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Zou Z, Fan W, Liu H, Liu Q, He H, Huang F. The roles of 5-HT in orofacial pain. Oral Dis 2024; 30:3838-3849. [PMID: 38622872 DOI: 10.1111/odi.14960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/10/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES Acute and chronic orofacial pain are very common and remain a vexing health problem that has a negative effect on the quality of life. Serotonin (5-HydroxyTryptamine, 5-HT) is a kind of monoamine neurotransmitter that is involved in many physiological and pathological processes. However, its role in orofacial pain remains inconclusive. Therefore, this review aims to summarize the recent advances in understanding the effect exerted by 5-HT on the modulation of orofacial pain. SUBJECTS AND METHODS An extensive search was conducted on PubMed and Web of Science for pertinent studies focusing on the effects of 5-HT on the modulation of orofacial pain. RESULTS In this review, we concisely review how 5-HT mediates orofacial pain, how 5-HT is regulated and how we can translate these findings into clinical applications for the prevention and/or treatment of orofacial pain. CONCLUSIONS 5-HT plays a key role in the modulation of orofacial pain, implying that 5-HT modulators may serve as effective treatment for orofacial pain. However, further research on the precise mechanisms underlying the modulation of orofacial pain is still warranted.
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Affiliation(s)
- Zhishan Zou
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Wenguo Fan
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Haotian Liu
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Qing Liu
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China
| | - Hongwen He
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Fang Huang
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
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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; 163:208.e1-208.e10. [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] [MESH Headings] [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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Puledda F, Sacco S, Diener HC, Ashina M, Al-Khazali HM, Ashina S, Burstein R, Liebler E, Cipriani A, Chu MK, Cocores A, Dodd-Glover F, Ekizoğlu E, Garcia-Azorin D, Göbel C, Goicochea MT, Hassan A, Hirata K, Hoffmann J, Jenkins B, Kamm K, Lee MJ, Ling YH, Lisicki M, Martinelli D, Monteith TS, Ornello R, Ozge A, Peres M, Pozo-Rosich P, Romanenko V, Schwedt TJ, Souza MNP, Takizawa T, Terwindt GM, Thuraiaiyah J, Togha M, Vandenbussche N, Wang SJ, Yu S, Tassorelli C. International Headache Society global practice recommendations for the acute pharmacological treatment of migraine. Cephalalgia 2024; 44:3331024241252666. [PMID: 39133176 DOI: 10.1177/03331024241252666] [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: 08/13/2024]
Abstract
BACKGROUND In an effort to improve migraine management around the world, the International Headache Society (IHS) has here developed a list of practical recommendations for the acute pharmacological treatment of migraine. The recommendations are categorized into optimal and essential, in order to provide treatment options for all possible settings, including those with limited access to migraine medications. METHODS An IHS steering committee developed a list of clinical questions based on practical issues in the management of migraine. A selected group of international senior and junior headache experts developed the recommendations, following expert consensus and the review of available national and international headache guidelines and guidance documents. Following the initial search, a bibliography of twenty-one national and international guidelines was created and reviewed by the working group. RESULTS A total of seventeen questions addressing different aspects of acute migraine treatment have been outlined. For each of them we provide an optimal recommendation, to be used whenever possible, and an essential recommendation to be used when the optimal level cannot be attained. CONCLUSION Adoption of these international recommendations will improve the quality of acute migraine treatment around the world, even where pharmacological options remain limited.
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Affiliation(s)
- Francesca Puledda
- Wolfson Sensory, Pain and Regeneration Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Hans-Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Messoud Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Haidar M Al-Khazali
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sait Ashina
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, USA
| | | | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Alexandra Cocores
- Department of Neurology - Headache Division, University of Miami, Miller School of Medicine, Miami, USA
| | - Freda Dodd-Glover
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Esme Ekizoğlu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - David Garcia-Azorin
- Headache Unit, Department of Neurology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Carl Göbel
- Kiel Migraine and Headache Centre, Kiel, Germany
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | | | - Amr Hassan
- Department of Neurology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Koichi Hirata
- Neurology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Jan Hoffmann
- Wolfson Sensory, Pain and Regeneration Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Katharina Kamm
- Department of Neurology, Klinikum der Universitat Munchen, Munich, Germany
| | - Mi Ji Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yu-Hsiang Ling
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Instituto de Investigación Médica Mercedes y Martín Ferreyra (INIMEC), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Marco Lisicki
- Instituto de Investigación Médica Mercedes y Martín Ferreyra (INIMEC), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Córdoba, Córdoba, Argentina
| | | | - Teshamae S Monteith
- Department of Neurology - Headache Division, University of Miami, Miller School of Medicine, Miami, USA
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Aynur Ozge
- Mersin University School of Medicine, Mersin, Turkey
| | - Mario Peres
- Institute of Psychiatry, HCFMUSP, Sao Paulo, Brazil
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron and Headache & Neurological Pain Research Group, Vall d'Hebron Institute of Research, Barcelona, Spain
| | | | | | | | - Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Janu Thuraiaiyah
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Mansoureh Togha
- Neurology ward, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Headache department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nicolas Vandenbussche
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Department of Neurology, AZ Sint-Jan Brugge, Bruges, Belgium
| | - Shuu-Jiun Wang
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Cristina Tassorelli
- IRCCS Mondino Foundation, Headache Science Center, Pavia, Italy
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
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Göbel CH, Heinze A, Cirkel A, Göbel H. Rizatriptan as an Over-the-Counter Triptan in the Treatment of Migraine Attacks. Pain Ther 2024; 13:813-827. [PMID: 38886287 PMCID: PMC11255172 DOI: 10.1007/s40122-024-00625-2] [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: 05/12/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Abstract
Around 91% of migraine patients use over-the-counter medicines to treat attacks, often without further treatment or medical consultation. This therapeutic principle is established in most countries, regardless of how the healthcare system is otherwise structured or financed. Using Germany as an example, the basis for an expansion of attack therapy with rizatriptan as an over-the-counter triptan is described. To achieve the best possible tolerability and safety in the context of self-medication, the lowest possible dose should be selected to provide the most favourable tolerability and safety profile in the context of self-medication through low dosages. The lowest approved dose of rizatriptan is 5 mg. This was investigated in three randomized controlled trials with 752 patients. The results show that rizatriptan at a dose of 5 mg is more effective than the triptans naratriptan 2.5 mg, almotriptan 12.5 mg and sumatriptan 50 mg, which were previously available for self-medication in Germany. There was no significant difference in the frequency of adverse events with rizatriptan 5 mg compared to placebo. Rizatriptan 5 mg does not have a higher side effect potential than sumatriptan 50 mg, which is already exempt from the prescription requirement. The reasons given show that rizatriptan in a dose of 5 mg for the treatment of acute migraine attacks fulfils the requirements for a transfer from prescription to pharmacy-only status at least as well as sumatriptan 50 mg, naratriptan 2.5 mg and almotriptan 12.5 mg. From a clinical care perspective, it is desirable for affected patients to have other options available for self-medication. Non-responders to other substances also have a further treatment option with rizatriptan 5 mg, with the same or even better risk-benefit profile, to treat migraine attacks safely, effectively and in a tolerable manner as part of self-medication.
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Affiliation(s)
- Carl H Göbel
- Kiel Migraine and Headache Centre, Heikendorfer Weg 9-27, 24149, Kiel, Germany.
| | - Axel Heinze
- Kiel Migraine and Headache Centre, Heikendorfer Weg 9-27, 24149, Kiel, Germany
| | - Anna Cirkel
- Kiel Migraine and Headache Centre, Heikendorfer Weg 9-27, 24149, Kiel, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Hartmut Göbel
- Kiel Migraine and Headache Centre, Heikendorfer Weg 9-27, 24149, Kiel, Germany
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Stubberud A, Borkenhagen S, Oteiza F, Dueland AN, Bugge C, Sæther EM, Tronvik E, Stovner LJ, Bjørk MH. Patterns of migraine medication use in Norway: A nationwide registry-based observational study. Cephalalgia 2024; 44:3331024241268212. [PMID: 39149980 DOI: 10.1177/03331024241268212] [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: 08/17/2024]
Abstract
OBJECTIVE The objective of this study was to describe and discuss patterns of migraine medication use in the entire Norwegian population. METHODS In this nationwide, observational study, all individuals with a migraine-related prescription between 2010 and 2020 were identified using the Norwegian Prescription Database. The outcomes of interest were the incidence and 1-year prevalence of migraine medication users, as well as individuals with triptan overuse. Patterns of medication use were statistically compared between women and men adjusted for age, year of treatment start, comorbidities and county of residence calculating adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS We identified 327,904 migraine medication users. The incidence ranged from 0.39% to 0.46%, and the 1-year prevalence increased from 1.99% to 2.99%. Preventive use increased >50% during the study period. Preventives were significantly more often prescribed to women than to men (39.72% vs. 33.75%; aOR 1.41, 95% CI 1.38 to 1.44). Triptan overuse was significantly more common among women, but women with overuse were more often using preventives, as compared to men (56.64% vs 52.69%; aOR = 1.43, 95% CI 1.37 to 1.49). CONCLUSION The prevalence of medically treated migraine is low. Overuse of triptans is frequent, especially among women. Clinicians should be encouraged to try out different triptans, recognize triptan overuse, and prescribe preventives when indicated.
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Affiliation(s)
- Anker Stubberud
- NorHEAD Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | | | - Christoffer Bugge
- Oslo Economics, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | | | - Erling Tronvik
- NorHEAD Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St Olavs University Hospital, Trondheim, Norway
| | - Lars Jacob Stovner
- NorHEAD Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St Olavs University Hospital, Trondheim, Norway
| | - Marte-Helene Bjørk
- NorHEAD Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
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Reina-Varona Á, Madroñero-Miguel B, Fierro-Marrero J, Paris-Alemany A, La Touche R. Efficacy of various exercise interventions for migraine treatment: A systematic review and network meta-analysis. Headache 2024; 64:873-900. [PMID: 38597252 DOI: 10.1111/head.14696] [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] [Received: 08/29/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To compare various exercise modalities' efficacy on migraine frequency, intensity, duration, and disability. BACKGROUND Exercise has been shown to be an effective intervention to reduce migraine symptoms and disability; however, no clear evidence exists regarding the most effective exercise modalities for migraine treatment. METHODS A systematic review was performed in PubMed, PEDro, Web of Science, and Google Scholar. Clinical trials that analyzed the efficacy of various exercise modalities in addressing the frequency, intensity, duration, and disability of patients with migraine were included. Eight network meta-analyses based on frequentist (F) and Bayesian (B) models were developed to estimate the direct and indirect evidence of various exercise modalities. Standardized mean difference (SMD) and 95% confidence (CI) and credible intervals (CrI) were calculated for each treatment effect based on Hedge's g and p scores to rank the modalities. RESULTS We included 28 studies with 1501 migraine participants. Yoga (F: SMD -1.30; 95% CI -2.09, -0.51; B: SMD -1.33; 95% CrI -2.21, -0.45), high-intensity aerobic exercise (F: SMD -1.30; 95% CI -2.21, -0.39; B: SMD -1.17; 95% CrI -2.20, -0.20) and moderate-intensity continuous aerobic exercise (F: SMD -1.01; 95% CI -1.63, -0.39; B: SMD -1.06; 95% CrI -1.74, -0.38) were significantly superior to pharmacological treatment alone for decreasing migraine frequency based on both models. Only yoga (F: SMD -1.40; 95% CI -2.41, -0.39; B: SMD -1.41; 95% CrI -2.54, -0.27) was significantly superior to pharmacological treatment alone for reducing migraine intensity. For diminishing migraine duration, high-intensity aerobic exercise (F: SMD -1.64; 95% CI -2.43, -0.85; B: SMD -1.56; 95% CrI -2.59, -0.63) and moderate-intensity continuous aerobic exercise (SMD -0.96; 95% CI -1.50, -0.41; B: SMD -1.00; 95% CrI -1.71, -0.31) were superior to pharmacological treatment alone. CONCLUSION Very low-quality evidence showed that yoga, high- and moderate-intensity aerobic exercises were the best interventions for reducing migraine frequency and intensity; high- and moderate-intensity aerobic exercises were best for decreasing migraine duration; and moderate-intensity aerobic exercise was best for diminishing disability.
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Affiliation(s)
- Álvaro Reina-Varona
- Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- PhD Program in Medicine and Surgery, Doctoral School, Universidad Autónoma de Madrid, Madrid, Spain
| | - Beatriz Madroñero-Miguel
- Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - José Fierro-Marrero
- Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- PhD Program in Medicine and Surgery, Doctoral School, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alba Paris-Alemany
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Roy La Touche
- Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
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Bishay AE, Fijany AJ, Holan C, Mubang RN, Montorfano L, Olsson SE, Troia T, Bakian A, Kassis SA, Tran BV. Analyzing Google Search Trends for Migraine Surgery and Nurtec in Response to Public Announcements. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5996. [PMID: 39027895 PMCID: PMC11257674 DOI: 10.1097/gox.0000000000005996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/17/2024] [Indexed: 07/20/2024]
Abstract
Background Nurtec, a versatile migraine medication, has gained popularity. However, the awareness of migraine surgery remains uncertain. Methods Following a descriptive approach, this cross-sectional study used Google Trends data as of December 1, 2023, to analyze internet search patterns. Approval from Vanderbilt University's institutional review board and adherence to Strengthening the Reporting of Observational Studies in Epidemiology guidelines were confirmed. Monthly relative search volume (RSV) data for "migraine surgery," "Nurtec," and "Rimegepant" were collected from January 1, 2004, to November 11, 2023, within the United States. Statistical analysis involved determining mean monthly RSV values and percentage changes for critical periods. Results For "Nurtec," a significant surge in RSV occurred from March 2020 to April 2020 (344%). Additional peaks were observed from June 2020 to July 2020 (66%), October 2020 to December 2020 (169%), May 2021 to June 2021 (33%), and May 2023 to June 2023 (14%). "Migraine surgery" exhibited a notable 400% increase in RSV, from March 2005 to May 2005. However, post-2006, RSV for "migraine surgery" consistently remained low without noticeable peaks. Conclusions The analysis of RSV trends for "Nurtec" and "migraine surgery" from 2004 to 2023 reveals the impact of pivotal events and marketing strategies on public interest. The distinct peaks in "Nurtec" RSV align with Food & Drug Administration approvals and marketing campaigns, highlighting the medication's accessibility. Conversely, the consistently low RSV for "migraine surgery" indicates limited awareness, emphasizing the need for enhanced promotion and education regarding surgical interventions.
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Affiliation(s)
| | - Arman J. Fijany
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Cole Holan
- Department of Plastic Surgery, Mayo Clinic, Rochester, Minn
| | - Ronnie N. Mubang
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Lisandro Montorfano
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Sofia E. Olsson
- Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, Tex
| | - Thomas Troia
- Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, Tex
| | - Arash Bakian
- University of Southern California, Los Angeles, Calif
| | - Salam Al Kassis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Bill V. Tran
- Department of Plastic Surgery, Mayo Clinic, Rochester, Minn
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8
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Nedergaard L, Martens MC, Christensen MDB, Pellesi L. Triptan treatment is associated with a higher number of red wine-induced migraine episodes: An exploratory questionnaire-based survey. Pain Pract 2024; 24:832-838. [PMID: 38450841 DOI: 10.1111/papr.13365] [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] [Received: 08/31/2023] [Revised: 12/30/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024]
Abstract
AIM Diet, including foods and beverages, affects migraine. Conversely, the influence of migraine therapies on dietary habits is largely unknown. This study aimed at investigating the effects of triptan intake on foods and drinks consumed by adults with migraine with and/or without aura. METHODS An exploratory questionnaire-based survey took place online between November 2022 and June 2023. Participants were recruited through advertisements shared on social media accounts (e.g., Facebook and Instagram) and seasonal newsletters of three Danish patient associations. In addition, posters and flyers in headache and pain centers at Danish hospitals and private neurological, pain, and physiotherapeutic clinics were utilized. RESULTS A total of 314 adults with migraine with and/or without aura completed the survey. Among the respondents, 236 individuals (75.2%) regularly used triptans to treat their migraines. Compared with non-triptan users, individuals using triptans were characterized by significantly more foods and/or drinks triggering migraine (74.2% vs. 56.4%, p = 0.005). Alcoholic beverages and most specifically red wine were overreported as migraine triggers by triptan users (48.3% vs. 21.8%, p < 0.001). In the week preceding the survey, red wine was significantly less consumed by triptan users than non-triptan users (92.4% vs. 76.9%, p < 0.001). CONCLUSIONS Patients who regularly consume triptans report red wine most frequently as a migraine trigger. Triptan users are characterized by a lower consumption of red wine than non-triptan users, suggesting that a regular triptan intake may promote an increased sensitivity to red wine-induced migraine.
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Affiliation(s)
- Laura Nedergaard
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | | | | | - Lanfranco Pellesi
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Tsirelis D, Tsekouras A, Stamati P, Liampas I, Zoupa E, Dastamani M, Tsouris Z, Papadimitriou A, Dardiotis E, Siokas V. The impact of genetic factors on the response to migraine therapy. Rev Neurosci 2024; 0:revneuro-2024-0045. [PMID: 38856190 DOI: 10.1515/revneuro-2024-0045] [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: 03/29/2024] [Accepted: 05/17/2024] [Indexed: 06/11/2024]
Abstract
Migraine is a multidimensional disease affecting a large portion of the human population presenting with a variety of symptoms. In the era of personalized medicine, successful migraine treatment presents a challenge, as several studies have shown the impact of a patient's genetic profile on therapy response. However, with the emergence of contemporary treatment options, there is promise for improved outcomes. A literature search was conducted in PubMed and Scopus, in order to obtain studies investigating the impact of genetic factors on migraine therapy outcome. Overall, 23 studies were included in the current review, exhibiting diversity in the treatments used and the genetic variants investigated. Divergent genes were assessed for each category of migraine treatment. Several genetic factors were identified to contribute to the heterogeneous response to treatment. SNPs related to pharmacodynamic receptors, pharmacogenetics and migraine susceptibility loci were the most investigated variants, revealing some interesting significant results. To date, various associations have been recorded correlating the impact of genetic factors on migraine treatment responses. More extensive research needs to take place with the aim of shedding light on the labyrinthine effects of genetic variations on migraine treatment, and, consequently, these findings can promptly affect migraine treatment and improve migraine patients' life quality in the vision of precise medicine.
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Affiliation(s)
- Daniil Tsirelis
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Alexandros Tsekouras
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Polyxeni Stamati
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Elli Zoupa
- Larisa Day Care Center of People with Alzheimer's Disease, Association for Regional Development and Mental Health (EPAPSY), 15124 Marousi, Greece
| | - Metaxia Dastamani
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Zisis Tsouris
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | | | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41100 Larissa, Greece
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10
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Hac NEF, Gold DR. Advances in diagnosis and treatment of vestibular migraine and the vestibular disorders it mimics. Neurotherapeutics 2024; 21:e00381. [PMID: 38845250 DOI: 10.1016/j.neurot.2024.e00381] [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: 03/10/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 07/15/2024] Open
Abstract
Dizziness is one of the most common chief complaints in both the ambulatory care setting and the emergency department. These symptoms may be representative of a broad range of entities. Therefore, any attempt at treatment must first start with determining the etiology. In this current perspective, we focus specifically on the diagnosis of and treatment of vestibular migraine, which is common and overlaps clinically with a variety of other diagnoses. We discuss the traditional treatments for vestibular migraine in addition to the recent explosion of novel migraine therapeutics. Because vestibular migraine can mimic, or co-exist with, a variety of other vestibular diseases, we discuss several of these disorders including persistent postural-perceptual dizziness, benign paroxysmal positional vertigo, post-concussive syndrome, Ménière's disease, and cerebrovascular etiologies. We discuss the diagnosis of each, as well as overlapping and distinguishing clinical features of which the reader should be aware. Finally, we conclude with evidence based as well as expert commentary on management, with a particular emphasis on vestibular migraine.
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11
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Barbanti P, Allais G, Cevoli S, Guerzoni S, Valeriani M, Vernieri F. The Role of the Combination Paracetamol/Caffeine in Treatment of Acute Migraine Pain: A Narrative Review. Pain Ther 2024; 13:319-346. [PMID: 38446344 PMCID: PMC11111640 DOI: 10.1007/s40122-024-00581-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Thirty years ago, the first migraine-specific drugs (triptans) appeared. Today two new categories (gepants and ditans) are marketed for acute migraine treatment. That said, is there still a role for conventional therapy? The aim of the present narrative review is to provide an expert overview examining the possible role of the combination paracetamol/caffeine in treatment of acute migraine pain. METHODS To understand possible settings for more appropriate use of paracetamol/caffeine (1000 mg/130 mg) in treatment of acute migraine, a structured literature search was performed using the PubMed database by a panel of experts from major Italian headache centers; articles not referring to migraine pain were excluded from this review; review articles were prioritized. RESULTS Overall response, even to newer specific and selective trigeminal targeted drugs (TTTs), is not over 60%; thus, there is still room for conventional therapies in acute migraine treatment. The panel identified settings in which the use of paracetamol/caffeine combination to treat acute migraine attacks might offer benefit considering the consolidated use through years, despite the lack of studies directly addressing the efficacy of paracetamol/caffeine in the identified populations: subjects > 65 years of age; presence of cardiovascular (CV) comorbidities; TTTs non-responders; pregnancy and breastfeeding; subjects < 18 years of age; paracetamol/caffeine as add-on therapy. CONCLUSIONS Paracetamol is included in the World Health Organization (WHO) essential drug list and has a high level of popularity among patients. Caffeine enhances the analgesic effect of other drugs including paracetamol. In early treatment of acute migraine pain, prescribing physicians might consider using the paracetamol/caffeine combination among other options.
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Affiliation(s)
- Piero Barbanti
- Headache and Pain Unit-IRCCS San Raffaele, via della Pisana 235, 00163, Rome, Italy.
- University San Raffaele, Rome, Italy.
| | - Gianni Allais
- Department of Surgical Sciences, Women's Headache Center, University of Turin, Turin, Italy
| | - Sabina Cevoli
- Sabina Cevoli IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Simona Guerzoni
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico di Modena, Modena, Italy
| | - Massimiliano Valeriani
- Developmental Neurology Unit, IRCSS Ospedale Pediatrico Bambino Gesù, Rome, Italy
- Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Fabrizio Vernieri
- Headache Unit, Fondazione Policlinico Campus Bio-Medico, Rome, Italy
- Neurology, Università Campus Bio-Medico di Roma, Rome, Italy
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Huang J, Wang X, Jin Y, Lou G, Yu Z. Trends and prescribing patterns of antimigraine medicines in nine major cities in China from 2018 to 2022: a retrospective prescription analysis. J Headache Pain 2024; 25:62. [PMID: 38654177 PMCID: PMC11036710 DOI: 10.1186/s10194-024-01775-6] [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] [Received: 03/26/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The objective of this study was to investigate the trends and prescribing patterns of antimigraine medicines in China. METHODS The prescription data of outpatients diagnosed with migraine between 2018 and 2022 were extracted from the Hospital Prescription Analysis Cooperative Project of China. The demographic characteristics of migraine patients, prescription trends, and corresponding expenditures on antimigraine medicines were analyzed. We also investigated prescribing patterns of combination therapy and medicine overuse. RESULTS A total of 32,246 outpatients who were diagnosed with migraine at 103 hospitals were included in this study. There were no significant trend changes in total outpatient visits, migraine prescriptions, or corresponding expenditures during the study period. Of the patients who were prescribed therapeutic medicines, 70.23% received analgesics, and 26.41% received migraine-specific agents. Nonsteroidal anti-inflammatory drugs (NSAIDs; 28.03%), caffeine-containing agents (22.15%), and opioids (16.00%) were the most commonly prescribed analgesics, with corresponding cost proportions of 11.35%, 4.08%, and 19.61%, respectively. Oral triptans (26.12%) were the most commonly prescribed migraine-specific agents and accounted for 62.21% of the total therapeutic expenditures. The proportion of patients receiving analgesic prescriptions increased from 65.25% in 2018 to 75.68% in 2022, and the proportion of patients receiving concomitant triptans decreased from 29.54% in 2018 to 21.55% in 2022 (both P < 0.001). The most frequently prescribed preventive medication classes were calcium channel blockers (CCBs; 51.59%), followed by antidepressants (20.59%) and anticonvulsants (15.82%), which accounted for 21.90%, 34.18%, and 24.15%, respectively, of the total preventive expenditures. Flunarizine (51.41%) was the most commonly prescribed preventive drug. Flupentixol/melitracen (7.53%) was the most commonly prescribed antidepressant. The most commonly prescribed anticonvulsant was topiramate (9.33%), which increased from 6.26% to 12.75% (both P < 0.001). A total of 3.88% of the patients received combined therapy for acute migraine treatment, and 18.63% received combined therapy for prevention. The prescriptions for 69.21% of opioids, 38.53% of caffeine-containing agents, 26.61% of NSAIDs, 13.97% of acetaminophen, and 6.03% of triptans were considered written medicine overuse. CONCLUSIONS Migraine treatment gradually converges toward evidence-based and guideline-recommended treatment. Attention should be given to opioid prescribing, weak evidence-based antidepressant use, and medication overuse in migraine treatment.
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Affiliation(s)
- Jing Huang
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, China
| | - Xinwei Wang
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, China
| | - Yiyi Jin
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, 315010, China
| | - Guodong Lou
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3rd East Qingchun Road, Hangzhou, Zhejiang Province, China
| | - Zhenwei Yu
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3rd East Qingchun Road, Hangzhou, Zhejiang Province, China.
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13
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Kirkland SW, Visser L, Meyer J, Junqueira DR, Campbell S, Villa-Roel C, Friedman BW, Essel NO, Rowe BH. The effectiveness of parenteral agents for pain reduction in patients with migraine presenting to emergency settings: A systematic review and network analysis. Headache 2024; 64:424-447. [PMID: 38644702 DOI: 10.1111/head.14704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES To assess the comparative effectiveness and safety of parenteral agents for pain reduction in patients with acute migraine. BACKGROUND Parenteral agents have been shown to be effective in treating acute migraine pain; however, the comparative effectiveness of different approaches is unclear. METHODS Nine electronic databases and gray literature sources were searched to identify randomized clinical trials assessing parenteral agents to treat acute migraine pain in emergency settings. Two independent reviewers completed study screening, data extraction, and Cochrane risk-of-bias assessment, with differences being resolved by adjudication. The protocol of the review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100096). RESULTS A total of 97 unique studies were included, with most studies reporting a high or unclear risk of bias. Monotherapy, as well as combination therapy, successfully reduced pain scores prior to discharge. They also increased the proportion of patients reporting pain relief and being pain free. Across the pain outcomes assessed, combination therapy was one of the higher ranked approaches and provided robust improvements in pain outcomes, including lowering pain scores (mean difference -3.36, 95% confidence interval [CI] -4.64 to -2.08) and increasing the proportion of patients reporting pain relief (risk ratio [RR] 2.83, 95% CI 1.74-4.61). Neuroleptics and metoclopramide also ranked high in terms of the proportion of patients reporting pain relief (neuroleptics RR 2.76, 95% CI 2.12-3.60; metoclopramide RR 2.58, 95% CI 1.90-3.49) and being pain free before emergency department discharge (neuroleptics RR 4.8, 95% CI 3.61-6.49; metoclopramide RR 4.1, 95% CI 3.02-5.44). Most parenteral agents were associated with increased adverse events, particularly combination therapy and neuroleptics. CONCLUSIONS Various parenteral agents were found to provide effective pain relief. Considering the consistent improvements across various outcomes, combination therapy, as well as monotherapy of either metoclopramide or neuroleptics are recommended as first-line options for managing acute migraine pain. There are risks of adverse events, especially akathisia, following treatment with these agents. We recommend that a shared decision-making model be considered to effectively identify the best treatment option based on the patient's needs.
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Affiliation(s)
- Scott W Kirkland
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Lloyd Visser
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Jillian Meyer
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | | | - Sandra Campbell
- Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Cristina Villa-Roel
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Benjamin W Friedman
- Department of Emergency Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | - Nana Owusu Essel
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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14
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de Mora F, Messlinger K. Is calcitonin gene-related peptide (CGRP) the missing link in food histamine-induced migraine? A review of functional gut-to-trigeminovascular system connections. Drug Discov Today 2024; 29:103941. [PMID: 38447930 DOI: 10.1016/j.drudis.2024.103941] [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] [Received: 09/27/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/08/2024]
Abstract
Calcitonin gene-related peptide (CGRP) and histamine plasma concentrations increase during migraine attacks. Both mediators are potent vasodilators, and they have been shown to reciprocally contribute to the release of each other in the trigeminovascular system, possibly driving migraine development. A high-histamine-content diet triggers migraine in patients who have histamine degradation deficiency owing to diaminooxidase (DAO) gene mutations. Therefore, studying functional links between exogenous histamine and CGRP seems promising for the understanding of diet-induced migraine generation. Notably, there is a lack of knowledge about the interplay of the enteric nervous system and the spinal/trigeminal somatosensory system with regard to CGRP and histamine. Based on background evidence, we propose that a functional interconnection between exogenous histamine and CGRP contributes to migraine development.
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Affiliation(s)
- Fernando de Mora
- Department of Pharmacology, Therapeutics and Toxicology, Edificio V, Universidad Autónoma de Barcelona, Campus UAB - 08193 Bellaterra, Barcelona, Spain
| | - Karl Messlinger
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 17, D-91054 Erlangen, Germany.
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15
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Burch R. Acute Treatment of Migraine. Continuum (Minneap Minn) 2024; 30:344-363. [PMID: 38568487 DOI: 10.1212/con.0000000000001402] [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: 04/05/2024]
Abstract
OBJECTIVE Most patients with migraine require acute treatment for at least some attacks. This article reviews the approach to the acute treatment of migraine, migraine-specific and nonspecific treatment options, rescue treatment and options for management in the emergency department and inpatient settings, and treatment during pregnancy and lactation. LATEST DEVELOPMENTS Triptans, ergot derivatives, and nonsteroidal anti-inflammatory drugs have historically been the main acute treatments for migraine. The development of new classes of acute treatment, including the small-molecule calcitonin gene-related peptide receptor antagonists (gepants) and a 5-HT1F receptor agonist (lasmiditan), expands available options. These new treatments have not been associated with vasospasm or increased cardiovascular risk, therefore allowing migraine-specific acute treatment for the more than 20% of adults with migraine who are at increased risk of cardiovascular events. Neuromodulation offers a nonpharmacologic option for acute treatment, with the strongest evidence for remote electrical neuromodulation. ESSENTIAL POINTS The number of available migraine treatments continues to expand, although triptans are still the mainstay of migraine-specific acute treatment. There is no one-size-fits-all acute treatment and multiple treatment trials are sometimes necessary to determine the optimal regimen for patients. Switching within and between classes, using the maximum allowed dose, using combination therapy, and counseling patients to treat early are all strategies that may improve patient response to acute treatment.
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16
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Kosunen M, Rossi J, Niskanen S, Metsä R, Kainu V, Lahelma M, Isomeri O. Healthcare resource utilization and associated costs among patients with migraine in Finland: A retrospective register-based study. PLoS One 2024; 19:e0300816. [PMID: 38507402 PMCID: PMC10954127 DOI: 10.1371/journal.pone.0300816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/05/2024] [Indexed: 03/22/2024] Open
Abstract
Migraine is a common chronic brain disorder, characterized by recurring and often disabling attacks of severe headache, with additional symptoms such as photophobia, phonophobia and nausea. Migraine affects especially the working age population. The objective of this retrospective observational register-based study was to analyze the use of healthcare services and associated costs in Finnish migraine patients. Study was based on aggregate data from January 1st, 2020, to December 31st, 2021, from the Finnish Institute for Health and Welfare's national registries. Patients were grouped into nine patient groups according to medication prescriptions and diagnoses. Healthcare resource utilization in specialty, primary, and occupational healthcare was assessed and analyzed separately for all-cause and migraine related healthcare contacts from a one-year period. The total number of patients was 175 711, and most (45%) of the patients belonged to a group that had used only one triptan. Migraine related total healthcare resource utilization was greater for patients that had used two or more triptans compared to those that had used only one. The patients with three or more preventive medications had the highest total migraine related healthcare resource utilization of the studied patient cohorts. Of the total annual healthcare costs 11.5% (50.6 million €) was associated to be migraine related costs. Total per patient per year healthcare costs were highest with patients that had used three or more preventive medications (5 626 €) and lowest in those with only one triptan (2 257 €). Our findings are in line with the recent European Headache Federation consensus statement regarding the unmet need in patients who have had inadequate response to two or more triptans. When assessing the patient access and cost-effectiveness of novel treatments for the treatment of migraine within different healthcare systems, a holistic analysis of the current disease burden along with potential gains for patients and healthcare service providers are essential information in guiding decision-making.
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Affiliation(s)
| | | | | | | | | | - Mari Lahelma
- NHG Finland, Nordic Healthcare Group, Helsinki, Finland
| | - Outi Isomeri
- NHG Finland, Nordic Healthcare Group, Helsinki, Finland
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17
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Diener HC, May A. New migraine drugs: A critical appraisal of the reason why the majority of migraine patients do not receive an adequate medication. Cephalalgia 2024; 44:3331024241228605. [PMID: 38520255 DOI: 10.1177/03331024241228605] [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: 03/25/2024]
Abstract
The last three decades have produced several novel and efficient medications to treat migraine attacks and reduce attack frequency. Additionally, promising approaches for the development of acute therapy and migraine prophylaxis continue to be pursued. At the same time as we witness the development of better and more efficient medications with continuously fewer side effects, we also realise that the high cost of such therapies means that only a minority of migraine patients who could benefit from these medications can afford them. Furthermore, information on cost-effectiveness is still lacking. Here, we compare availiable data, highlight open questions and suggest trials to close knowledge gaps. With good reason, our medicine is evidence-based. However, if this evidence is not collected, our decisions will continue to be based on marketing and assumptions. At the moment, we are not doing justice to our patients.
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Affiliation(s)
- Hans Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Arne May
- Department of Systems Neuroscience, University Hamburg, Hamburg, Germany
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18
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Corasaniti MT, Lawrence GW, Bagetta G, Iannacchero R, Tarsitano A, Monteleone A, Pagliaro M, Tonin P, Sandrini G, Nicotera P, Scuteri D. Combination of anti-CGRP/CGRP-R mAbs with onabotulinumtoxin A as a novel therapeutic approach for refractory chronic migraine: a retrospective study of real-world clinical evidence and a protocol for a double-blind, randomized clinical trial to establish the efficacy and safety. Front Pharmacol 2023; 14:1296577. [PMID: 38152694 PMCID: PMC10751376 DOI: 10.3389/fphar.2023.1296577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/22/2023] [Indexed: 12/29/2023] Open
Abstract
Chronic migraine is a disabling neurovascular disorder that ranks amongst the top causes of years lived with disability worldwide. The duration and the frequency of migraine affect cognitive and affective domains, inducing worsening of memory, executive functions, orientation and causing anxiety. Population-based studies report a worrying level of resistance to treatments. Therefore, this study aims: 1) to assess efficacy of monoclonal antibodies (mAbs) directed towards the calcitonin gene-related peptide (CGRP) or its receptor (CGRP-R) for chronic migraine resistant to current preventatives; 2) to design a clinical trial protocol to evaluate the efficacy and safety of combination therapy utilizing anti-CGRP/CGRP-R together with onabotulinumtoxin A in patients suffering from resistant chronic migraine; 3) to provide a molecular rationale for combination therapy. A controlled trial is warranted as pooled analysis of real-world data from our group highlighted that combined treatment provides ≥50% reduction vs. baseline (onabotulinumtoxin A) of monthly headache days (MHDs) in up to 58.8% of patients, but there has been only sparse application of this combined therapy to date. The mAbs chosen are: erenumab, because its combination effect with onabotulinumtoxin A improved symptoms in 65% of patients; eptinezumab, due to its faster action. The results highlight that early diagnosis of migraine improves therapeutic outcomes with mAbs alone, confirming their effectiveness and the need for an adequately powered clinical trial evaluating the safety and potential superior effectiveness of eptinezumab/erenumab and onabotulinumtoxin A together.
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Affiliation(s)
- M. T. Corasaniti
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - G. W. Lawrence
- Department of Biotechnology, Dublin City University, Dublin, Ireland
| | - G. Bagetta
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - R. Iannacchero
- Department of Neurology, Headache Center, Regional Hospital “Pugliese-Ciaccio”, Catanzaro, Italy
| | - A. Tarsitano
- Pain Therapy Center, Provincial Health Authority (ASP), Cosenza, Italy
| | - A. Monteleone
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - M. Pagliaro
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - P. Tonin
- Regional Center for Serious Brain Injuries, S. Anna Institute, Crotone, Italy
| | - G. Sandrini
- Department of Brain and Behavioral Sciences, IRCCS C. Mondino Foundation Neurologic Institute, University of Pavia, Pavia, Italy
| | - P. Nicotera
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - D. Scuteri
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
- Regional Center for Serious Brain Injuries, S. Anna Institute, Crotone, Italy
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Chiang CC, Fang X, Horvath Z, Cadiou F, Urani A, Poh W, Narimatsu H, Cheng Y, Dodick DW. Simultaneous Comparisons of 25 Acute Migraine Medications Based on 10 Million Users' Self-Reported Records From a Smartphone Application. Neurology 2023; 101:e2560-e2570. [PMID: 38030397 PMCID: PMC10791049 DOI: 10.1212/wnl.0000000000207964] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Many acute treatment options exist for migraine. However, large-scale, head-to-head comparisons of treatment effectiveness from real-world patient experience reports are lacking. METHODS This is a retrospective analysis of 10,842,795 migraine attack records extracted from an e-diary smartphone application between June 30, 2014, and July 2, 2020. We analyzed 25 acute medications among 7 classes-acetaminophen, nonsteroid anti-inflammatory drugs (NSAIDs), triptans, combination analgesics, ergots, antiemetics, and opioids. Gepants and ditan were not included in this analysis. Different doses and formulations of each medication, according to the generic names, were combined in this analysis. We used a 2-level nested logistic regression model to analyze the odds ratio (OR) of treatment effectiveness of each medication by adjusting concurrent medications and the covariance within the same user. Subgroup analyses were conducted for users in the United States, the United Kingdom, and Canada. RESULTS Our final analysis included 4,777,524 medication-outcome pairs from 3,119,517 migraine attacks among 278,006 users. Triptans (mean OR 4.8), ergots (mean OR 3.02), and antiemetics (mean OR 2.67) were the top 3 classes of medications with the highest effectiveness, followed by opioids (mean OR 2.49), NSAIDs (other than ibuprofen, mean OR 1.94), combination analgesics (acetaminophen/acetylsalicylic acid/caffeine) (OR 1.69, 95% CI 1.67-1.71), others (OR 1.49, 95% CI 1.47-1.50), and acetaminophen (OR 0.83, 95% CI 0.83-0.84), using ibuprofen as the reference. Individual medications with the highest ORs were eletriptan (OR 6.1, 95% CI 6.0-6.3), zolmitriptan (OR 5.7, 95% CI 5.6-5.8), and sumatriptan (OR 5.2, 95% CI 5.2-5.3). The ORs of acetaminophen, NSAIDS, combination analgesics, and opioids were mostly around or less than 1, suggesting similar or lower reported effectiveness compared with ibuprofen. The ORs for 24 medications, except that of acetylsalicylic acid, achieved statistical significance with p < 0.0001, and our nested logistic regression model achieved an area under the curve (AUC) of 0.849. Country-specific subgroup analyses revealed similar ORs of each medication and AUC (United States 0.849, United Kingdom 0.864, and Canada 0.842), demonstrating the robustness of our analysis. DISCUSSION Using a big data approach, we analyzed patient-generated real-time records of 10 million migraine attacks and conducted simultaneous head-to-head comparisons of 25 acute migraine medications. Our findings that triptans, ergots, and antiemetics are the most effective classes of medications align with the guideline recommendations and offer generalizable insights to complement clinical practice. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with migraine, selected acute medications (e.g., triptans, ergots, antiemetics) are associated with higher odds of user-rated positive response than ibuprofen.
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Affiliation(s)
- Chia-Chun Chiang
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| | - Xuemin Fang
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| | - Zsolt Horvath
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| | - Francois Cadiou
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| | - Alexandre Urani
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| | - Weijie Poh
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| | - Hiroto Narimatsu
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| | - Yu Cheng
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| | - David W Dodick
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
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20
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Gaul C, Zaranek L, Goßrau G. [Complementary and supplementary procedures in the treatment of headache]. Schmerz 2023; 37:448-460. [PMID: 37432483 DOI: 10.1007/s00482-023-00738-1] [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] [Received: 03/19/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 07/12/2023]
Abstract
In Germany, headache is one of the illnesses that most frequently leads to health impairments and to consultation with physicians. Even in children, headache is often associated with restricted activities of daily life. Nevertheless, the level of care for headache disorders is disproportionate to the medical needs. As a result, patients regularly use complementary and supportive therapeutic procedures. This review shows the procedures currently used for primary headache in childhood and adulthood, the methodological approaches and existing scientific evidence. The safety of the therapeutic options is also classified. These methods include physiotherapy, neural therapy, acupuncture, homeopathy, phytotherapy and the intake of dietary supplements. For children and adolescents with headaches, there are studies in the field of dietary supplements for coenzyme Q10, riboflavin, magnesium and vitamin D, which indicate specific effects in the reduction of headaches.
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Affiliation(s)
- Charly Gaul
- Kopfschmerzzentrum Frankfurt, Dalbergstr. 2a, 65929, Frankfurt, Deutschland.
| | - Laura Zaranek
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Dresden, Dresden, Deutschland
| | - Gudrun Goßrau
- Universitäts SchmerzCentrum - USC, Universitätsklinikum Dresden, Medizinische Fakultät, Technische Universität Dresden, Dresden, Deutschland
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21
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Kowacs PA, Sampaio Rocha-Filho PA, Peres MFP, Edvinsson L. The history and rationale of the development of new drugs for migraine treatment. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:1084-1097. [PMID: 38157876 PMCID: PMC10756794 DOI: 10.1055/s-0043-1777723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
Migraine is one of the most prevalent and disabling diseases in the world. Migraine attack treatments and prophylactic treatments of this disease are essential to lessen its individual, social, and economic impact. This is a narrative review of the main drugs used for treating migraine, as well as the experimental models and the theoretical frameworks that led to their development. Ergot derivatives, triptans, non-steroid anti-inflammatory drugs, tricyclic antidepressants, beta-blockers,: flunarizine,: valproic acid,: topiramate, onabotulinumtoxin A, ditans, monoclonal antibodies against CGRP and its receptor, and gepants are discussed. Possible therapeutic targets for the development of new drugs that are under development are also addressed. Many of the drugs currently in use for treating migraine were developed for the treatment of other diseases, but have proven effective for the treatment of migraine, expanding knowledge about the disease. With a better understanding of the pathophysiology of migraine, new drugs have been and continue to be developed specifically for the treatment of this disease.
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Affiliation(s)
- Pedro André Kowacs
- Instituto de Neurologia de Curitiba, Serviço de Neurologia, Curitiba PR, Brazil.
- Universidade Federal do Paraná, Complexo Hospital de Clínicas, Unidade do Sistema Nervoso, Curitiba PR, Brazil.
| | - Pedro Augusto Sampaio Rocha-Filho
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Divisão de Neuropsiquiatria, Recife PE, Brazil.
- Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Clínica de Cefaleia, Recife PE, Brazil.
| | | | - Lars Edvinsson
- Lund University, Institute of Clinical Sciences, 22185 Lund, Sweden.
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22
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Takizawa T, Ihara K, Uno S, Ohtani S, Watanabe N, Imai N, Nakahara J, Hori S, Garcia-Azorin D, Martelletti P. Metabolic and toxicological considerations regarding CGRP mAbs and CGRP antagonists to treat migraine in COVID-19 patients: a narrative review. Expert Opin Drug Metab Toxicol 2023; 19:951-967. [PMID: 37925645 DOI: 10.1080/17425255.2023.2280221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Migraine pharmacological therapies targeting calcitonin gene-related peptide (CGRP), including monoclonal antibodies and gepants, have shown clinical effect and optimal tolerability. Interactions between treatments of COVID-19 and CGRP-related drugs have not been reviewed. AREAS COVERED An overview of CGRP, a description of the characteristics of each CGRP-related drug and its response predictors, COVID-19 and its treatment, the interactions between CGRP-related drugs and COVID-19 treatment, COVID-19 and vaccination-induced headache, and the neurological consequences of Covid-19. EXPERT OPINION Clinicians should be careful about using gepants for COVID-19 patients, due to the potential drug interactions with drugs metabolized via CYP3A4 cytochrome. In particular, COVID-19 treatment (especially nirmatrelvir packaged with ritonavir, as Paxlovid) should be considered cautiously. It is advisable to stop or adjust the dose (10 mg atogepant when used for episodic migraine) of gepants when using Paxlovid (except for zavegepant). CGRP moncolconal antibodies (CGRP-mAbs) do not have drug - drug interactions, but a few days' interval between a COVID-19 vaccination and the use of CGRP mAbs is recommended to allow the accurate identification of the possible adverse effects, such as injection site reaction. Covid-19- and vaccination-related headache are known to occur. Whether CGRP-related drugs would be of benefit in these circumstances is not yet known.
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Affiliation(s)
- Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Ihara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
- Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Shunsuke Uno
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Seiya Ohtani
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Narumi Watanabe
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Imai
- Department of Neurology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Satoko Hori
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - David Garcia-Azorin
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Paolo Martelletti
- School of Health Sciences, Unitelma Sapienza University of Rome, Rome, Italy
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23
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Wells-Gatnik WD, Martelletti P. Gepants in the acute management of migraine. Pain Manag 2023; 13:627-630. [PMID: 37942638 DOI: 10.2217/pmt-2023-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
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24
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Overeem LH, Raffaelli B, Fleischmann R, Süße M, Vogelgesang A, Maceski AM, Papadopoulou A, Ruprecht K, Su W, Koch M, Siebert A, Arkuszewski M, Tenenbaum N, Kuhle J, Reuter U. Serum tau protein elevation in migraine: a cross-sectional case-control study. J Headache Pain 2023; 24:130. [PMID: 37726712 PMCID: PMC10507851 DOI: 10.1186/s10194-023-01663-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Migraine is a disorder associated with neuropeptide release, pain and inflammation. Tau protein has recently been linked to inflammatory diseases and can be influenced by neuropeptides such as CGRP, a key neurotransmitter in migraine. Here, we report serum concentrations of total-tau protein in migraine patients and healthy controls. METHODS In this cross-sectional study, interictal blood samples from n = 92 patients with episodic migraine (EM), n = 93 patients with chronic migraine (CM), and n = 42 healthy matched controls (HC) were studied. We assessed serum total-tau protein (t-tau) and for comparison neurofilament light chain protein (NfL), glial fibrillary acidic protein (GFAP), and ubiquitin carboxy-terminal hydrolase L (UCH-L1) concentrations using the Neurology 4-plex kit, on a single molecule array HD-X Analyzer (Quanterix Corp Lexington, MA). Matched serum/cerebrospinal fluid (CSF) samples were used for post-hoc evaluations of a central nervous system (CNS) source of relevant findings. We applied non-parametric tests to compare groups and assess correlations. RESULTS Serum t-tau concentrations were elevated in EM [0.320 (0.204 to 0.466) pg/mL] and CM [0.304 (0.158 to 0.406) pg/mL] patients compared to HC [0.200 (0.114 to 0.288) pg/mL] (p = 0.002 vs. EM; p = 0.025 vs. CM). EM with aura [0.291 (0.184 to 0.486 pg/mL); p = 0.013] and EM without aura [0.332 (0.234 to 0.449) pg/mL; p = 0.008] patients had higher t-tau levels than HC but did not differ between each other. Subgroup analysis of CM with/without preventive treatment revealed elevated t-tau levels compared to HC only in the non-prevention group [0.322 (0.181 to 0.463) pg/mL; p = 0.009]. T-tau was elevated in serum (p = 0.028) but not in cerebrospinal fluid (p = 0.760). In contrast to t-tau, all proteins associated with cell damage (NfL, GFAP, and UCH-L1), did not differ between groups. DISCUSSION Migraine is associated with t-tau elevation in serum but not in the CSF. Our clinical study identifies t-tau as a new target for migraine research.
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Affiliation(s)
- Lucas Hendrik Overeem
- Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
- Doctoral Program, International Graduate Program Medical Neurosciences, Humboldt Graduate School, Berlin, 10117, Germany
| | - Bianca Raffaelli
- Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
- Clinician Scientist Program, Berlin Institute of Health (BIH), Berlin, 10117, Germany
| | - Robert Fleischmann
- Department of Neurology, Universitätsmedizin Greifswald, Greifswald, 17475, Germany
| | - Marie Süße
- Department of Neurology, Universitätsmedizin Greifswald, Greifswald, 17475, Germany
| | - Antje Vogelgesang
- Department of Neurology, Universitätsmedizin Greifswald, Greifswald, 17475, Germany
| | - Aleksandra Maleska Maceski
- Department of Neurology, University Hospital and University of Basel, Basel, 4051, Switzerland
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, 4051, Switzerland
| | - Athina Papadopoulou
- Department of Neurology, University Hospital and University of Basel, Basel, 4051, Switzerland
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, 4051, Switzerland
| | - Klemens Ruprecht
- Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Wendy Su
- Novartis Pharma AG, Basel, 4056, Switzerland
| | - Mirja Koch
- Novartis Pharma AG, Basel, 4056, Switzerland
| | - Anke Siebert
- Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | | | - Nadia Tenenbaum
- EMD Serono Research and Development Institute, New York, NY, USA
| | - Jens Kuhle
- Department of Neurology, University Hospital and University of Basel, Basel, 4051, Switzerland
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, 4051, Switzerland
| | - Uwe Reuter
- Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
- Department of Neurology, Universitätsmedizin Greifswald, Greifswald, 17475, Germany.
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25
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Hervik JB, Foss EB, Stub T. Living with chronic headaches: A qualitative study from an outpatient pain clinic in Norway. Explore (NY) 2023; 19:702-709. [PMID: 36725462 DOI: 10.1016/j.explore.2023.01.004] [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] [Received: 08/15/2022] [Revised: 12/26/2022] [Accepted: 01/17/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although headache is considered a frequently experienced type of pain, the challenges, experiences, and perceptions of people suffering from chronic headaches are poorly understood. The aim of this study was to gain subjective information regarding these aspects in daily life, in order to answer the research question "What is life like with a chronic headache?" METHODOLOGY Semi-structured, in-depth interviews were conducted with 16 patients who suffered from chronic headaches. Five main domains were explored: emotions related to headaches; trauma/stressful events; behavioural changes, relationships, and coping mechanisms. ANALYSIS AND INTERPRETATION Participants reported that pain restricted their lives in many ways, including not being able to work, loss of status, identity, freedom, intimate relationships and friends. The majority believed that psychological and/or physiological trauma was the reason for their headaches. New information that emerged from this study was how common life events not usually considered major traumas, initiated and maintained symptoms. Shame and feelings of stigmatization appeared to be strongly associated with chronic pain, leading to a scenario where thriving, contentment and enjoyment were often lacking. MAIN RESULTS This study provided an in-depth understanding of how chronic headache adversely affects the lives of sufferers. Chronic headaches restrict sufferers' lives, resulting in emotional and behavioural changes and a high level of disability. The complexity of chronic headaches in clinical practice is hugely underestimated, and poorly understood by society in general.
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Affiliation(s)
- Jill Brook Hervik
- Department of Anaesthesia, Pain Clinic, Vestfold Hospital Trust, 3116, Tønsberg, Norway
| | - Eva B Foss
- Department of Anaesthesia, Pain Clinic, Vestfold Hospital Trust, 3116, Tønsberg, Norway
| | - Trine Stub
- UiT The Arctic University of Norway National Research Center in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Sciences, Department of Community Medicine, Hansine Hansens veg 19, 9019 Tromsø, Norway.
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26
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Schoenfuss ES. Treating acute migraine with ubrogepant. JAAPA 2023; 36:25-28. [PMID: 37668477 DOI: 10.1097/01.jaa.0000931424.73007.a5] [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: 09/06/2023]
Abstract
ABSTRACT Acute migraine affects millions of people and is one of the most common primary care complaints in the United States. Available first-line abortive treatments are limited and vary in efficacy. Newer medications such as calcitonin gene-related peptide (CGRP) receptor antagonists may be a useful alternative. This article describes the use of ubrogepant, a new CGRP receptor antagonist, in a patient with contraindications to traditional medications used for acute migraine.
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Affiliation(s)
- Erin S Schoenfuss
- Erin S. Schoenfuss practices family medicine at Aspirus Medical Group in Weston, Wisc., and is a doctor of medical science candidate at A.T. Still University in Mesa, Ariz. The author has disclosed no potential conflicts of interest, financial or otherwise
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27
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del-Blanco-Muñiz JA, Martín-Vera D, Sosa-Reina MD, Trinidad-Morales A, de-la-Plaza-San-Frutos M, Sánchez-Sierra A. Cervical Impairments in Subjects with Chronic Migraine: An Observational Study. Life (Basel) 2023; 13:1773. [PMID: 37629630 PMCID: PMC10455975 DOI: 10.3390/life13081773] [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: 07/17/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE The aim of this investigation was to compare the thickness of the deep local muscles in the neck region, as well as local and widespread sensitivity and functionality, between individuals with migraine and healthy control subjects. METHODS An observational study was carried out in accordance with the STROBE statements. The flexor longus colli and multifidus, two neck-stabilizing muscles, were measured using B-mode ultrasound imaging. The upper trapezius, masseter, temporalis, anterior tibialis, and median nerve all underwent bilateral pressure-pain threshold (PPT) assessments. The statistical program SPSS 29.0 was used to implement the Mann-Whitney U test and Chi-squared test. Spearman Rho was utilized to establish the correlations between the variables. RESULTS Sixty participants were enrolled in the study. The subjects, who were matched in terms of age, gender, and body mass index (BMI), were equally divided into migraine and control groups. No significant differences between the groups were found in the multifidus CSA regarding both sides at rest (right: p = 0.625; left: p = 0.203). However, in contraction, the multifidus CSA showed a significant decrease on the left side in the patients with migraine compared to the controls (p = 0.032), but no significant differences were found in the right multifidus CSA in contraction between the two groups (p = 0.270). In comparison to the healthy volunteers, the migraine sufferers showed a substantial reduction in CSA in the longus colli muscle on both the left side (p = 0.001) and the right side at rest (p = 0.003), as well as in the CSA of the left longus colli in contraction (p < 0.001). Furthermore, the migraine patients showed significantly lower PPT compared to the healthy subjects in local and widespread areas bilaterally. All the parameters revealed higher sensitization in the migraine group in the following areas: the right and left temporal regions (p < 0.001), the right and left upper trapezius (p < 0.001 and p < 0.01, respectively), the right and left masseter muscles (p < 0.01), the right and left median nerves (p < 0.001 and p < 0.01, respectively), and the right and left anterior tibialis muscles (p < 0.001). In terms of the craniocervical flexion test (CCFT), the migraine patients demonstrated significantly lower values than the healthy subjects (p < 0.001). A moderate positive correlation was noted between the PPT in the right temporalis muscle and that in the left longus colli and the right multifidus in contraction. The PPT in the right temporalis muscle also exhibited a positive correlation with the CCFT, although this correlation was low. Between the PPT values, the upper trapezius on both sides showed a moderate positive correlation with the median nerve bilaterally. CONCLUSIONS This research suggests that individuals with migraine may experience local and widespread pain sensitization. A decrease in functionality due to the low muscle endurance of the deep cervical muscles is also accompanied by low values of muscle thickness in contraction. These findings may help to select more accurate treatment approaches for patients with migraine.
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Affiliation(s)
- José Angel del-Blanco-Muñiz
- Faculty of Sport Sciences, Department of Physiotherapy, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain; (J.A.d.-B.-M.); (M.D.S.-R.); (M.d.-l.-P.-S.-F.); (A.S.-S.)
- Therapeutic Exercise and Functional Rehabilitation Research Group, Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain
| | - Daniel Martín-Vera
- Faculty of Sport Sciences, Department of Physiotherapy, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain; (J.A.d.-B.-M.); (M.D.S.-R.); (M.d.-l.-P.-S.-F.); (A.S.-S.)
- Therapeutic Exercise and Functional Rehabilitation Research Group, Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain
| | - Maria Dolores Sosa-Reina
- Faculty of Sport Sciences, Department of Physiotherapy, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain; (J.A.d.-B.-M.); (M.D.S.-R.); (M.d.-l.-P.-S.-F.); (A.S.-S.)
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain
| | - Alfonso Trinidad-Morales
- Faculty of Social Sciences and Communication, Department of Education and Humanities, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain;
- Aqualab Research Group, Faculty of Social Sciences and Communication, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain
| | - Marta de-la-Plaza-San-Frutos
- Faculty of Sport Sciences, Department of Physiotherapy, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain; (J.A.d.-B.-M.); (M.D.S.-R.); (M.d.-l.-P.-S.-F.); (A.S.-S.)
- Therapeutic Exercise and Functional Rehabilitation Research Group, Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain
| | - Alberto Sánchez-Sierra
- Faculty of Sport Sciences, Department of Physiotherapy, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain; (J.A.d.-B.-M.); (M.D.S.-R.); (M.d.-l.-P.-S.-F.); (A.S.-S.)
- Therapeutic Exercise and Functional Rehabilitation Research Group, Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain
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La Touche R, Fierro-Marrero J, Sánchez-Ruíz I, Rodríguez de Rivera-Romero B, Cabrera-López CD, Lerma-Lara S, Requejo-Salinas N, de Asís-Fernández F, Elizagaray-García I, Fernández-Carnero J, Matesanz-García L, Pardo-Montero J, Paris-Alemany A, Reina-Varona Á. Prescription of therapeutic exercise in migraine, an evidence-based clinical practice guideline. J Headache Pain 2023; 24:68. [PMID: 37286937 PMCID: PMC10245624 DOI: 10.1186/s10194-023-01571-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/24/2023] [Indexed: 06/09/2023] Open
Abstract
The main objective of this clinical practice guideline is to provide a series of recommendations for healthcare and exercise professionals, such as neurologists, physical therapists, and exercise physiologists, regarding exercise prescription for patients with migraine.This guideline was developed following the methodology and procedures recommended in the Appraisal of Guidelines for Research and Evaluation (AGREE). The quality of evidence and strength of recommendations were evaluated with the Scottish Intercollegiate Guidelines Network (SIGN). A systematic literature review was performed and an established appraisal process was employed to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development, and Evaluation methodology).The evaluation of the current evidence, the elaboration of the grades of recommendation, and their validation show a B grade of recommendation for aerobic exercise, moderate-continuous aerobic exercise, yoga, and exercise and lifestyle recommendations for the improvement of symptoms, disability, and quality of life in patients with migraine. Relaxation techniques, high-intensity interval training, low-intensity continuous aerobic exercise, exercise and relaxation techniques, Tai Chi, and resistance exercise obtained a C grade of recommendation for the improvement of migraine symptoms and disability.
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Affiliation(s)
- Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- PhD Program in Medicine and Surgery. Doctoral School, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
| | - José Fierro-Marrero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Irene Sánchez-Ruíz
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Borja Rodríguez de Rivera-Romero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Carlos Donato Cabrera-López
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Sergio Lerma-Lara
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Néstor Requejo-Salinas
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Francisco de Asís-Fernández
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Research Group Breatherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Ignacio Elizagaray-García
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, 28023, Madrid, Spain
| | - Josué Fernández-Carnero
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28922, Alcorcón, Spain
| | - Luís Matesanz-García
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, 28023, Madrid, Spain
| | - Joaquín Pardo-Montero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Alba Paris-Alemany
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain.
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain.
- Department of Radiology, Rehabilitation and Physiotherapy. Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain.
| | - Álvaro Reina-Varona
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- PhD Program in Medicine and Surgery. Doctoral School, Universidad Autónoma de Madrid, Madrid, Spain
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Wahab S, Kataria S, Woolley P, O'Hene N, Odinkemere C, Kim R, Urits I, Kaye AD, Hasoon J, Yazdi C, Robinson CL. Literature Review: Pericranial Nerve Blocks for Chronic Migraines. Health Psychol Res 2023; 11:74259. [PMID: 37139462 PMCID: PMC10151122 DOI: 10.52965/001c.74259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Purpose of Review Headaches, especially migraines, are one of the most pervasive neurological disorders affecting up to 15.9% of the population. Current methods of migraine treatment include lifestyle changes, pharmacologic, and minimally invasive techniques such as peripheral nerve stimulation (PNS) and pericranial nerve blocks (PNB). Recent Findings PNBs are used to treat and prevent migraines and involves injection of local anesthetics with or without corticosteroids. PNBs include the greater occipital, supraorbital, supratrochlear, lesser occipital, auriculotemporal, sphenopalantine ganglion, and cervical root nerve blocks. Of the PNBs, the most extensively studied is the greater occipital nerve block (GONB) which has been shown to be an efficacious treatment for migraines, trigeminal neuralgia, hemi-crania continua, and post-lumbar puncture, post-concussive, cluster, and cervicogenic headaches but not medication overuse and chronic tension type headaches. Summary In this review, we aim to summarize the recent literature on PNBs and their efficacy in the treatment of migraines including a brief discussion of peripheral nerve stimulation.
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Affiliation(s)
- Stephanie Wahab
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
| | - Saurabh Kataria
- Louisiana State University Health Shreveport, Department of Neurology, Shreveport, LA
| | - Parker Woolley
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
| | - Naanama O'Hene
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
| | - Chima Odinkemere
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
| | - Rosa Kim
- Georgetown University Hospital, Department of General Surgery, Medstar, Washington, DC
| | | | - Alan D Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Jamal Hasoon
- UTHealth McGovern Medical School, Department of Anesthesiology, Critical Care and Pain Medicine, Houston, TX
| | - Cyrus Yazdi
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
| | - Christopher L Robinson
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
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30
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Hartley MJ, Gounder P, Oliphant H. Spontaneous periocular ecchymosis: a major review. Orbit 2023; 42:124-129. [PMID: 36374198 DOI: 10.1080/01676830.2022.2142944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Periocular ecchymosis, or periocular bruising, is a common clinical finding. Periocular skin is thin with an extensive vascular network, making this anatomical region prone to bruising. The most common etiology is trauma, but rarely, patients can present with spontaneous periocular ecchymosis (SPE). The pathophysiology of SPE is complex and varied. In this literature review of 121 articles, we assessed the frequency and variety of causation of this infrequent entity. The main finding was that by far the most common diagnosis causing SPE is amyloidosis and neoplasm, most notably neuroblastoma. Amyloidosis accounted for 23% articles (28/121) and neuroblastoma for 17% articles (21/121). Overall, neoplastic processes accounted for 30% of the articles (36/121), raised intracranial pressure and vascular malformations for 19% of the articles (23/121), migraine and atypical headache for 7% of the articles (8/121), while iatrogenic accounted for 5% of the articles (6/121). Through exploration and appreciation of the pathophysiology, we hope to foster a greater understanding in the clinician to establish underlying etiology, from benign to life-threatening, when presented with SPE.
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Affiliation(s)
- Matthew J Hartley
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK
| | - Pav Gounder
- Royal Sussex County Hospital, Sussex Eye Hospital, Brighton, UK
| | - Huw Oliphant
- Royal Sussex County Hospital, Sussex Eye Hospital, Brighton, UK
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31
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Frazier R, Li BUK, Venkatesan T. Diagnosis and Management of Cyclic Vomiting Syndrome: A Critical Review. Am J Gastroenterol 2023:00000434-990000000-00677. [PMID: 36791365 DOI: 10.14309/ajg.0000000000002216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
Cyclic vomiting syndrome (CVS) is a chronic disorder of gut-brain interaction characterized by recurrent disabling episodes of nausea, vomiting, and abdominal pain. CVS affects both children and adults with a prevalence of approximately 2% in the United States. CVS is more common in female individuals and affects all races. The pathophysiology of CVS is unknown and a combination of genetic, environmental, autonomic, and neurohormonal factors is believed to play a role. CVS is also closely associated with migraine headaches and likely have a shared pathophysiology. The diagnosis of CVS is based on the Rome criteria, and minimal recommended testing includes an upper endoscopy and imaging studies of the abdomen. CVS is frequently associated with anxiety, depression, and autonomic dysfunction. Patients with CVS commonly use cannabis therapeutically for symptom relief. By contrast, cannabinoid hyperemesis syndrome is believed to be a subset of CVS with chronic heavy cannabis use leading to hyperemesis. Due to the recalcitrant nature of the illness, patients often visit the emergency department and are hospitalized for acute CVS flares. Guidelines on the management of CVS recommend a biopsychosocial approach. Prophylactic therapy consists of tricyclic antidepressants (amitriptyline), antiepileptics (topiramate), and aprepitant in refractory patients. Abortive therapy consists of triptans, antiemetics (ondansetron), and sedation. Treatment of comorbid conditions is extremely important to improve overall patient outcomes. CVS has a significant negative impact on patients, families, and the healthcare system, and future research to understand its pathophysiology and develop targeted therapies is needed.
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Affiliation(s)
- Rosita Frazier
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - B U K Li
- Division of Gastroenterology, Hepatology & Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thangam Venkatesan
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, Ohio, USA
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32
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Observational Analysis of the Costs Associated with Acute Treatment of Breakthrough Migraine Attacks in Medicaid Patients Using Preventive Therapies. Adv Ther 2023; 40:1141-1152. [PMID: 36648736 PMCID: PMC9988741 DOI: 10.1007/s12325-022-02386-w] [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: 11/21/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Medications for preventive treatment of migraine reduce migraine frequency, usually measured by a reduction in monthly migraine days (MMD), but generally do not eliminate the need for acute treatment. To assess the economic impact of treatment-related reductions in frequency, methodological guidance recommends capturing cost differences along the spectrum of MMD. OBJECTIVE Characterize monthly migraine medication costs along the spectrum of MMD for patients using calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) for prevention. METHODS Medicaid State Drug Utilization Data (SDUD) were used to identify formulations and per-unit costs for oral, intranasal, and parenteral migraine-specific medications for acute and preventive treatment used by fee-for-service (FFS) Medicaid enrollees in 2020. National drug codes of relevant therapies were used to match SDUD to formulation characteristics including substance, route of administration, and branded/generic marketing status. Mean per-unit cost and the formulation's share of total prescriptions were estimated. Monthly medication costs were modeled based on formulations' per-unit costs and frequency of acute medication use during clinical trials of CGRP mAbs. RESULTS In the SDUD, there were 563,338 prescriptions for migraine-specific acute medications; triptans accounted for 97.37%. Triptan formulations prescribed were 83.78% oral tablet, 10.89% orally disintegrating tablet, 2.60% intranasal, and 2.73% parenteral. Dihydroergotamine accounted for < 1% of total prescriptions and had the highest per-unit cost ($443.50, branded intranasal). There were 97,119 prescriptions for CGRP mAbs, the majority for erenumab (45.73%) or galcanezumab (45.24%). Modeled monthly acute and preventive medication costs ranged from approximately $550 in patients with the fewest MMD treated with oral triptans to > $1500 in patients with the most MMD treated with dihydroergotamine. CONCLUSION In consideration of the migraine-specific acute medications used in FFS Medicaid 2020, for patients using CGRP mAbs for prevention, medication costs may vary significantly with the number of breakthrough attacks treated per month and the type of migraine-specific acute therapy used.
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Gawde P, Shah H, Patel H, Bharathi KS, Patel N, Sethi Y, Kaka N. Revisiting Migraine: The Evolving Pathophysiology and the Expanding Management Armamentarium. Cureus 2023; 15:e34553. [PMID: 36879707 PMCID: PMC9985459 DOI: 10.7759/cureus.34553] [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: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Migraine affects about one billion people worldwide yearly and is one of the most common neurologic illnesses, with a high prevalence and morbidity, particularly among young adults and females. Migraine is associated with many comorbidities, including stress, sleep difficulties, and suicidal ideation. Migraine, despite its widespread occurrence, is underdiagnosed and undertreated. Because of the complicated and primarily unknown mechanisms of migraine formation, several social and biological risk factors, such as hormone imbalances, genetic and epigenetic impacts, and cardiovascular, neurological, and autoimmune illnesses, have been proposed. Through the mid-20th century diversion of the now-defunct vascular theory, the pathophysiology of migraine has developed from a historical study of the "humours" to a distinct entity as a neurological disorder. The range of therapeutic targets has broadened significantly, increasing the number of specialized clinical trials. Understanding the biology of migraine through careful research has resulted in the identification of major therapeutic classes: (i) triptans, serotonin 5-HT1B/1D receptor agonists, (ii) gepants, calcitonin gene-related peptide (CGRP) receptor antagonists, (iii) ditans, 5-HT1F receptor agonists, (iv) CGRP monoclonal antibodies, and (v) glurants, mGlu5 modulators, with further targets being explored. This review provides a comprehensive overview of the most recent literature on epidemiology and risk factors and exposes knowledge gaps.
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Affiliation(s)
- Prathamesh Gawde
- Medicine and Surgery, Lokmanya Tilak Municipal Medical College, Mumbai, IND
| | - Harsh Shah
- Medicine and Surgery, Pandit Deendayal Upadhyay Medical College, Rajkot, IND
| | - Harsh Patel
- Internal Medicine, GMERS (Gujarat Medical Education and Research Society) Medical College, Sola, Ahmedabad, IND
| | | | - Neil Patel
- Medicine and Surgery, GMERS (Gujarat Medical Education and Research Society) Medical College, Himmatnagar, IND
| | - Yashendra Sethi
- Medicine and Surgery, Government Doon Medical College, Dehradun, IND
| | - Nirja Kaka
- Medicine and Surgery, GMERS (Gujarat Medical Education and Research Society) Medical College, Himmatnagar, IND
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Gupta S, Perla A, Roy A, Vitore JG, K B, Salave S, Rana D, Sharma A, Rathod R, Kumar H, Benival D. In Vivo Evaluation of Almotriptan malate Formulation through Intranasal Route for the Treatment of Migraine: Systematic Development and Pharmacokinetic Assessment. AAPS PharmSciTech 2023; 24:32. [PMID: 36627414 DOI: 10.1208/s12249-022-02496-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Migraine headaches are usually intolerable, and a quick-relief treatment remains an unmet medical need. Almotriptan malate is a serotonin (5-HT1B/1D) receptor agonist approved for the treatment of acute migraine in adults. It is currently available in an oral tablet dosage form and has a Tmax of 1-3 h, and therefore, there is a medical need to develop a non-invasive rapidly acting formulation. We have developed an intranasal formulation of almotriptan malate using the quality-by-design (QbD) approach. A 2-factor 3-level full factorial design was selected to build up the experimental setting. The developed formulation was characterized for pH, viscosity, in vitro permeation, ex vivo permeation, and histopathological tolerance. To assess the potential of the developed formulation to produce a rapid onset of action following intranasal delivery, a pharmacokinetic study was performed in the Sprague-Dawley rat model and compared to the currently available marketed oral tablet formulation. For this, the LC-MS/MS bioanalytical method was developed and used for the determination of plasma almotriptan malate concentrations. Results of a pharmacokinetic study revealed that intranasal administration of optimized almotriptan malate formulation enabled an almost five-fold reduction in Tmax and about seven-fold increase in bioavailability in comparison to the currently available oral tablet formulation, suggesting the potential of developed almotriptan malate intranasal formulation in producing a rapid onset of action as well as enhanced bioavailability.
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Affiliation(s)
- Shubham Gupta
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Akhil Perla
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Abhishek Roy
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Jyotsna G Vitore
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Bharathi K
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Sagar Salave
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Dhwani Rana
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Amit Sharma
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Rajeshwari Rathod
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Hemant Kumar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Derajram Benival
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India. .,Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research-Ahmedabad (NIPER-A), Gandhinagar, 382355, Gujarat, India.
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35
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Khokhlov AL, Leykin ZN. [Comparative clinical study of pharmacokinetics and bioequivalence of Relonova and Maxalt]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:68-74. [PMID: 37655413 DOI: 10.17116/jnevro202312308168] [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: 09/02/2023]
Abstract
OBJECTIVE Evaluation of the bioequivalence of the tested Relonova, tablets, 10 mg and Maxalt, tablets, 10 mg drugs on an empty stomach in healthy volunteers. MATERIAL AND METHODS The pharmacokinetic analysis population included 40 volunteers, the safety analysis population included 40 volunteers. The average age of randomized volunteers (men - 20, women - 20) was 29.3±8.9 years, height 1.71±0.09 m, body weight 70.86±11.66 kg, mean BMI 24.18±2.81 kg/m2. The method used high performance liquid chromatography with tandem mass spectrometric detection. Statistical analysis of the obtained data was performed based on the assumption of a log-normal distribution of the parameters AUC0-72 and Cmax. RESULTS The ratio of geometric means for the key pharmacokinetic parameters (AUC0-t, AUC0-inf and Cmax) of rizatriptan is close to 90%, CI is within the acceptable range for bioequivalent drugs (80-125%). The intrasubject variability (CVintra) for rizatriptan was 23.74% (Cmax), 10.94% (AUC0-t). The average profiles of the pharmacokinetic curves of rizatriptan when taking the test and reference drugs have similar shapes. Relonova and reference Maxalt are bioequivalent. CONCLUSION The results of the study make it possible to recommend Relonova for further clinical study and wide practical application.
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Affiliation(s)
- A L Khokhlov
- Yaroslavl State Medical University, Yaroslavl, Russia
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36
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Comparison of ibuprofen and dexketoprofen in the management of migraine-related headache in the emergency department. Notf Rett Med 2022. [DOI: 10.1007/s10049-022-01105-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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37
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Arca KN, Cai J, Wang F, Kassim G, Hasler WL, Batheja MJ. Migraine and Gastroparesis. Curr Neurol Neurosci Rep 2022; 22:813-821. [PMID: 36370318 DOI: 10.1007/s11910-022-01241-3] [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] [Accepted: 09/30/2022] [Indexed: 11/15/2022]
Abstract
PURPOSEOF REVIEW Migraine is a chronic and disabling disease affecting a significant proportion of the world's population. There is evidence that gastroparesis, a gastrointestinal (GI) dysmotility disorder in which transit of gastric contents is delayed, can occur in the setting of migraine. This article aims to review recent literature on overlap in the pathophysiology and clinical manifestations of migraine and gastroparesis and highlight management considerations when these disorders coexist. RECENT FINDINGS There has been increasing recognition of the importance of the connection between the GI tract and the brain, and mounting evidence for the overlap in the pathophysiology of migraine and gastroparesis specifically. There exists a complex interplay between the central, autonomic, and enteric nervous systems. Studies show that gastroparesis may be present during and between acute migraine attacks necessitating modification of management to optimize outcomes. Gastric dysmotility in the setting of migraine can impact absorption of oral migraine medications and alternate formulations should be considered for some patients. Noninvasive vagus nerve stimulation has been FDA cleared for migraine treatment and is also being studied in gastroparesis. Dysfunction of the autonomic nervous system is a significant feature in the pathophysiology of gut motility and migraine, making treatments that modulate the vagus nerve attractive for future research.
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Affiliation(s)
- Karissa N Arca
- Department of Neurology, Mayo Clinic Arizona, Scottsdale, AZ, USA.
| | - Jacqueline Cai
- Department of Internal Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Fangfang Wang
- Department of Internal Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Gassan Kassim
- Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - William L Hasler
- Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Mashal J Batheja
- Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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Exploring the Tryptophan Metabolic Pathways in Migraine-Related Mechanisms. Cells 2022; 11:cells11233795. [PMID: 36497053 PMCID: PMC9736455 DOI: 10.3390/cells11233795] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Migraine is a complex neurovascular disorder, which causes intense socioeconomic problems worldwide. The pathophysiology of disease is enigmatic; accordingly, therapy is not sufficient. In recent years, migraine research focused on tryptophan, which is metabolized via two main pathways, the serotonin and kynurenine pathways, both of which produce neuroactive molecules that influence pain processing and stress response by disturbing neural and brain hypersensitivity and by interacting with molecules that control vascular and inflammatory actions. Serotonin has a role in trigeminal pain processing, and melatonin, which is another product of this pathway, also has a role in these processes. One of the end products of the kynurenine pathway is kynurenic acid (KYNA), which can decrease the overexpression of migraine-related neuropeptides in experimental conditions. However, the ability of KYNA to cross the blood-brain barrier is minimal, necessitating the development of synthetic analogs with potentially better pharmacokinetic properties to exploit its therapeutic potential. This review summarizes the main translational and clinical findings on tryptophan metabolism and certain neuropeptides, as well as therapeutic options that may be useful in the prevention and treatment of migraine.
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Tepper SJ, Ailani J, Ray S, Hirman J, Shrewsbury SB, Aurora SK. Variability in recurrence rates with acute treatments for migraine: why recurrence is not an appropriate outcome measure. J Headache Pain 2022; 23:148. [PMID: 36414952 PMCID: PMC9682643 DOI: 10.1186/s10194-022-01519-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Headache recurrence is a common feature of acute therapies, whether approved or still in development, and continues to be a significant problem for both the patient and the clinician. Further complicating this issue is lack of standardization in definitions of recurrence used in clinical trials, as well as disparity in patient characteristics, rendering a comparison of different acute medications challenging. Recurrence has serious clinical implications, which can include an increased risk for new-onset chronic migraine and/or development of medication overuse headache. The aim of this review is to illustrate variability of recurrence rates depending on prevailing definitions in the literature for widely used acute treatments for migraine and to emphasize sustained response as a clinically relevant endpoint for measuring prolonged efficacy. BODY: A literature search of PubMed for articles of approved acute therapies for migraine that reported recurrence rates was performed. Study drugs of interest included select triptans, gepants, lasmiditan, and dihydroergotamine mesylate. An unpublished post hoc analysis of an investigational dihydroergotamine mesylate product that evaluated recurrence rates using several different definitions of recurrence common in the literature is also included. Depending on the criteria established by the clinical trial and the definition of recurrence used, rates of recurrence vary considerably across different acute therapies for migraine, making it difficult to compare results of different trials to assess the sustained (i.e., over a single attack) and the prolonged (i.e., over multiple attacks) efficacy of a particular study medication. CONCLUSION A standardized definition of recurrence is necessary to help physicians evaluate recurrence rates of different abortive agents for migraine. Sustained pain relief or freedom may be more comprehensive efficacy outcome measures than recurrence. Future efficacy studies should be encouraged to use the recommended definition of sustained pain freedom set by the International Headache Society.
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Affiliation(s)
| | - Jessica Ailani
- MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Joe Hirman
- Pacific Northwest Statistical Consulting, Inc, Woodinville, WA, USA
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Berger AA, Keefe J, Stark CW, Moore M, Ramírez GF, Cucarola JR, Han AH, Kaye AD, Ganti L. Eptinezumab-jjmr, a humanized monoclonal specific to Calcitonin Gene Related Peptide, for the preventive treatment of migraine in adults. Health Psychol Res 2022; 10:38439. [DOI: 10.52965/001c.38439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose of Review Migraines are prevalent and cause significant morbidity, decline in quality of life and healthcare costs universally. Treatment options are varied, but efficacy is limited. This review centers on Eptinezumab-jjmr, a humanized monoclonal specific to CGRP for the prevention of migraines in adults. Herein presented are the science and mechanism of action, indication and clinical evidence for use. Recent Findings Migraines are severe, recurrent headaches, which are either episodic or chronic in nature. The pain is severe, often accompanied by co-morbid symptoms, such as photophobia, phonophobia, nausea and emesis, and is limiting in nature. It is a prevalent disorder that causes significant, worldwide disability, morbidity, suffering, and costs. The pathophysiology of migraines is actively studied, though recent research points to an initiating event causing migraine generation, that is then propagated by other brain regions, a significant one being the trigeminocervical complex. This is driven by biochemical transmitters, chiefly CGRP. This discovery led to the development of CGRP-targeting drugs, including gepants (small molecular antagonists) and anti-CGRP antibodies, such as Eptinezumab-jjmr. Traditional therapy includes preventative and abortive treatment; however, adherence with preventative treatment has been historically poor, and certain types of abortive therapy carry risks and side effects that preclude them from a large patient population. Moreover, traditional therapy often falls short in migraine therapy. CGRP antagonist, including Eptinezumab, aims to cover the gaps in migraine therapy. We present here evidence to support the safe and effective use of Eptinezumab for the prevention of migraines. Summary Migraines are a prevalent primary headache disorder causing significant morbidity worldwide. Traditional abortive and preventative treatments fall short for many patients. Eptinezumab is part of new generation of CGRP-targeting medications and has shown significant evidence to support its use for the prevention of migraines. Further research is required to properly compare eptinezumab with existing pharmacotherapy and update guidelines on the appropriate combinations of therapies that are not available and the correct patient selection for each.
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Affiliation(s)
| | | | | | - Matthew Moore
- Louisiana State University Shreveport School of Medicine
| | | | | | | | | | - Latha Ganti
- University of Central Florida School of Medicine
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Ezzati A, Buse DC, Fanning KM, Reed ML, Martin VT, Lipton RB. Predictors of treatment-response to Acute Prescription Medications in Migraine: Results from the American Migraine Prevalence and Prevention (AMPP) Study. Clin Neurol Neurosurg 2022; 223:107511. [DOI: 10.1016/j.clineuro.2022.107511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/21/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
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Frazier R, Venkatesan T. Current understanding of the etiology of cyclic vomiting syndrome and therapeutic strategies in its management. Expert Rev Clin Pharmacol 2022; 15:1305-1316. [PMID: 36259482 DOI: 10.1080/17512433.2022.2138341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Cyclic vomiting syndrome is a chronic debilitating disorder of the gut-brain interaction and is characterized by recurrent episodes of nausea and vomiting.Recent studies indicate that it is common and affects 2% of the US population. Unfortunately, there is significant heterogeneity in the management of these patients in the medical community. This review article aims to bridge this gap and will review the epidemiology and etiology with a focus on management of CVS. AREAS COVERED This article reviews the epidemiology, and pathophysiology of CVS and impact on patients. It also discusses management based on recent guidelines based on which is intended for the busy clinician. A literature search was done using PubMed and key words "cyclic vomiting", "management", "etiology", and pathophysiology were used to identify articles of importance. EXPERT OPINION CVS is a complex, poorly understood disorder of gut-brain interaction (DGBI) and has a significant negative impact on patients, families and the healthcare system. Recent guidelines recommend a multidisciplinary approach to management using prophylactic therapy in moderate-severe CVS and abortive medication for acute flares. However more research is needed to better understand the pathophysiology and develop targeted therapies for CVS.
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Affiliation(s)
- Rosita Frazier
- Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona
| | - Thangam Venkatesan
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, OH
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Berger AA, Winnick A, Carroll AH, Welschmeyer A, Li N, Colon M, Paladini A, Ramírez GF, Hasoon J, Cornett EM, Song J, Varrassi G, Kaye AM, Kaye AD, Ganti L. Rimegepant for the treatment of migraine. Health Psychol Res 2022; 10:38534. [PMID: 36262478 PMCID: PMC9560892 DOI: 10.52965/001c.38534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Migraine is a common form of primary headache, affecting up to 1 in every 6 Americans. The pathophysiology is an intricate interplay of genetic factors and environmental influence and is still being elucidated in ongoing studies. The trigeminovascular system is now known to have a significant role in the initiation of migraines, including the release of pain mediators such as CGRP and substance P. Traditional treatment of migraine is usually divided into acute and preventive treatment. Acute therapy includes non-specific therapy, such as NSAIDs and other analgesics, which may provide relief in mild to moderate migraines. 5-HT1 agonists may provide relief in severe migraine, but are not universally effective and carry a significant side-effect profile with frequent redosing requirement. Prophylactic therapy may reduce the occurrence of acute migraine attacks in selected patients, but does not completely eliminate it. More recently, CGRP antagonism has been studied and shown to be effective in both abortion and prevention of migraine. Novel medications, targeting CGRP, divide into CGRP antibodies and receptor antagonists (gepants). Rimegepant, a second-generation gepant, has shown efficacy in several clinical trials in treating acute migraine. Ongoing trials are also evaluating its role in migraine prophylaxis, and results are promising. It is also generally safer for use than existing options, does not appear to increase the chance of developing chronic migraines, and carries a very tolerable side effects profile. It is a part of a growing arsenal in migraine treatment, and may present the silver bullet for treatment of this disease.
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Affiliation(s)
- Amnon A Berger
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Ariel Winnick
- Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, University of California School of Optometry
| | | | | | | | - Marc Colon
- Department of Psychiatry, and Behavioral Medicine, Louisiana State University Health Science Center Shreveport
| | | | | | - Jamal Hasoon
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center
| | | | | | | | - Adam M Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Shreveport
| | - Latha Ganti
- University of Central Florida College of Medicine
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Scuteri D, Tarsitano A, Tonin P, Bagetta G, Corasaniti MT. Focus on zavegepant: the first intranasal third-generation gepant. Pain Manag 2022; 12:879-885. [PMID: 36189708 DOI: 10.2217/pmt-2022-0054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Migraine is the leading cause of years lived with disability in people under 50 and its burden is increased by calcitonin gene-related peptide (CGRP)-driven chronicity. Newly approved small molecules that antagonize the CGRP receptor, gepants, have advanced from the hepatotoxic first-generation telcagepant to third-generation intranasal zavegepant; during this process of drug development, rimegepant, ubrogepant and atogepant, which are orally administered, have been launched and approved for clinical use with no warning for hepatotoxicity. Real-world, long-term postmarketing data about the efficacy and safety of gepants are awaited. The aim of the present drug evaluation study was to provide an overview of the novel, third-generation intranasal Zavegepant, encompassing its development and future perspectives.
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Affiliation(s)
- Damiana Scuteri
- Department of Pharmacy, Pharmacotechnology Documentation & Transfer Unit, Preclinical & Translational Pharmacology, Health & Nutritional Sciences, University of Calabria, Rende, 87036, Italy.,Regional Center for Serious Brain Injuries, S. Anna Institute, Crotone, 88900, Italy
| | - Assunta Tarsitano
- Pain Therapy Center, Provincial Health Authority (ASP), Cosenza, 87100, Italy
| | - Paolo Tonin
- Regional Center for Serious Brain Injuries, S. Anna Institute, Crotone, 88900, Italy
| | - Giacinto Bagetta
- Department of Pharmacy, Pharmacotechnology Documentation & Transfer Unit, Preclinical & Translational Pharmacology, Health & Nutritional Sciences, University of Calabria, Rende, 87036, Italy
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Reina-Varona Á, Rodríguez de Rivera-Romero B, Cabrera-López CD, Fierro-Marrero J, Sánchez-Ruiz I, La Touche R. Exercise interventions in migraine patients: a YouTube content analysis study based on grades of recommendation. PeerJ 2022; 10:e14150. [PMID: 36199286 PMCID: PMC9528906 DOI: 10.7717/peerj.14150] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/07/2022] [Indexed: 01/21/2023] Open
Abstract
Background Migraine is the second leading cause of disability worldwide, engendering a high economic cost in developed countries. The adverse events related to pharmacological treatment use have increased interest in non-pharmacological interventions such as exercise. YouTube offers a public source of information for migraine patients regarding exercise interventions for migraine improvement. However, this information has not been validated to ensure the quality and validity of its content. Objective This qualitative content analysis study aims to review and evaluate YouTube videos regarding exercise for migraine. Methods A systematic review of the current evidence regarding exercise for migraine was performed to establish evidence classification and grades of recommendation with the Scottish Intercollegiate Guidelines Network tool. The data sources were PubMed, PEDro, Cochrane, EBSCO, Google Scholar and Web of Science. The quality of YouTube videos on exercise in migraine was reviewed using the Global Quality Scale and DISCERN scale. Finally, the classification in grades of recommendation was used to evaluate the included videos in terms of the various exercise modalities. Results The classification into recommendation grades showed a grade B for aerobic exercise, yoga and changes in lifestyle behavior regarding exercise. A total of 129 videos were included. The healthcare and exercise professional authors produced higher quality videos with a significant statistical difference, although the alternative therapists and patients' videos had a greater impact and a higher viewership based on correlation analysis. The evaluation of the videos based on the recommendation grades could only include 90 videos. 71% of these videos showed a B grade of recommendation, which corresponded to fewer than half of the total included videos. Conclusions YouTube needs higher quality videos on exercise for migraine, and healthcare and exercise professional authors need to improve their scoping strategies to acquire more views. The authors of YouTube videos should have better access to the best current evidence regarding exercise interventions in migraine.
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Affiliation(s)
- Álvaro Reina-Varona
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Aravaca, Madrid, Spain
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Borja Rodríguez de Rivera-Romero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Carlos Donato Cabrera-López
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - José Fierro-Marrero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Irene Sánchez-Ruiz
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Roy La Touche
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Aravaca, Madrid, Spain
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Madrid, Spain
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Oral transmucosal delivery of eletriptan for neurological diseases. Int J Pharm 2022; 627:122222. [PMID: 36155795 DOI: 10.1016/j.ijpharm.2022.122222] [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: 08/05/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 11/21/2022]
Abstract
Migraine is a highly prevalent neurological disease affecting circa 1 billion patients worldwide with severe incapacitating symptoms, which significantly diminishes the quality of life. As self-medication practice, oral administration of triptans is the most common option, despite its relatively slow therapeutic onset and low drug bioavailability. To overcome these issues, here we present, to the best of our knowledge, the first study on the possibility of oral transmucosal delivery of one of the safest triptans, namely eletriptan hydrobromide (EB). Based on a comprehensive set of in vitro and ex vivo experiments, we highlight the conditions required for oral transmucosal delivery, potentially giving rise to similar, or even higher, drug plasma concentrations expected from conventional oral administration. With histology and tissue integrity studies, we conclude that EB neither induces morphological changes nor impairs the integrity of the mucosal barrier following 4 h of exposure. On a cellular level, EB is internalized in human oral keratinocytes within the first 5 min without inducing toxicity at the relevant concentrations for transmucosal delivery. Considering that the pKa of EB falls within the physiologically range, we systematically investigated the effect of pH on both solubility and transmucosal permeation. When the pH is increased from 6.8 to 10.4, the drug solubility decreases drastically from 14.7 to 0.07 mg/mL. At pH 6.8, EB gave rise to the highest drug flux and total permeated amount across mucosa, while at pH 10.4 EB shows greater permeability coefficient and thus higher ratio of permeated drug versus applied drug. Permeation experiments with model membranes confirmed the pH dependent permeation profile of EB. The distribution of EB in different cellular compartments of keratinocytes is pH dependent. In brief, high drug ionization leads to higher association with the cell membrane, suggesting ionic interactions between EB and the phospholipid head groups. Moreover, we show that the chemical permeation enhancer DMSO can be used to enhance the drug permeation significantly (i.e., 12 to 36-fold increase). Taken together, this study presents important findings on transmucosal delivery of eletriptan via the oral cavity and paves the way for clinical investigations for a fast and safe migraine treatment.
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Grosberg B, Rabany L, Vizel M, Ironi A, Harris D, Stark-Inbar A, Smith TR. Effectiveness comparison of remote electrical neuromodulation and standard-care medications for acute treatment of chronic migraine: a post-hoc analysis. Pain Manag 2022; 12:837-844. [PMID: 36097974 DOI: 10.2217/pmt-2022-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The current study compared the effectiveness of remote electrical neuromodulation (REN) to that of standard-care medications for acute treatments of migraine, using a within-subjects design. Materials & methods: Post-hoc within-subject analysis was performed on data from 78 adult chronic migraine patients who participated in a clinical trial with REN, on four end points: single-treatment pain relief, single-treatment pain freedom, consistency of pain relief and consistency of pain freedom. Results: No statistical differences were found between REN and the tested medications, in any of the effectiveness outcomes: single-treatment pain relief p = 0.056, single-treatment pain freedom p = 0.532, consistency of pain relief p = 0.369, consistency of pain freedom p = 1.00. Conclusion: The results suggest that REN may provide an effective non-pharmacological alternative for standard care abortive medications in individuals impacted by chronic migraine.
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Affiliation(s)
- Brian Grosberg
- Hartford Hospital, 65 Memorial Rd #508, West Hartford, CT 06107, USA
| | - Liron Rabany
- Theranica Bio-Electronics, Ha'Omanut St. 4, Netanya, 4250438, Israel
| | - Maya Vizel
- Theranica Bio-Electronics, Ha'Omanut St. 4, Netanya, 4250438, Israel
| | - Alon Ironi
- Theranica Bio-Electronics, Ha'Omanut St. 4, Netanya, 4250438, Israel
| | - Dagan Harris
- Theranica Bio-Electronics, Ha'Omanut St. 4, Netanya, 4250438, Israel
| | - Alit Stark-Inbar
- Theranica Bio-Electronics, Ha'Omanut St. 4, Netanya, 4250438, Israel
| | - Timothy R Smith
- StudyMetrix Research, LLC 3862 Mexico Rd, St. Peters, MO 63303, USA
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Daniel O, Tepper SJ, Deutsch L, Sharon R. External Concurrent Occipital and Trigeminal Neurostimulation Relieves Migraine Headache: A Prospective, Randomized, Double-Blind, Sham-Controlled Trial. Pain Ther 2022; 11:907-922. [PMID: 35661128 PMCID: PMC9314547 DOI: 10.1007/s40122-022-00394-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/05/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Current external peripheral nerve stimulation devices stimulate only one nerve. This prospective, randomized, double-blind, sham-controlled trial assessed efficacy, safety, and tolerability of a novel external combined occipital and trigeminal neurostimulation (eCOT-NS) device as a self-administered home treatment for migraine (Relivion®MG, Neurolief Ltd; Netanya, Israel). METHODS Episodic and chronic migraine subjects (N = 55) were randomized to receive active (n = 27) or sham (n = 28) treatment. Subjects received eCOT-NS devices and performed 60 ± 20-min home treatments within 45 min of migraine episode onset. The primary endpoint was relative (percent) change in mean baseline VAS pain scores 1 h after treatment initiation. Treatment outcomes assessed at 1-, 2-, and 24-h post-treatment initiation were pain reduction and proportion of pain-free subjects and treatment responders, defined as ≥ 50% pain reduction. Categorical pain ratings (none, mild, moderate, and severe pain) were also analyzed. RESULTS Active stimulation was significantly more effective than sham stimulation for decreasing pain intensity at 1 h (53% vs. 10%), 2 h (52% vs. 17%), and 24 h (71% vs. 34%). Pain-free ratings were greater for the active treatment arm at 1 h (29.2% vs. 16%), 2 h (41.7% vs. 20%), and 24 h (65.2% vs. 40%). The number of subjects with baseline moderate or severe migraine pain who were pain-free at 2 h was significantly greater among active treatment subjects (43% vs. 10.5%). The responder rate was significantly higher among the active treatment group at 1 h (67% vs. 20%), 2 h (66.7% vs. 32%,), and 24 h (78.3% vs. 48%). Overall headache relief was significantly higher in the active treatment group at 1 h (67% vs. 26%) and 2 h (76% vs. 31.6%). Mild adverse events, reported by a minority of subjects, resolved spontaneously. CONCLUSIONS eCOT-NS provides superior clinically meaningful relief and freedom from migraine pain, offering an effective and safe therapy for acute treatment of migraine. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03398668.
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Affiliation(s)
- Oved Daniel
- Headache and Facial Pain Clinic, Ramat-Aviv Medical Center, Tel-Aviv, Israel
| | - Stewart J. Tepper
- Geisel School of Medicine at Dartmouth, Hanover, NH USA ,Dartmouth Headache Center, Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | - Lisa Deutsch
- BioStats Statistical Consulting, Ltd, Modiin, Israel
| | - Roni Sharon
- Tel-Aviv University Sackler School of Medicine, Tel-Aviv, Israel ,Department of Neurology, Chaim Sheba (Tel HaShomer) Medical Center, Ramat Gan, Israel
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Tepper SJ, Grosberg B, Daniel O, Kuruvilla DE, Vainstein G, Deutsch L, Sharon R. Migraine treatment with external concurrent occipital and trigeminal neurostimulation—A randomized controlled trial. Headache 2022; 62:989-1001. [DOI: 10.1111/head.14350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Stewart J. Tepper
- Geisel School of Medicine at Dartmouth Hanover New Hampshire USA
- Dartmouth Headache Center Lebanon New Hampshire USA
| | - Brian Grosberg
- Hartford Healthcare Headache Center Ayer Neuroscience Institute West Hartford Connecticut USA
- Department of Neurology University of Connecticut School of Medicine Farmington Connecticut USA
| | - Oved Daniel
- Headache and Facial Pain Clinic Ramat‐Aviv Medical Center Tel‐Aviv Israel
| | | | - Gabriel Vainstein
- Kahn‐Sagol‐Maccabi Research and Innovation Institute Maccabi Healthcare Services Tel Aviv Israel
| | - Lisa Deutsch
- BioStats Statistical Consulting Ltd. Modiin Israel
| | - Roni Sharon
- Tel‐Aviv University Sackler School of Medicine Tel‐Aviv Israel
- Department of Neurology Chaim Sheba (Tel HaShomer) Medical Center Ramat Gan Israel
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50
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Ogunlaja OI, Goadsby PJ. Headache: Treatment update. eNeurologicalSci 2022; 29:100420. [PMID: 36636337 PMCID: PMC9830470 DOI: 10.1016/j.ensci.2022.100420] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/10/2022] [Indexed: 01/16/2023] Open
Abstract
Primary headache disorders in particular migraine are one of the most common causes of disability worldwide. Given the high burden of migraine in terms of disability, there has been an effort to develop migraine specific therapies that has led to the availability of new drugs including 5HT1F receptor agonists-ditans (lasmiditan), small molecule calcitonin gene-related peptide (CGRP) receptor antagonists-gepants: (ubrogepant, rimegepant, atogepant) and anti-CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab and eptinezumab). However, some of these treatments incur a high cost and may not be a feasible option for most patients in resource limited settings. Lasmiditan and the gepants are a good option for patients with moderate-severe migraine attacks who cannot use triptans due variously to poor tolerability, or cardio- or cerebrovascular disease. For practical purposes, the new anti-CGRP monoclonal antibodies are best reserved for patients who have failed to have efficacy or had intolerable side effects from multiple traditional oral preventives.
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Affiliation(s)
- Oyindamola I. Ogunlaja
- NIHR King's Clinical Research Facility and SLaM Biomedical Research Centre, King's College London, UK
| | - Peter J. Goadsby
- NIHR King's Clinical Research Facility and SLaM Biomedical Research Centre, King's College London, UK,Department of Neurology, University of California, Los Angeles, CA, USA,Corresponding author at: Wellcome Foundation Building, King's College Hospital, London SE5 9PJ, UK.
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