Est Bron France
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7
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Abstract
Abstract
Purpose of review
Among the spectrum of pain conditions, cluster headache represents one of the most severe. Targeted therapies for cluster headache are evolving thus improving the available therapeutic armamentarium. A better understanding of the currently available therapies, as well as new and emerging options, may aide physicians to manage affected sufferers better by evolving treatment guidance.
Recent findings
While classic first-line medications are useful in some patients with cluster headache, they are often accompanied by significant side effects that limit their use. Recently, novel treatments with better tolerability and decreased medication interactions have proven to be effective. A remarkable example of this is the blockage of the calcitonin gene-related peptide pathway with monoclonal antibodies, which may be a key element in the future treatment of cluster headache. The sphenopalatine ganglion and vagus nerve perform a critical role in the regulation of pain and the trigeminal autonomic reflex. Neuromodulation therapies targeting these structures have shown excellent tolerability and few significant adverse events, constituting a promising form of treatment. Finally, several potential therapeutic targets are examined in this review, such as small molecule CGRP receptor antagonists, known as gepants, and serotonin receptor 5-HT1F receptor agonists: ditans.
Summary
In summary, a deepening of the understanding of cluster headache mechanisms in recent years has driven the evolution of sophisticated therapeutic approaches that could allow a new era in the treatment of this difficult condition.
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8
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Abstract
Cluster headache is characterised by attacks of excruciating unilateral headache or facial pain lasting 15 min to 3 h and is seen as one of the most intense forms of pain. Cluster headache attacks are accompanied by ipsilateral autonomic symptoms such as ptosis, miosis, redness or flushing of the face, nasal congestion, rhinorrhoea, peri-orbital swelling and/or restlessness or agitation. Cluster headache treatment entails fast-acting abortive treatment, transitional treatment and preventive treatment. The primary goal of prophylactic and transitional treatment is to achieve attack freedom, although this is not always possible. Subcutaneous sumatriptan and high-flow oxygen are the most proven abortive treatments for cluster headache attacks, but other treatment options such as intranasal triptans may be effective. Verapamil and lithium are the preventive drugs of first choice and the most widely used in first-line preventive treatment. Given its possible cardiac side effects, electrocardiogram (ECG) is recommended before treating with verapamil. Liver and kidney functioning should be evaluated before and during treatment with lithium. If verapamil and lithium are ineffective, contraindicated or discontinued because of side effects, the second choice is topiramate. If all these drugs fail, other options with lower levels of evidence are available (e.g. melatonin, clomiphene, dihydroergotamine, pizotifen). However, since the evidence level is low, we also recommend considering one of several neuromodulatory options in patients with refractory chronic cluster headache. A new addition to the preventive treatment options in episodic cluster headache is galcanezumab, although the long-term effects remain unknown. Since effective preventive treatment can take several weeks to titrate, transitional treatment can be of great importance in the treatment of cluster headache. At present, greater occipital nerve injection is the most proven transitional treatment. Other options are high-dose prednisone or frovatriptan.
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9
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Abstract
Cluster headache is a strictly unilateral headache that occurs in association with cranial autonomic features. It is an excruciating syndrome and is probably one of the most painful conditions known to mankind with female patients describing each attack as being worse than childbirth. In most patients, it has a striking circannual and circadian periodicity. This disorder has a highly stereotyped clinical phenotype and responds to specific therapies, thereby underlying the importance of distinguishing it from other primary headache syndromes. In this review, the clinical manifestations, differential diagnosis, diagnostic workup and treatment options for this syndrome have been outlined.
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Affiliation(s)
- Manjit S Matharu
- Headache Group, Institute of Neurology, Queen Square, London, WC1N 3BG, UK
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10
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van Passel L, Arif H, Hirsch LJ. Topiramate for the treatment of epilepsy and other nervous system disorders. Expert Rev Neurother 2014; 6:19-31. [PMID: 16466308 DOI: 10.1586/14737175.6.1.19] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Initially synthesized as an oral hypoglycemic agent, topiramate was approved for use as an anticonvulsant in 1996. Its broad spectrum efficacy in epilepsy, including as monotherapy and in children, is well established. Topiramate has also been used in the management of nonepileptic neurologic and psychiatric conditions, including migraine prophylaxis (with firmly established efficacy), obesity (with some evidence of long-term maintenance of weight loss), substance dependence, bipolar disorder and neuropathic pain, and it has been investigated as a possible neuroprotective agent. Paresthesias and cognitive side effects are the most common troublesome adverse effects. Recent trends towards lower doses may help achieve the best combination of efficacy and tolerability.
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Affiliation(s)
- Leonie van Passel
- Comprehensive Epilepsy Center, Neurological Institute, Columbia University, Box NI-135, New York, NY 10032, USA.
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11
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Lambru G, Matharu MS. Trigeminal autonomic cephalalgias: A review of recent diagnostic, therapeutic and pathophysiological developments. Ann Indian Acad Neurol 2012; 15:S51-61. [PMID: 23024564 PMCID: PMC3444219 DOI: 10.4103/0972-2327.100007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 09/16/2011] [Accepted: 11/24/2011] [Indexed: 11/25/2022] Open
Abstract
The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders that are characterized by strictly unilateral trigeminal distribution pain occurring in association with ipsilateral cranial autonomic symptoms. This group includes cluster headache, paroxysmal hemicrania and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. These disorders are very painful, often considered to be some of the most painful conditions known to mankind, and consequently are highly disabling. They are distinguished by the frequency of attacks of pain, the length of the attacks and very characteristic responses to medical therapy, such that the diagnosis can usually be made clinically, which is important because it dictates therapy. The management of TACs can be very rewarding for physicians and highly beneficial to patients.
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Affiliation(s)
- Giorgio Lambru
- Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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12
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Disability in chronic daily headache: state of the art and future directions. Neurol Sci 2011; 32 Suppl 1:S71-6. [DOI: 10.1007/s10072-011-0552-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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13
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Valguarnera F, Tanganelli P. The efficacy of withdrawal therapy in subjects with chronic daily headache and medication overuse following prophylaxis with topiramate and amitriptyline. Neurol Sci 2010; 31 Suppl 1:S175-7. [PMID: 20464616 DOI: 10.1007/s10072-010-0319-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Management of patients affected by chronic daily headache (CDH) with medication overuse constitutes one of the most important unresolved problems. The uncertainty regarding the classification and the prophylaxis are a remarkable part of this problem. Objectives are to: (1) to evaluate the efficacy of withdrawal therapy following prophylaxis with topiramate and amitriptyline in a population affected by CDH and medication overuse with follow-up at 1 (T1), 3 (T2) and 6 (T3) months; (2) to identify which group of the Silberstein's CDH classification (1994) may benefit from this protocol. Inclusion criteria are patients with CDH (headache for more >15 days/month for at least 3 consecutive months) and medication overuse according with IHS second edition (8.2 group); exclusion criteria are patients with secondary headache. All patients included in the study were hospitalized for 1 week. Type of overuse: combination of medications, 38%; analgesics, 29%; triptans, 29%; opioids, 2%; ergotamines, 2%. During hospitalization the following protocol was applied: desametasone 4 mg i.v./day for 1 week, diazepam 6 mg/day for 10 days and prophylaxis with amitriptylin plus topiramate. This prophylaxis was protracted for at least 6 months. The dosages assumed ranged for amitriptylin from 10 to 20 mg/day and for topiramate from 50 to 100 mg/day. In the last 4 years 105 patients with CDH (age 24-89 years; f 96; m 9) were admitted to the hospital. The protocol was applied in 52 patients (age, 29-65 years; f 49; m 3). At T1, 89% of the patients did not fall again into medication overuse; at T2, 64%; and at T3,45% of the patients remained free from overuse. According to the Silberstein' proposal at T1, 93% of the subjects was affected by transformed migraine; and 7% by tension-type headache. At T3, all the patients free from overuse were affected by transformed migraine. Our data suggest that the patients affected by CDH and medication overuse benefit from withdrawal therapy performed during hospitalization plus prophylaxis with amitriptyline plus topiramate. This combination seems a good pharmacological solution to reduce the risk of relapse.
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Affiliation(s)
- Fabio Valguarnera
- Department Head-Neck, ASL 3 Genovese, P.A. Micone Hospital, Largo N. Rosso 2, 16154, Genoa, Italy
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14
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Pharmacological prophylaxis of chronic migraine: a review of double-blind placebo-controlled trials. Neurol Sci 2010; 31 Suppl 1:S23-8. [DOI: 10.1007/s10072-010-0268-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Carmona S, Bruera O. Prophylatic treatment of migraine and migraine clinical variants with topiramate: an update. Ther Clin Risk Manag 2009; 5:661-9. [PMID: 19707282 PMCID: PMC2731022 DOI: 10.2147/tcrm.s3427] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Indexed: 11/23/2022] Open
Abstract
Migraine and migraine variants are common, chronic and incapacitating neurovascular disorders with a high impact on health resources. There is an extensive evidence base provided by double-blind, placebo-controlled trials showing that topiramate is a safe, effective and well tolerated drug in the management of migraine and its variants, being especially promising in the management of migraine-vertigo syndrome. Models both in the US and the UK have also shown that it offers a cost benefit when direct and indirect costs are evaluated, by reducing work loss, improving quality of life and reducing the use of increasingly scarce health resources.
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Affiliation(s)
- Sergio Carmona
- Department of Neuro-otology and Pain and Headache, Instituto de Neurociencias de Buenos Aires INEBA, Buenos Aires, Argentina
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16
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Abstract
Chronic paroxysmal hemicrania (CPH) is a rare primary headache syndrome, which is classified along with cluster headache and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) as a trigeminal autonomic cephalalgia. CPH is exquisitely responsive to indomethacin, so much so that the response is one of the current diagnostic criteria. The case of a patient with CPH, who had marked epigastric symptoms with indomethacin treatment and responded well to topiramate 150 mg daily, is reported. Cessation of topiramate caused return of episodes, and the response has persisted for 2 years. Topiramate may be a treatment option in CPH.
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Affiliation(s)
- A S Cohen
- Headache Group, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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17
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Grazzi L, Andrasik F, Usai S, Bussone G. Treatment of chronic migraine with medication overuse: is drug withdrawal crucial? Neurol Sci 2009; 30 Suppl 1:S85-8. [DOI: 10.1007/s10072-009-0079-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Abstract
Advances in our understanding of the pathophysiology of migraine have resulted in important breakthroughs in treatment. For example, understanding of the role of serotonin in the cerebrovascular circulation has led to the development of triptans for the acute relief of migraine headaches, and the identification of cortical spreading depression as an early central event associated wih migraine has brought renewed interest in antiepileptic drugs for migraine prophylaxis. However, migraine still remains inadequately treated. Indeed, it is apparent that migraine is not a single disease but rather a syndrome that can manifest itself in a variety of pathological conditions. The consequences of this may be that treatment needs to be matched to particular patients. Clinical research needs to be devoted to identifying which sort of patients benefit best from which treatments, particularly in the field of prophylaxis. We propose four patterns of precipitating factors (adrenergic, serotoninergic, menstrual, and muscular) which may be used to structure migraine prophylaxis. Finally, little is known about long-term outcome in treated migraine. It is possible that appropriate early prophylaxis may modify the long-term course of the disease and avoid late complications.
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Affiliation(s)
- Michel Dib
- Fédération du système nerveux central, Hôpital de la Salpêtrière, Assistance Publique- Hôpitaux de Paris, France
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19
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Colombo B, Dalla Libera D, Annovazzi PO, Comi G. Headache therapy with neuronal stabilising drugs. Neurol Sci 2008; 29 Suppl 1:S131-6. [DOI: 10.1007/s10072-008-0904-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Straube A, May A, Kropp P, Katsarava Z, Haag G, Lampl C, Sándor P, Diener HC, Evers S. Therapie primärer chronischer Kopfschmerzen. Schmerz 2008; 22:531-34, 536-40, 542-3. [DOI: 10.1007/s00482-008-0645-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Headache with medication overuse: treatment strategies and proposals of relapse prevention. Neurol Sci 2008; 29:93-8. [DOI: 10.1007/s10072-008-0867-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Accepted: 03/10/2008] [Indexed: 10/22/2022]
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22
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Coppola F, Rossi C, Mancini ML, Corbelli I, Nardi K, Sarchielli P, Calabresi P. Language disturbances as a side effect of prophylactic treatment of migraine. Headache 2008; 48:86-94. [PMID: 18184290 DOI: 10.1111/j.1526-4610.2007.00860.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Language disturbances have been previously described as word-finding difficulties in epileptic patients. These disturbances have been recently reported in migraineurs in treatment with topiramate but they have never been defined and assessed in these patients with the aid of neuropsychological testing. OBJECTIVE To verify the occurrence of language disturbances as a side effect of topiramate treatment in episodic and chronic migraine patients. METHODS Language disturbances were recorded on the basis of spontaneous reports of 30 migraine patients treated with topiramate and 2 control groups (20 patients treated with other prophylactic drugs and 20 patients without prophylactic treatment) and were explored with neuropsychological tests. Psychiatric comorbidity was assessed using Zung Anxiety and Depression Scales. RESULTS Language disturbances were referred by 26.7% (n=8) of patients during topiramate treatment but by none of the patients in the 2 control groups. All patients in the topiramate group had a worse performance on all tests compared to patients of the 2 control groups. Moreover, in the topiramate group, patients with referred language disturbances had higher scores for all neuropsychological test variables, indicative of a worse performance. Some language functions (Trail Making Tests A and B) seemed to be influenced by the concomitant presence of psychiatric comorbidities, particularly anxiety and depression. CONCLUSION It can be hypothesized that a disorder such as migraine, which involves numerous cortical and subcortical circuits implicated in the transmission and behavioral and emotional processing of pain, represents a facilitated substrate for the occurrence of language disturbances due to topiramate. This could be the expression of a more generalized impairment of cognitive processing. These aspects should be investigated in prospective studies involving larger migraine patient samples.
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Affiliation(s)
- Francesca Coppola
- Neurologic Clinic, Department of Medical and Surgical Specialties and Public Health, University of Perugia, Italy
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Millán-Guerrero RO, Isais-Millán R, Barreto-Vizcaíno S, Gutiérrez I, Rivera-Castaño L, Trujillo-Hernández B, Baltazar LM. Subcutaneous histamine versus topiramate in migraine prophylaxis: a double-blind study. Eur Neurol 2008; 59:237-42. [PMID: 18264012 DOI: 10.1159/000115637] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Accepted: 08/31/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Histamine has a selective affinity for H3 receptors and it may specifically inhibit the neurogenic edema response involved in migraine pathophysiology. OBJECTIVE To evaluate the therapeutic potential of subcutaneous administration of histamine in migraine prophylaxis, compared with oral administration of topiramate. METHODS Ninety patients with migraine were selected in a 12-week double-blind controlled clinical trial to evaluate the efficacy of subcutaneous administration of histamine (1-10 ng twice a week) compared with oral administration of topiramate (100 mg daily dose). The variables studied were: headache intensity, frequency, duration, analgesic intake and Migraine Disability Assessment. RESULTS The data collected during the 12 weeks of treatment revealed that headache symptoms improved in both the histamine and topiramate groups, which was evident within the first month after the initiation of treatment, with statistically significant (p < 0.001) reductions in headache frequency (50%), Migraine Disability Assessment score (75%), intensity of pain (51%), duration of migraine attacks (45%), as well as in the use of rescue medication (52%). CONCLUSION The present study provides evidence of the efficacy of subcutaneously applied histamine and orally administered topiramate in migraine prophylaxis. Subcutaneously applied histamine may represent a novel and effective therapeutic alternative in resistant migraine patients.
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Affiliation(s)
- R O Millán-Guerrero
- Department of Neurology, Unidad de Investigación Médica en Epidemiología Clínica, Hospital General de Zona UMF No 1 IMSS Colima, Colima, México.
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24
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Dowson AJ, Kilminster SG, Salt R. Clinical Profile of Botulinum Toxin A in Patients with Chronic Headaches and Cervical Dystonia. Drugs R D 2008; 9:147-58. [DOI: 10.2165/00126839-200809030-00002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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25
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Dowson A, Bundy M, Salt R, Kilminster S. Patient Preference for Triptan Formulations: A Prospective Study With Zolmitriptan. Headache 2007; 47:1144-51. [DOI: 10.1111/j.1526-4610.2007.00805.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Lakshmi CVS, Singhi P, Malhi P, Ray M. Topiramate in the prophylaxis of pediatric migraine: a double-blind placebo-controlled trial. J Child Neurol 2007; 22:829-35. [PMID: 17715274 DOI: 10.1177/0883073807304201] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Several large, randomized controlled trials have demonstrated the efficacy of topiramate in migraine prophylaxis in adults. However, there are limited data about the use of topiramate in migraine prophylaxis in children. We conducted this single-center, double-blind, placebo-controlled trial to evaluate the efficacy and safety of topiramate in the prophylaxis of migraine in children. A total of 44 children with migraine were randomized using random number tables to receive topiramate (n = 22) or placebo (n = 22). The total duration of treatment was 4 months, including a baseline period of 1 month during which topiramate was titrated weekly in 25-mg increments to 100 mg/d in 2 divided doses or to the maximum tolerated dose. The titration was followed by a 12-week maintenance phase during which topiramate was given in 2 divided doses. The primary outcome measures were the reduction in the mean migraine frequency and severity of headache. Secondary outcome measures included the number of times analgesics were required for a month for acute attacks and functional disability. Functional disability was measured by comparing school absenteeism and Pediatric Migraine Disability Assessment Scale (PedMIDAS). The decrease in mean (+/-SD) monthly migraine frequency from 16.14 (+/-9.35) at baseline to 4.27 (+/-1.95) at the end of the study in the topiramate group was significantly greater as compared with a decrease from 13.38 (+/-7.78) to 7.48 (+/-5.94) at the end of the study in the placebo group (P = .025). The difference in number of rescue medications used for topiramate and placebo was not statistically significant (P = .059). There was a statistically significant decrease in the PedMIDAS score from 50.66 (+/-32.1) to 10.42 (+/-6.39) at the end of the study in the topiramate group compared with a decrease from 42.66 (+/-27.5) to 23.7 (+/-19.1) at the end of 4 months in the placebo group (P = .003). The decrease in school absenteeism was significant with topiramate compared with placebo (P = .002). Weight loss, decreased concentration in school, sedation, and parasthesias were important side effects with topiramate. Most of these side effects were mild to moderate and were not significant enough to cause dropout from the study.
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Affiliation(s)
- C V S Lakshmi
- Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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27
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Abstract
The trigeminal autonomic cephalgias include cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). The evidence for the current treatment options for each of these syndromes is considered, including oxygen, sumatriptan, and verapamil in cluster headache, indomethacin in paroxysmal hemicrania, and intravenous lidocaine and lamotrigine in SUNCT. Some treatments such as topiramate have an effect in all of these, as well as in migraine and other pain syndromes. The involvement of the hypothalamus in functional imaging studies implies that this may be a substrate for targeting treatment options in the future.
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Affiliation(s)
- Anna S Cohen
- Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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28
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Benoliel R, Sharav Y, Eliav E. Painful posttraumatic trigeminal neuropathy: a case report of relief with topiramate. Cranio 2007; 25:57-62. [PMID: 17304919 DOI: 10.1179/crn.2007.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A case of chronic neuropathic pain in the infraorbital region following an untreated displaced zygomatic fracture is presented. The case responded favorably to topiramate and sensory testing revealed signs of nerve damage that remained unchanged over the follow-up period (six months) parallel to an analgesic effect. The clinical pharmacology of topiramate, which is reviewed, includes enhanced neuronal stability and neuroprotection, making it a possible candidate in the treatment of painful orofacial neuropathies.
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Affiliation(s)
- Rafael Benoliel
- Dept. of Oral Medicine, The Hebrew University, Hadassah Faculty of Dental Medicine, P.O.B. 12272, Jerusalem 91120, Israel.
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29
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Ettinger AB, Argoff CE. Use of antiepileptic drugs for nonepileptic conditions: psychiatric disorders and chronic pain. Neurotherapeutics 2007; 4:75-83. [PMID: 17199018 PMCID: PMC7479709 DOI: 10.1016/j.nurt.2006.10.003] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Antiepileptic drugs (AEDs) are commonly utilized for nonepileptic conditions, including various psychiatric disorders and pain syndromes. Evidence for their benefit in these nonepileptic conditions varies widely among different drugs, but there is, in general, a paucity of published multicenter randomized double-blind trials. Variable levels of evidence suggest that lamotrigine and the vagal nerve stimulator have antidepressant properties. Carbamazepine, valproate, lamotrigine, and oxcarbazepine appear to have mood stabilizing properties while gabapentin, pregabalin, and tiagabine have anxiolytic benefits. Barbiturates, topiramate, and possibly phenytoin may precipitate or exacerbate depression. Underlying depression and anxiety symptoms may be exacerbated by levetiracetam, while psychotic symptoms have rarely been reported with topiramate, levetiracetam, and zonisamide. Pregabalin, gabapentin, carbamazepine, and oxcarbazepine have been used to treat neuropathic pain such as postherpetic neuralgia, and diabetic polyneuropathy. Topiramate and divalproex sodium have utility in the prophylaxis or acute treatment of migraine. Further rigorous studies are needed to clarify the utility of AEDs in nonepileptic conditions.
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Affiliation(s)
- Alan B Ettinger
- North Shore-Long Island Jewish Health System, New Hyde Park, New York 11040, USA.
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30
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Goadsby PJ. Neuromodulatory approaches to the treatment of trigeminal autonomic cephalalgias. ACTA NEUROCHIRURGICA. SUPPLEMENT 2007; 97:99-110. [PMID: 17691295 DOI: 10.1007/978-3-211-33081-4_12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The trigeminal autonomic cephalalgias (TACs) are a group of primary headache syndromes characterised by intense pain and associated activation of cranial parasympathetic autonomic outflow pathways out of proportion to the pain. The TACs include cluster headache, paroxysmal hemicrania and SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing). The pathophysiology of these syndromes involves activation of the trigeminal-autonomic reflex, whose afferent limb projects into the trigeminocervical complex in the caudal brainstem and upper cervical spinal cord. Functional brain imaging has shown activations in the posterior hypothalamic grey matter in TACs. This paper reviews the anatomy and physiology of these conditions and the brain imaging findings. Current treatments are summarised and the role of neuromodulation procedures, such as occipital nerve stimulation and deep brain stimulation in the posterior hypothalamus are reviewed. Neuromodulatory procedures are a promising avenue for these highly disabled patients with treatment refractory TACs.
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Affiliation(s)
- P J Goadsby
- The National Hospital for Neurology and Neurosurgery, Institute of Neurology, Queen Square, London, UK.
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31
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Samsam M, Coveñas R, Ahangari R, Yajeya J, Narváez J. Role of neuropeptides in migraine: where do they stand in the latest expert recommendations in migraine treatment? Drug Dev Res 2007. [DOI: 10.1002/ddr.20193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Cohen AS, Goadsby PJ. Paroxysmal hemicrania responding to topiramate. J Neurol Neurosurg Psychiatry 2007; 78:96-7. [PMID: 17172571 PMCID: PMC2117807 DOI: 10.1136/jnnp.2006.096651] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Revised: 06/24/2006] [Accepted: 07/21/2006] [Indexed: 11/03/2022]
Abstract
Chronic paroxysmal hemicrania (CPH) is a rare primary headache syndrome, which is classified along with cluster headache and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) as a trigeminal autonomic cephalalgia. CPH is exquisitely responsive to indomethacin so much so that the response is one of the current diagnostic criteria. The case of a patient with CPH, who had marked epigastric symptoms with indomethacin treatment and responded well to topiramate 150 mg daily, is reported. Cessation of topiramate caused return of episodes, and the response has persisted for 2 years. Topiramate may be a treatment option in CPH.
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Affiliation(s)
- A S Cohen
- Headache Group, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Karslioğlu EH, Karakiliç H, Taner E, Coşar B. Topiramate-induced psychotic exacerbation: case report and review of literature. Int J Psychiatry Clin Pract 2007; 11:285-90. [PMID: 24940728 DOI: 10.1080/13651500601117215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background. Topiramate (TPM) is a new antiepileptic drug that is used mainly in the treatment of refractory partial epileptic seizures. There are some studies reporting TPM's effectiveness in the treatment and maintenance of some psychiatric illnesses such as acute mania, some other affective disorders, post-traumatic stress disorder and binge-eating disorder. On the other hand, it has been shown that TPM may cause mild to moderate cognitive impairment and is thought to be responsible for a series of neuro-psychiatric signs and symptoms. Some of the available articles that have mentioned the relationship of psychotic symptoms and topiramate usage are discussed. Objective. The present paper aims to discuss a case of psychotic exacerbation purported to occur after TPM administration and to review specifically the literature on TPM's potential for inducing psychotic symptoms. The patient presented here is thought to be an undiagnosed schizophrenia patient until his admission to our clinic (Department of Psychiatry, Gazi University Medical School) with TPM-exacerbated psychotic symptoms. Conclusions. The current findings are still subject to controversy because of the presence of both individual case reports and case series on the association between appearance of psychotic symptoms and TPM usage.
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Abstract
Hypnic headache is a rare cause of benign headache in the elderly. This is a clinical report of a 67-year-old housewife, suffering from hypnic headache, in which topiramate yielded a successful prophylactic effect at 100 mg/day.
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Affiliation(s)
- Marco Guido
- Azienda Ospedaliero-Universitaria Ospedali Riuniti, Medical and Neurological Sciences, Clinic of Nervous System Diseases, University of Foggia, Italy
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36
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Abstract
Current migraine preventive therapies are often unsatisfactory because of their limited efficacy, adverse effects, and drug interactions. An open-label, non-controlled study of botulinum toxin type A (BTX-A) suggested some benefits for patients with migraine. To assess the efficacy and safety of BTX-A, a randomized, double-blind, vehicle-controlled, parallel group study was conducted in 32 patients with a history of 2 to 8 migraine attacks per month, with or without aura. The patients were randomized to receive single administrations of 50-U BTX-A or vehicle injected into multiple sites of pericranial muscles at the same visit. Patients kept daily diaries in which they recorded outcome measures like migraine frequency, migraine severity, and the occurrence of migraine-associated symptoms. Patients graded symptoms on a 4-point scale ranging from grades 0 to 3 before and up to 3-months after treatment. The assessments were made at 0, 1, and 3 months. The primary efficacy parameters included number of headaches resolved (grade 3/2 to grade 0) and alleviation of other accompanying symptoms of migraine. The supplementary end point included improvement in quality of life (QOL). About 75% of patients reported complete relief to mild headache (grade 0-1) by BTX-A and none by placebo group. Patient' QOL parameters like energy/vitality and feelings and concerns about the treatment had shown considerable improvement. However, normal day-to-day work functioning and social interactions deteriorated. No adverse effects were reported in any of the patients in either of the groups during the study. It is evident from the study that pericranial injection of 50-U BTX-A showed good efficacy and tolerability as a prophylactic agent. However, this therapy will be expensive to the patients, but it is far superior in providing relief to the patients compared with existing therapies.
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Affiliation(s)
- K S Anand
- Ram Manohar Lohia Hospital, New Delhi, India.
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37
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Abstract
Migraine is a common primary headache disorder often associated with significant disability. While many individuals are able to limit therapy to acute treatment of attacks, others need medication to reduce the attack frequency and/or severity. Evidence-based guidelines exist regarding indications and goals for migraine preventive treatment. The specific prophylactic approach needs to be individualized taking into account multiple variables. Medications used in this task vary widely in proven efficacy and presumed mechanisms of action. This review's goal is to discuss the issues that guide the decision-making process in migraine preventive treatment.
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Affiliation(s)
- Ivan Garza
- Headache Division, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
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Kuhn J, Bewermeyer H. Behandlung eines atypischen und therapierefraktären Clusterkopfschmerzes mit Topiramat. Schmerz 2006; 20:160-3. [PMID: 15928910 DOI: 10.1007/s00482-005-0401-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cluster headache is the third most frequent type of primary cephalgia only exceeded in frequency by tension-type headache and migraine. Cluster headache is characterized by periodic attacks of unilateral excruciating pain and accompanying autonomic features. It is arguably the most disabling form of primary headache. Therefore, prompt recognition of this disorder is necessary to provide an opportunity for effective treatment. We report on a patient with cluster headache, who complained about an atypical interval of dull headache between the cluster attacks, thus excluding the differential diagnosis of hemicrania continua. The common drugs for acute cluster attacks proved to be ineffective as well as prophylactic treatment with steroids and verapamil. Only administration of topiramate led to relief of pain.
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Affiliation(s)
- J Kuhn
- Neurologische Klinik des Krankenhauses Merheim, Kliniken der Stadt Köln.
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39
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Grazzi L, Andrasik F. Medication-overuse headache: Description, treatment, and relapse prevention. Curr Pain Headache Rep 2006; 10:71-7. [PMID: 16499833 DOI: 10.1007/s11916-006-0012-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Medication-overuse headache (MOH) has increasingly become a focus within the field of headache. The biologic and physiopathologic origin for MOH likely resides in receptor physiology, but it also is probable that the initiation and sustaining dynamics of this pathologic condition involve several other factors. Not all patients with frequent headache eventually overuse their medications, but when it happens (the percentage is approximately 1%), the diagnosis of MOH is clinically important because patients rarely respond to preventive medications while overusing acute medications. Properly treating medication overuse and preventing relapse require recognition of the different factors that contribute to its development and perpetuation, including some behaviors and psychologic elements that are important in sustaining the overuse of medication. The problem regarding the diagnosis, the classification, and clinical aspects of MOH is reviewed in this article. The different therapeutic approaches, initial outcomes, and long-term durability of treatment also are discussed.
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Affiliation(s)
- Licia Grazzi
- Headache Center, Neurological Institute C.Besta, Milan, Italy.
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40
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Abstract
Medication-overuse headache (MOH) is a clinically important entity and it is now well documented that the regular use of acute symptomatic medication by people with migraine or tension-type headache increases the risk of aggravation of the primary headache. MOH is one the most common causes of chronic migraine-like syndrome. In this article, we analyse the possible mechanisms that underlie sensitization in MOH by comparing these mechanisms with those reported for other forms of drug addiction. Moreover, the evidence for cognitive impulsivity in drug overuse in headache and in other forms of addiction associated with dysfunction of the frontostriatal system will be discussed. An integrative hypothesis for compulsive reward-seeking in MOH will be presented.
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Affiliation(s)
- Paolo Calabresi
- Clinica Neurologica, Dipartimento di Neuroscienze, Università Tor Vergata, Rome, Italy.
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41
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Ozkara C, Ozmen M, Erdogan A, Yalug I. Topiramate related obsessive-compulsive disorder. Eur Psychiatry 2005; 20:78-9. [PMID: 15642451 DOI: 10.1016/j.eurpsy.2004.09.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Revised: 08/25/2004] [Accepted: 08/30/2004] [Indexed: 11/22/2022] Open
Affiliation(s)
- Cigdem Ozkara
- Department of Neurology, Istanbul University, Cerrahpasa Medical Faculty, Cerrahpasa Cad, Kocamustafapasa, 34230, Istanbul, Turkey.
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42
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Grazzi L, Andrasik F, D'Amico D, Usai S, Kass S, Bussone G. Disability in chronic migraine patients with medication overuse: treatment effects at 1-year follow-up. Headache 2004; 44:678-83. [PMID: 15209690 DOI: 10.1111/j.1526-4610.2004.04127.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine (1) the clinical course of a sample of chronic migraine patients with drug overuse 6 and 12 months following in-patient treatment and (2) whether functional impairment, assessed by the Migraine Disability Assessment (MIDAS) questionnaire, improved upon treatment. BACKGROUND Patients with chronic migraine and medication overuse are particularly difficult to treat (prophylactic medications that otherwise are effective become ineffective; discontinuation of the offending medication can lead to withdrawal headache; physical and emotional dependence can be present, as well as increased psychological involvement; initial treatment gains can be difficult to maintain). METHODS Of the 106 patients meeting criteria for chronic migraine with medication overuse, 84 went on to complete a structured in-patient treatment, consisting of medication withdrawal and then prophylactic treatment. RESULTS As a group, the patients were improved at both 6- and 12-month follow-up, with respect to two headache parameters (frequency and medication use) and three measures of functional impact extracted from the MIDAS questionnaire (Total Score, Headache Frequency, and Headache Intensity). CONCLUSION Chronic migraine accompanied with medication overuse led to the considerable disability prior to treatment. However, notable improvement occurred coincident with the treatment. This suggests that successful treatment has more wide-ranging positive benefits beyond mere symptom reduction. To our knowledge, this is the first investigation where the MIDAS questionnaire has been used prospectively as an outcome measure in patients with chronic migraine and medication overuse to assess disability subsequent to a semi-standardized treatment program.
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43
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Abstract
Cluster headache (CH) is a primary headache syndrome characterized by short-lasting unilateral head pain attacks accompanied by ipsilateral oculofacial autonomic phenomena. Approximately 20% of CH patients have the chronic form and need continuous medical care. In the chronic form, attacks continue unabated for years, often on a daily basis, resulting in severe debilitation. It is a common experience that drug treatments are able to control or prevent the attacks in approximately 80% of chronic CH patients. In the remaining 20% of chronic cases, drugs are ineffective. Until recently, the etiology of CH was poorly understood and this hampered the development of new therapies. However, we have now gained a much improved understanding of the peripheral and central mechanisms giving rise to the pain in CH and this has inspired the development of new treatment approaches, which, although still in the initial phases of validation, appear to be very promising. Among these, the novel approach based on hypothalamic deep brain stimulation is one of the most promising.
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Affiliation(s)
- Massimo Leone
- Centro Cefalee, Istituto Nazionale Neurologico, Carlo Besta, via Caloria 11, 20133 Milano, Italy.
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44
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Abstract
Cluster headache is a relatively rare episodic headache disorder.Although traditionally it is believed to be a male-related disorder,the sex ratios are changing toward a more even balance. The disorder is characterized by bouts of daily headaches with pain-free remissions for extended times. Though attacks are brief, they are severe and typically are associated with autonomic symptoms. Medical therapies are the mainstay of treatment, with the goal being prevention of headaches in a cycle. Acute therapies, although effective, may be limited in usefulness because of attack frequency. Intractable cases may benefit from histamine desensitization and surgical treatments.
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Affiliation(s)
- Frederick G Freitag
- Diamond Headache Clinic, Suite 500, 467 West Deming Place, Chicago, IL 60614, USA.
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45
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Abstract
The number of migraine treatments and our understanding of migraine pathophysiology are both increasing. Newer treatments focus on migraine prevention. Botulinum toxin (BTX) is a potent neurotoxin used primarily to treat diseases associated with increased muscle activity. Recently, BTX was found to have antinociceptive effects that are probably independent of its muscle-relaxant action. Clinical trials support the efficacy of BTX type A (and possibly also type B) in the treatment of migraine. The anticonvulsant topiramate was recently shown to be effective for migraine prevention. At the low doses used for this indication, cognitive side effects are not a major concern. Another new approach to migraine prevention is angiotensin type 1 (AT1) receptor blockade. The high tolerability of the AT1 receptor blocker candesartan warrants further studies to assess its role in migraine prevention.
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Affiliation(s)
- Avi Ashkenazi
- Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA
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46
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Krymchantowski AV, Tavares C, Penteado Jd JDC, Adriano M. Topiramato no tratamento preventivo da migrânea: experiência em um centro terciário. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:91-5. [PMID: 15122440 DOI: 10.1590/s0004-282x2004000100016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Crises freqüentes de migrânea requerem tratamento preventivo. Alguns anticonvulsivantes têm sido preconizados baseado na importância progressiva da hiperexcitabilidade cortical na fisiopatologia da migrânea. O topiramato é um desses medicamentos e sua eficácia foi demonstrada em estudos recentes. O objetivo deste estudo foi avaliar a aderência e resposta ao uso do topiramato em pacientes em tratamento em uma clínica especializada. Durante dois anos todos os pacientes para os quais o topiramato foi prescrito deveriam ser avaliados após três meses. Grau de aderência, redução da freqüência da cefaléia superior a 50% e efeitos adversos foram avaliados. Entre 175 pacientes incluídos, 134 (76,6%) aderiram ao seu uso. Houve redução da freqüência >50% em 82 (61,2%) dos pacientes. Em 105 (78,4%) pacientes ocorreu emagrecimento médio de 3,4 Kg e os efeitos colaterais mais observados foram parestesias (39,6%); distúrbios emocionais (17,9%); distúrbios do raciocínio (12,7%); distúrbios da memória (12,7%) e alterações no paladar em 11,9% dos pacientes estudados. Concluímos que o topiramato foi eficaz e houve aderência ao seu uso na maioria dos pacientes. Além disso, sua tolerabilidade foi aceitável. Estudos controlados são necessários para confirmar estas observações.
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47
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Lampl C, Bonelli S, Ransmayr G. Efficacy of Topiramate in Migraine Aura Prophylaxis: Preliminary Results of 12 Patients. Headache 2004; 44:174-6. [PMID: 14756858 DOI: 10.1111/j.1526-4610.2004.04036.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the efficacy of topiramate in the treatment of migraine aura. Antiepileptic drugs may be useful in migraine prevention through such mechanisms as acting directly on the nociceptive system or by modulating the biochemical phenomena of aura. Topiramate acts directly on N-methyl-d-aspartate and amino-3-hydroxy-5-methylisoxazole-4-propionic acid/kainate glutamate receptors and modulates calcium ion channel activity by inhibiting high-voltage-activated L-type calcium ion channels. METHODS Twelve patients with migraine with aura were enrolled in an open-label study and treated with topiramate for 6 months. The dose of topiramate was increased weekly by 25 mg up to a daily dose of 100 mg after 4 weeks. RESULTS In all 12 patients after 6 months of treatment, topiramate did not statistically influence aura frequency (P=.317) or duration (P=.480) compared with baseline. Mild to moderate side effects were observed, but they did not interfere with treatment. Consistent with previous observations, migraine frequency as well as headache intensity and duration improved statistically significantly. CONCLUSION Topiramate is not effective in preventing migraine aura.
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Affiliation(s)
- Christian Lampl
- Pain and Headache Centre, Department of Neurology and Psychiatry, General Hospital Linz, Austria
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Kanner AM, Wuu J, Faught E, Tatum WO, Fix A, French JA. A past psychiatric history may be a risk factor for topiramate-related psychiatric and cognitive adverse events. Epilepsy Behav 2003; 4:548-52. [PMID: 14527497 DOI: 10.1016/j.yebeh.2003.07.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Topiramate (TPM) is a new antiepileptic drug (AED) that has been found to be associated with a high prevalence of cognitive adverse events (CAEs). The prevalence of psychiatric adverse events (PAEs) has yet to be established. The purpose of this study was to determine the prevalence of PAEs related to TPM when used in polytherapy regimens in a large cohort of adult patients with epilepsy, to identify any association between the occurrences of CAEs and PAEs and to identify predictors of PAEs and CAEs. METHODS Investigators from 16 epilepsy centers (PADS group) prospectively obtained postmarketing safety and efficacy data on 596 patients aged 16 years and older. All data were recorded on standardized data retrieval forms, completed at the initial visit, while follow-up data were obtained every 6 months or at the time of discontinuation. RESULTS PAEs were identified in 75 (12.6%) patients: 30 (5%) experienced symptoms of depression and 34 (5.7%) of aggressive behavior and irritability, while 9 patients experienced symptoms of psychosis (1.5%). CAEs were reported by 247 (41.5%) patients. There was a significant association between the occurrences of CAEs and PAEs. A past psychiatric history was a predictor of CAEs, while older age and past psychiatric history were predictors of PAEs. CONCLUSIONS The use of TPM in polytherapy regimens can cause PAEs and CAEs and their occurrence is significantly correlated. Patients with a past psychiatric history may be at a higher risk for experiencing PAEs and CAEs.
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Affiliation(s)
- Andres M Kanner
- Department of Neurological Sciences, Rush-Presbyterian St. Luke's Medical Center, Rush Medical College, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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