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Mínguez-Olaondo A, Días PA, de Munáin EL, Grozeva V, Laspra-Solís C, Villalba IM, García-Martín V, Vila-Pueyo M, Barandiarán M, Zabalza RJ, Bengoetxea A. Behavioral therapy in migraine: Expanding the therapeutic arsenal. Eur J Neurol 2024:e16414. [PMID: 39034641 DOI: 10.1111/ene.16414] [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: 02/05/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND AND PURPOSE The US Headache Consortium developed evidence-based guidelines for the treatment of migraine and found grade A evidence in support of behavior therapy (BT). Understanding the mechanisms of BT may improve the management of migraine and reduce its burden. METHODS We performed a narrative review to define the current evidence of BT and determine its usefulness in migraine management. RESULTS The information was obtained from 116 publications, with 56 of them retrieved through direct searches in PubMed (2011-2020) and the remainder selected by the authors to complete the content. BT might reduce migraine impact by decreasing the sympathetic nervous system's response to stress and increasing pain tolerance. Acting in headache-related surroundings can be improved, together with headache duration and self-efficacy. Applications such as mobile health and electronic health applications can help to carry out healthier lifestyle patterns. Regarding medication overuse, BT seems to be a good choice, with similar results to pharmacological prophylaxis. Advantages of using BT are the lack of adverse effects and the unrestricted use in children, where BT is postulated to be even more effective than the standardized pharmacopeia. CONCLUSIONS BT is an interesting tool that can be used as an add-on therapy in migraine. Through BT, the autonomy and empowerment of migraine patients is enhanced. BT may not cure migraine, but it could help to reduce pain severity perception, disability, and migraine impact, adding an emotive and cognitive approach to the perceptive role of pharmacopeia. Thus, a better approach in migraine, implementing specific therapeutic management, can improve migraine control.
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Affiliation(s)
- Ane Mínguez-Olaondo
- Neurology Department, Hospital Universitario Donostia-Osakidetza , Neuroscience Area, Biogipuzkoa Health Institute, Donostia, Spain
- Athenea Neuroclinics, Donostia, Spain
- Department of Medicine and Department of Physical Therapy, Faculty of Health Sciences, University of Deusto, Bilbao and San Sebastian, Spain
| | - Patricia Alves Días
- Neurology Department, Hospital Universitario Donostia-Osakidetza , Neuroscience Area, Biogipuzkoa Health Institute, Donostia, Spain
- Athenea Neuroclinics, Donostia, Spain
- Department of Medicine and Department of Physical Therapy, Faculty of Health Sciences, University of Deusto, Bilbao and San Sebastian, Spain
| | | | | | - Carmen Laspra-Solís
- Department of Psychiatry and Clinical Psychology, University Clinic of Navarra, Madrid, Spain
| | | | - Valvanuz García-Martín
- Neurology Department, Hospital Universitario Donostia-Osakidetza , Neuroscience Area, Biogipuzkoa Health Institute, Donostia, Spain
| | - Marta Vila-Pueyo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Myriam Barandiarán
- Neurology Department, Hospital Universitario Donostia-Osakidetza , Neuroscience Area, Biogipuzkoa Health Institute, Donostia, Spain
- Athenea Neuroclinics, Donostia, Spain
- Department of Medicine and Department of Physical Therapy, Faculty of Health Sciences, University of Deusto, Bilbao and San Sebastian, Spain
| | - Ramon J Zabalza
- Neurology Department, Hospital Universitario Donostia-Osakidetza , Neuroscience Area, Biogipuzkoa Health Institute, Donostia, Spain
| | - Ana Bengoetxea
- Athenea Neuroclinics, Donostia, Spain
- Unité de Recherche en Sciences de l'Ostéopathie, Faculté des Sciences de la Motricité, Université Libre de Bruxelles, Brussels, Belgium
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Suzuki K, Suzuki S, Haruyama Y, Funakoshi K, Fujita H, Sakuramoto H, Hamaguchi M, Kobashi G, Hirata K. Associations between the burdens of comorbid sleep problems, central sensitization, and headache-related disability in patients with migraine. Front Neurol 2024; 15:1373574. [PMID: 38601337 PMCID: PMC11006273 DOI: 10.3389/fneur.2024.1373574] [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: 01/20/2024] [Accepted: 02/15/2024] [Indexed: 04/12/2024] Open
Abstract
Objective Sleep disturbances are common in migraine patients and affect quality of life. Central sensitization (CS) is likely to play a role in the increased severity and chronicity of migraine. We hypothesized that the number of comorbid sleep problems would affect headache-related disability through the effects of central sensitization (CS). Methods We performed a cross-sectional study including 215 consecutive patients with migraine. Insomnia was defined as a Pittsburgh Sleep Quality Index (PSQI) global score greater than 5. Probable REM sleep behavior disorder (pRBD) was defined as an RBD screening score of 5 or greater. Excessive daytime sleepiness (EDS) was defined as an Epworth Sleepiness Scale score of 10 or higher. Suspected sleep apnea (SA) was defined as patients with snoring or sleep apnea witnessed 3 or more nights a week. CS was assessed by the Central Sensitization Inventory (CSI). Results Restless legs syndrome, insomnia, EDS, SA and pRBD were observed in 25.6%, 71.6%, 34.4%, 10.2%, and 21.4%, respectively, of the patients. At least one sleep problem was present in 87.0% of the patients. According to the results of the multinomial logistic regression analysis with no sleep problems as a reference, after we corrected for adjustment factors, the Migraine Disability Assessment (MIDAS) score significantly increased when three or more comorbid sleep problems were present. According to our mediation analysis, an increased number of sleep problems had a direct effect on the MIDAS score after we adjusted for other variables, and the CSI score was indirectly involved in this association. Conclusion The present study showed an association between migraine-related disability and the burden of multiple sleep problems, which was partially mediated by CS.
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Affiliation(s)
- Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Mibu, Japan
| | - Shiho Suzuki
- Department of Neurology, Dokkyo Medical University, Mibu, Japan
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University, Mibu, Japan
| | - Kei Funakoshi
- Department of Neurology, Dokkyo Medical University, Mibu, Japan
| | - Hiroaki Fujita
- Department of Neurology, Dokkyo Medical University, Mibu, Japan
| | | | - Mai Hamaguchi
- Department of Neurology, Dokkyo Medical University, Mibu, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University, Mibu, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Mibu, Japan
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Golovacheva VA, Golovacheva AA, Fateeva TG, Parfenov VA. [Cognitive behavioral therapy in the treatment of patients with chronic migraine and concomitant chronic insomnia: a prospective, randomized trial]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:110-117. [PMID: 38934675 DOI: 10.17116/jnevro2024124052110] [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: 06/28/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of a multidisciplinary program, including Cognitive behavioral therapy (CBT), in the treatment of patients with chronic migraine (CM) and concomitant chronic insomnia (CI). MATERIAL AND METHODS The study included 96 patients with CM and CI, average age 35.7±8.6. All patients underwent clinical interviews and testing using clinical and psychological techniques. Patients were randomized into two groups: group 1 received study treatment (an multudisciplinary program including CBT for pain and insomnia, combined with standard treatment for migraine), group 2 received standard treatment for migraine (preventive and acute pharmacotherapy for migraine, recommendations about lifestyle and sleep hygiene). All patients were assessed for clinical and psychological parameters before treatment and at 3, 6, 12 and 18 months follow-up. RESULTS At 3 month follow-up a statistically significant improvement was observed in group 1: a decrease in the frequency of headaches and the use of painkillers, parameters on the Insomnia Severity Index (ITI), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory, and the Migraine Disability Assessment (MIDAS) (p<0.05). At 6, 12 and 18 months follow-up the achieved improvements were maintained. At 3 month follow-up, group 2 showed a statistically significant improvement in only 4 parameters: a decrease in the frequency of headaches and painkiller use, and parameters for ITI and MIDAS. These parameters increased to values that were not statistically significantly different from the parameters before treatment in group 2 at 6 month follow-up. At 3 month follow-up in group 165% of patients achieved clinical effect (CE) according to CM (headache frequency decreased by 50% or more), in group 2 - 40%, which was not statistically significantly different (p>0.001); in group 1, 76% of patients achieved CE according to CI (ITI decreased by 8 points or more), which is statistically significantly more than in group 2 with 45% of patients with CE (p<0.001). At 18 month follow-up, in group 1, 81.5% of patients achieved CE according to CM, which is statistically significantly more than in group 2 with 33% of patients with CE (p<0.001); in group 1, 85% of patients achieved CE according to CI, which is statistically significantly more than in group 2, where 38% of patients had CE (p<0.001). CONCLUSION High effectiveness of CBT in patients with CM and combined CI was noted.
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Affiliation(s)
- V A Golovacheva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A A Golovacheva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - T G Fateeva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - V A Parfenov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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de Bergeyck R, Geoffroy PA. Insomnia in neurological disorders: Prevalence, mechanisms, impact and treatment approaches. Rev Neurol (Paris) 2023; 179:767-781. [PMID: 37620177 DOI: 10.1016/j.neurol.2023.08.008] [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: 07/14/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
Insomnia is more prevalent in neurological disorders compared to the general population, with rates ranging from 11 to 74.2% in neurodegenerative disorders, 20 to 37% in vascular diseases, 13.3 to 50% in inflammatory diseases, 28.9 to 74.4% in epilepsy, and nearly 70% in migraines. Insomnia in neurological disorders stems from a variety of factors, encompassing physical and neuropsychiatric factors, behavioral patterns, and disruptions in the biological clock and circadian rhythm. There are bidirectional connections between neurological disorders and insomnia. Insomnia in neurological disorders worsens symptoms, resulting in heightened depressive symptoms, elevated mortality rates, reduced quality of life, and intensified acute symptoms. Managing comorbid sleep disorders, especially in the presence of psychiatric comorbidities, is crucial. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line recommendation for insomnia management in neurological disorders. Other treatments are second-line strategies. Melatonin may demonstrate effectiveness in addressing insomnia, with soporific and chronobiotic effects. Furthermore, it has the potential to alleviate "sundowning" and behavioral disturbances, while generally being well-tolerated. Other treatment options that may be of interest include morning bright light therapy, sedative antidepressants, new orexin dual antagonists and levodopa specifically indicated for Parkinson's disease. Benzodiazepines and z-drugs can be used primarily during acute phases to prevent pharmacotolerance and minimize side effects. However, they should be avoided in patients with neurological disorders and not used in patients over 75 years old due to the risk of falls and confusion. In neurological disorders, insomnia has a profound impact on daytime functioning, making its management crucial. Effective treatment can result in improved outcomes, and additional research is necessary to investigate alternative therapeutic options and enhance patient care.
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Affiliation(s)
- R de Bergeyck
- Centre ChronoS, GHU Paris - Psychiatry Neurosciences, 1, rue Cabanis, 75014 Paris, France.
| | - P A Geoffroy
- Centre ChronoS, GHU Paris - Psychiatry Neurosciences, 1, rue Cabanis, 75014 Paris, France; Département de psychiatrie et d'addictologie, DMU Neurosciences, GHU Paris Nord, hôpital Bichat-Claude-Bernard, AP-HP, 75018 Paris, France; Université Paris Cité, NeuroDiderot, Inserm U1141, 75019 Paris, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5, rue Blaise-Pascal, 67000 Strasbourg, France
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Pelzer N, de Boer I, van den Maagdenberg AMJM, Terwindt GM. Neurological and psychiatric comorbidities of migraine: Concepts and future perspectives. Cephalalgia 2023; 43:3331024231180564. [PMID: 37293935 DOI: 10.1177/03331024231180564] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND This narrative review aims to discuss several common neurological and psychiatric disorders that show comorbidity with migraine. Not only can we gain pathophysiological insights by studying these disorders, comorbidities also have important implications for treating migraine patients in clinical practice. METHODS A literature search on PubMed and Embase was conducted with the keywords "comorbidity", "migraine disorders", "migraine with aura", "migraine without aura", "depression", "depressive disorders", "epilepsy", "stroke", "patent foramen ovale", "sleep wake disorders", "restless legs syndrome", "genetics", "therapeutics". RESULTS Several common neurological and psychiatric disorders show comorbidity with migraine. Major depression and migraine show bidirectional causality and have shared genetic factors. Dysregulation of both hypothalamic and thalamic pathways have been implicated as a possibly cause. The increased risk of ischaemic stroke in migraine likely involves spreading depolarizations. Epilepsy is not only bidirectionally related to migraine, but is also co-occurring in monogenic migraine syndromes. Neuronal hyperexcitability is an important overlapping mechanism between these conditions. Hypothalamic dysfunction is suggested as the underlying mechanism for comorbidity between sleep disorders and migraine and might explain altered circadian timing in migraine. CONCLUSION These comorbid conditions in migraine with distinct pathophysiological mechanisms have important implications for best treatment choices and may provide clues for future approaches.
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Affiliation(s)
- Nadine Pelzer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Irene de Boer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arn M J M van den Maagdenberg
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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Hu L, Wang EJH. Sleep as a Therapeutic Target for Pain Management. Curr Pain Headache Rep 2023; 27:131-141. [PMID: 37162641 DOI: 10.1007/s11916-023-01115-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a summary of the utilization of sleep as a therapeutic target for chronic pain and to evaluate the recent literature on current and proposed pharmacologic and non-pharmacologic sleep interventions used in the management of pain disorders. RECENT FINDINGS Sleep is a promising therapeutic target in the treatment of pain disorders with both non-pharmacologic and pharmacologic therapies. Non-pharmacologic therapies include cognitive behavioral therapy and sensory-based therapies such as pink noise, audio-visual stimulation, and morning bright light therapy. Pharmacologic therapies include melatonin, z-drugs, gabapentinoids, and the novel orexin antagonists. However, more research is needed to clarify if these therapies can improve pain specifically by improving sleep. There is a vast array of investigational opportunities in sleep-targeted therapies for pathologic pain, and larger controlled, prospective trials are needed to fully elucidate their efficacy.
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Affiliation(s)
- Lizbeth Hu
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Eric Jyun-Han Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Johns Hopkins Blaustein Pain Treatment Center, 601 North Caroline Street, Suite 3062, Baltimore, MD, 21287, USA.
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Walker D, Zhang N, Natbony LR. Insomnia and Migraine: A Review of Evidence-Based, Biobehavioral Interventions. Curr Pain Headache Rep 2023; 27:19-25. [PMID: 36701076 DOI: 10.1007/s11916-023-01100-x] [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: 01/17/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the current evidence for Cognitive Behavioral Therapy for Insomnia (CBT-I) for patients with migraine and comorbid insomnia. In this article, we provide a narrative review of the literature on CBT-I and migraine, highlighting recent advances in research into this topic. Finally, we propose a way for clinicians to integrate CBT-I into clinical practice. RECENT FINDINGS Multiple studies support CBT-I as a validated modality for the treatment of insomnia in migraine. CBT-I is used to treat insomnia and should be offered as first line therapy. Clinicians should screen for insomnia in all patients with headache, especially in those with migraine, to best manage this condition through the implementation of specific insomnia treatment.
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Affiliation(s)
- David Walker
- Department of Neurology, Stanford School of Medicine, Palo Alto, CA, USA
| | - Niushen Zhang
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurology, Stanford School of Medicine, Palo Alto, CA, USA
| | - Lauren R Natbony
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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8
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Seng EK, Martin PR, Houle TT. Lifestyle factors and migraine. Lancet Neurol 2022; 21:911-921. [PMID: 36115363 DOI: 10.1016/s1474-4422(22)00211-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 04/11/2022] [Accepted: 04/29/2022] [Indexed: 01/19/2023]
Abstract
Migraine, a common and disabling neurological disorder, is among the top reasons for outpatient visits to general neurologists. In addition to pharmacotherapy, lifestyle interventions are a mainstay of treatment. High-quality daily diary studies and intervention studies indicate intraindividual variations in the associations between lifestyle factors (such as stress, sleep, diet, and physical activity) and migraine attack occurrence. Behaviour change interventions can directly address overlapping lifestyle factors; combination approaches could capitalise on multiple mechanisms. These findings provide useful directions for integration of lifestyle management into routine clinical care and for future research.
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Affiliation(s)
- Elizabeth K Seng
- Albert Einstein College of Medicine, Montefiore Medical Center and Yeshiva University, Bronx, NY, USA.
| | - Paul R Martin
- Department of Psychiatry, Monash Medical Centre, Monash University, Melbourne, VIC, Australia; School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Timothy T Houle
- Massachusetts General Hospital, Harvard School of Medicine, Boston, MA, USA
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Currò CT, Ciacciarelli A, Vitale C, La Spina P, Toscano A, Vita G, Trimarchi G, Silvestri R, Autunno M. Sleep and sleep-modifying factors in chronic migraine patients during the COVID-19 lockdown. Neurol Sci 2022; 43:6639-6655. [PMID: 36138296 PMCID: PMC9510535 DOI: 10.1007/s10072-022-06378-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/28/2022] [Indexed: 11/30/2022]
Abstract
Aims The objective of the present study was to evaluate sleep features and sleep-modifying factors in patients with chronic migraine (CM) during the first Italian COVID-19 lockdown. Material and methods The study was based on an e-mail survey addressed to CM patients of our headache center. The survey investigated demographic, life-style, sleep, psychological, and migraine features during the first COVID-19 lockdown period and the month before. The outcomes were sleep quality (measured using PSQI) and variation in sleep quality, duration, and latency. Results Ninety-two patients were included. The mean PSQI was 11.96. Sleep quality was improved in 14.1%, stable in 47.8%, and worsened in 38.0%. Sleep latency was reduced in 5.4%, stable in 46.7%, and increased in 47.8%. Sleep duration was reduced in 29.3%, stable in 34.8%, and increased in 35.9%. Significant associations were found with age, work/study, remote working, job loss, meal quality change, smoking variation, COVID-19 province prevalence, home-inhabitant relationship, ratio of house size/number of people, stress, state anxiety, anxiety/depression variation, future concern variation, computer hours, internet hours, and television hours. Conclusion The study described sleep features of chronic migraineurs during COVID-19 lockdown, pinpointing the main factors involved in sleep quality and sleep changes. Our findings revealed that migraineurs’ sleep was closely linked with life-style and psychological features. Several modifiable factors came to light and they should be considered in order to develop an optimal management of CM. An appropriate and more aware treatment of sleep problems could be a way to improve migraineurs’ life. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-022-06378-0.
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Affiliation(s)
- Carmelo Tiberio Currò
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy.
- Neurological Department, Mirano Hospital, ULSS3 Serenissima, Mirano, Venice, Italy.
| | - Antonio Ciacciarelli
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Chiara Vitale
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
- Department of Neurology, Sant'Elia Hospital, ASP Caltanissetta, Caltanissetta, Italy
| | - Paolino La Spina
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
| | - Antonio Toscano
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
| | - Giuseppe Vita
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
| | | | - Rosalia Silvestri
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
| | - Massimo Autunno
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
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Duan S, Ren Z, Xia H, Wang Z, Zheng T, Liu Z. Association between sleep quality, migraine and migraine burden. Front Neurol 2022; 13:955298. [PMID: 36090858 PMCID: PMC9459411 DOI: 10.3389/fneur.2022.955298] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe relationship between sleep and migraine is well known to be bidirectional. However, few studies have systematically assessed the association between sleep quality and the risk of developing migraine, and its gender and age differences are unclear. And there is currently limited evidence on the associations between sleep quality and migraine-related burdens.ObjectiveThe objectives of this study were to: (1) explore the association between sleep quality and the risk of developing migraine, and its gender and age differences; (2) investigate the associations between sleep quality and the total pain burden, severity, disability, headache impact, quality of life, anxiety, and depression of migraine patients.MethodsThis study consecutively enrolled 134 migraine patients and 70 sex- and age-matched healthy control subjects. Sleep quality was assessed through the Pittsburgh Sleep Quality Index (PSQI). Logistic regression and linear regression analyses were used to explore the associations between sleep quality with the risk of developing migraine and the migraine-related burdens.ResultsThe prevalence of poor sleep quality in migraine patients was significantly higher than that in subjects without migraine (P < 0.001). After adjusting for various confounding factors, the risk of migraine with poor sleep quality remained 3.981 times that of those with good sleep quality. The subgroup analysis showed that there were significant additive interactions between poor sleep quality and the risk of migraine in gender, age, and education level (P for interaction < 0.05), and the stronger correlations were found in females, populations with ages more than 35 years old, and with lower education levels. In addition, multivariate linear regression analysis showed that poor sleep quality was significantly and independently associated with the total pain burden, severity, headache impact, quality of life, anxiety, and depression in migraine patients (P trend < 0.05).ConclusionPoor sleep quality was significantly independently associated with an increased risk of developing migraine and the migraine-related burdens. Strengthening PSQI assessment is valuable for the early prevention and treatment of migraine patients.
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Affiliation(s)
- Shaojie Duan
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Zhiying Ren
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Hui Xia
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Ziyao Wang
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Tao Zheng
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Zunjing Liu
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
- Department of Neurology, Peking University People's Hospital, Beijing, China
- *Correspondence: Zunjing Liu
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11
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Klan T, Gaul C, Liesering-Latta E, Both B, Held I, Hennemann S, Witthöft M. Efficacy of Cognitive-Behavioral Therapy for the Prophylaxis of Migraine in Adults: A Three-Armed Randomized Controlled Trial. Front Neurol 2022; 13:852616. [PMID: 35572937 PMCID: PMC9101654 DOI: 10.3389/fneur.2022.852616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundBehavioral approaches are central to the preventive treatment of migraine but empirical evidence regarding efficacy and effectiveness is still sparse. This study aimed to evaluate the efficacy of a newly developed migraine-specific, integrative cognitive-behavioral therapy program (miCBT) combining several approaches (trigger and stress management, coping with fear of attacks, relaxation training) by comparing it with a single behavioral approach (relaxation training, RLX) as an active control group and a waiting-list control group (WLC).MethodsIn a three-armed open-label randomized controlled trial, 121 adults with migraine were assigned to either miCBT, RLX or WLC. The outpatient group therapy (miCBT or RLX) consisted of seven sessions each 90 min. Participants who completed the WLC were subsequently randomized to one of the two treatment groups. Primary outcomes were headache days, headache-related disability, emotional distress, and self-efficacy. The baseline was compared to post-treatment, and followed by assessments 4- and 12-months post-treatment to compare miCBT and RLX.ResultsMixed-model analyses (intention-to-treat sample, 106 participants) showed significantly stronger pre-post improvements in self-efficacy (assessed by the Headache Management Self-Efficacy Scale, HMSE-G-SF) in both treatment groups compared to the WLC (mean difference at post; miCBT: 4.67 [0.55–8.78], p = 0.027; RLX: 4.42 [0.38 to 8.46], p = 0.032), whereas no other significant between-group differences were observed. The follow-up analyses revealed significant within-group improvements from baseline to 12-month follow-up in all four primary outcomes for both treatments. However, between-group effects (miCBT vs. RLX) were not significant at follow-up.ConclusionThe miCBT has no better treatment effects compared to RLX in migraine-prophylaxis. Both treatments effectively increase patients' self-efficacy.Trial RegistrationGerman Clinical Trials Register (www.drks.de; DRKS-ID: DRKS00011111).
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Affiliation(s)
- Timo Klan
- Department of Psychology, Johannes Gutenberg University of Mainz, Mainz, Germany
- *Correspondence: Timo Klan
| | - Charly Gaul
- Headache Center Frankfurt, Frankfurt, Germany
| | | | - Bernhard Both
- Department of Psychology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Isabella Held
- Department of Psychology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Severin Hennemann
- Department of Psychology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Michael Witthöft
- Department of Psychology, Johannes Gutenberg University of Mainz, Mainz, Germany
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ŞAFAK D, KORKMAZER B, ŞAHİN EM. THE ASSOCIATION BETWEEN MIGRAINE AND SLEEP QUALITY. KONURALP TIP DERGISI 2022. [DOI: 10.18521/ktd.765038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Behavioral Management of Episodic Migraine: Maintaining a Healthy Consistent Lifestyle. Curr Pain Headache Rep 2022; 26:247-252. [PMID: 35212864 DOI: 10.1007/s11916-022-01023-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To describe the most recent findings related to lifestyle behaviors and migraine. RECENT FINDINGS An individualized conceptualization of how lifestyle factors impact migraine activity has increased our understanding of the role of behavioral interventions for episodic migraine. Healthy diets of several types have been associated with migraine attack reduction, whereas disruptions in diet like skipping meals are associated with migraine attack onset. Both aerobic activity and lower intensity yoga interventions show promise for migraine prevention. Sleep disruption has been associated with migraine day and may have a bi-directional relationship. Both increases and decreases in stress have been associated with migraine activity. Evidence is converging around the principle that highly unusual disruptions in daily routine are particularly associated with migraine attack onset and that a consistent healthy lifestyle is a key feature of effective behavioral migraine prevention strategies.
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14
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Golovacheva VA, Golovacheva AA, Parfenov VA. Chronic migraine treatment: multidisciplinary approach. Case report. TERAPEVT ARKH 2022; 93:1528-1532. [DOI: 10.26442/00403660.2021.12.201247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 01/15/2022] [Indexed: 11/22/2022]
Abstract
We described clinical case of chronic migraine and such comorbid disorders as insomnia and panic disorder. The influence of anxiety, insomnia, painkillers overuse on the chronicity of migraine has been shown. Multidisciplinary program was made for treatment of patient with chronic migraine, insomnia and panic disorder. Multidisciplinary program included education, detoxification therapy, cognitive-behavioral therapy and pharmacotherapy. Patient's mistaken ideas about disorders was changed by using of cognitive-behavioral therapy. Also techniques of cognitive-behavioral therapy were needed for education of patient about effective skills to overcome pain, insomnia and anxiety. The transformation of migraine from chronic to episodic, improved sleep, improved emotional state and functional activity were noted after 3 months of treatment. Follow-up of the patient for 12 months showed long lasting positive effect of treatment for chronic migraine, insomnia and panic disorder.
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15
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Tkachenko V, Korabelnikova E. Comorbidity of tension headache and insomnia. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:46-52. [DOI: 10.17116/jnevro202212203146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Behavioral Health, Telemedicine, and Opportunities for Improving Access. Curr Pain Headache Rep 2022; 26:919-926. [PMID: 36418847 PMCID: PMC9684808 DOI: 10.1007/s11916-022-01096-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize advances in behavioral treatments for pain and headache disorders, as well as recent innovations in telemedicine for behavioral treatments. RECENT FINDINGS Research for behavioral treatments continues to support their use as part of a multidisciplinary approach to comprehensive management for pain and headache conditions. Behavioral treatments incorporate both behavioral change and cognitive interventions and have been shown to improve outcomes beyond that of medical management alone. The onset of the COVID-19 public health emergency necessitated the rapid uptake of nontraditional modalities for behavioral treatments, particularly telemedicine. Telemedicine has long been considered the answer to several barriers to accessing behavioral treatments, and as a result of COVID-19 significant progress has been made evaluating a variety of telemedicine modalities including synchronous, asynchronous, and mobile health applications. Researchers are encouraged to continue investigating how best to leverage these modalities to improve access to behavioral treatments and to continue evaluating the efficacy of telemedicine compared to traditional in-person care. Comprehensive pain and headache management should include behavioral treatments to address a variety of behavior change and cognitive targets. Policy changes and advances in telemedicine for behavioral treatments provide the opportunity to address historical barriers limiting access.
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17
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Artemenko AR, Filatova E, Vorobyeva YD, Do TP, Ashina M, Danilov AB. Migraine and light: A narrative review. Headache 2022; 62:4-10. [PMID: 35041220 DOI: 10.1111/head.14250] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In this narrative review, we summarize clinical and experimental data on the effect of light in migraine and discuss future prospects. BACKGROUND Effective nonpharmacological treatment of hypersensitivity to light in migraine is an unmet clinical need. Current management strategies primarily consist of seeking a dark room and avoiding light exposure. Advances in the past 2 decades have improved our understanding of the underlying pathophysiology of how migraine is influenced by light. This may provide promising avenues for novel approaches in clinical management. METHODS We searched MEDLINE for articles published from database inception up to September 1, 2021. We used the search term "migraine" with the search terms "light," "photophobia," "treatment," "trigger," "circadian rhythm," "environment," and/or "pathophysiology." RESULTS Light is commonly reported as a trigger factor of migraine attacks, however, early manifestation of photophobia and false attribution is likely the actual cause based on data deriving from retrospective, prospective, and experimental studies. The most common photophobia symptoms in migraine are exacerbation of headache by light and abnormal sensitivity to light with the underlying neural pathways likely being dependent on ongoing activity in the trigeminovascular system. Clinical studies and experimental models have identified mediators of photophobia and uncovered narrow wavebands of the light spectrum that may reduce pain intensity during a migraine attack. Consequently, novel devices have undergone exploratory clinical trials with promising results. CONCLUSION False attribution is likely the reason why light is commonly reported as a trigger factor of migraine attacks, and a prospective confirmation is required to prevent unnecessary avoidance. The observation that individuals with migraine are not equally photophobic to all wavebands of the light spectrum opens the potential for innovative pain management strategies. In this context, using human-centric lighting (also called integrative lighting) to mimic the natural daylight cycle and avoid harmful wavebands through modern technology may prove beneficial. Future research should identify direct and indirect consequences of light and other environmental factors in migraine to fill out knowledge gaps and enable evidence-based care strategies within institutions, work environments, and other settings.
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Affiliation(s)
- Ada R Artemenko
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Elena Filatova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yulia D Vorobyeva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Thien Phu Do
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Messoud Ashina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Danish Knowledge Center on Headache Disorders, Glostrup, Denmark.,Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan
| | - Alexey B Danilov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Cho JH, Kremer S, Young J. Who to Refer to a Behavioral Insomnia Clinic? - Recommendations Based on Treatment Rationale and Response Prediction. CURRENT SLEEP MEDICINE REPORTS 2021; 7:213-220. [PMID: 34804765 PMCID: PMC8596854 DOI: 10.1007/s40675-021-00220-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
Purpose of Review Response to cognitive-behavioral therapy for insomnia (CBT-I) is variable across individuals, and specialty insomnia clinics that provide CBT-I are few. To personalize insomnia treatments and maximize the cost-effectiveness of CBT-I, this paper reviews the conceptual model and content of CBT-I and the predictors of adherence/response to CBT-I as the basis for understanding who is most likely to benefit from CBT-I. Recent Findings Specific patient-related attributes that predict benefit from CBT-I include (1) presence of maladaptive behaviors that serve as perpetuating factors of insomnia; (2) greater motivation to pursue therapy and higher treatment expectancies regarding CBT-I; (3) reduced use of hypnotics; (4) longer sleep duration; and (5) adequately treated psychiatric comorbidities. Summary People presenting with chronic insomnia and these attributes may warrant prioritization in referral to behavioral insomnia clinics. Conversely, those who do not have such favorable characteristics may require interventions that address modifiable factors associated with poor adherence/response to CBT-I.
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Affiliation(s)
- Joshua H Cho
- UCLA Insomnia Clinic, Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, 300 UCLA Medical Plaza, Suite 3200A, Los Angeles, CA 90095 USA
| | - Stephanie Kremer
- UCLA Insomnia Clinic, Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, 300 UCLA Medical Plaza, Suite 3200A, Los Angeles, CA 90095 USA
| | - Jeffrey Young
- UCLA Insomnia Clinic, Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, 300 UCLA Medical Plaza, Suite 3200A, Los Angeles, CA 90095 USA
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19
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Gazerani P. Nightmares in Migraine: A Focused Review. Behav Sci (Basel) 2021; 11:bs11090122. [PMID: 34562960 PMCID: PMC8471052 DOI: 10.3390/bs11090122] [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: 07/04/2021] [Revised: 08/21/2021] [Accepted: 09/01/2021] [Indexed: 11/24/2022] Open
Abstract
Nightmares usually occur during the sleep phase of rapid eye movement (REM) and are associated with some physical symptoms, including sweating, shortness of breath, and lower limb movements. Emotions of fear, anger, shame, and sadness may also accompany nightmares. These symptoms can occur during dreaming, upon awakening, or later when the dream experience is recollected. Nightmares may sporadically occur for everyone, but nightmare disorders are associated with features of impaired mental and physical health and require professional medical treatment. The occurrence of nightmares with several disorders has been reported in the literature, but in migraines it has only been investigated in a small number of studies. Considering the existing relationship between sleep disorders and migraine, the occurrence of nightmares in migraine can negatively affect this association and elevate the risk of depression and anxiety. This, in turn, further reduces the quality of life of affected individuals. Hence, expanding the knowledge on the link between nightmares and migraine, promoting an acceptable quantity and quality of sleep through pharmacological and nonpharmacological interventions in the management of nightmares in migraine, and further scientific investigation of the biopsychosocial mechanisms underlying the link, will be highly valuable for optimal care. This focused review, therefore, gives a brief overview of the current understanding of nightmares in migraine to highlight the open questions and value of further research. The ultimate goal is to contribute to timely recognition and sufficient action to offer beneficial outcomes for affected patients.
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Affiliation(s)
- Parisa Gazerani
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; or
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg E, Denmark
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20
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Turner DP, Deng H, Houle TT. Statistical Hypothesis Testing: Overview and Application. Headache 2021; 60:302-308. [PMID: 32011739 DOI: 10.1111/head.13706] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Dana P Turner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hao Deng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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21
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Abstract
PURPOSE OF REVIEW This article provides an overview of preventive interventions for migraine, including when to start and how to choose a treatment, pharmacologic options (both older oral treatments and new monoclonal antibodies to calcitonin gene-related peptide [CGRP] or its receptor), nonpharmacologic treatment such as neuromodulation, and preventive treatment of refractory migraine. RECENT FINDINGS The migraine preventive treatment landscape has been transformed by the development of monoclonal antibodies targeting CGRP or its receptor. These treatments, which are given subcutaneously or intravenously monthly or quarterly, have high efficacy and were well tolerated in clinical trials. Emerging real-world studies have found higher rates of adverse events than were seen in clinical trials. They are currently recommended for use if two traditional preventive therapies have proven inadequate. Since the commonly cited 2012 American Headache Society/American Academy of Neurology migraine prevention guidelines were released, clinical trials supporting the preventive use of lisinopril, candesartan, and memantine have been published. Neuromodulation devices, including external trigeminal nerve stimulation and single-pulse transcranial magnetic stimulation devices, have modest evidence to support preventive use. The American Headache Society/American Academy of Neurology guidelines for the preventive treatment of migraine are currently being updated. A new class of oral CGRP receptor antagonists (gepants) is being tested for migraine prevention. SUMMARY Successful preventive treatment of migraine reduces disease burden and improves quality of life. Many pharmacologic and nonpharmacologic treatment options are available for the prevention of migraine, including newer therapies aimed at the CGRP pathway as well as older treatments with good evidence for efficacy. Multiple treatment trials may be required to find the best preventive for an individual patient.
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22
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Ashina M, Buse DC, Ashina H, Pozo-Rosich P, Peres MFP, Lee MJ, Terwindt GM, Halker Singh R, Tassorelli C, Do TP, Mitsikostas DD, Dodick DW. Migraine: integrated approaches to clinical management and emerging treatments. Lancet 2021; 397:1505-1518. [PMID: 33773612 DOI: 10.1016/s0140-6736(20)32342-4] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022]
Abstract
Migraine is a highly disabling neurological disorder that directly affects more than 1 billion individuals worldwide. Available treatment options differ between countries and include acute, preventive, and non-pharmacological therapies. Because of major progress in the understanding of migraine pathogenesis, novel mechanism-based medications have emerged and expanded the armamentarium of treatments. We provide a comprehensive overview of the current standard of care that will enable informed clinical management. First, we discuss the efficacy, tolerability, and safety profile of various pharmacological therapies for acute and preventive treatment of migraine. Second, we review the current knowledge on non-pharmacological therapies, such as neuromodulation and biobehavioural approaches, which can be used for a multidisciplinary approach to clinical management. Third, we emphasise that any effective treatment strategy starts with building a therapeutic plan tailored to individual clinical characteristics, preferences, and needs. Finally, we explore the outlook of emerging mechanism-based treatments that could address unmet challenges in clinical management of migraine.
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Affiliation(s)
- Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Danish Knowledge Center on Headache Disorders, Glostrup, Denmark; Department of Nervous Diseases of the Institute of Professional Education, IM Sechenov First Moscow State Medical University, Moscow, Russia; Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan.
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Håkan Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Headache Research Group, Vall d'Hebron Institute of Research, Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Mario F P Peres
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil
| | - Mi Ji Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Headache Science Centre, Institute for Research, Hospitalization and Healthcare, Mondino Foundation, Pavia, Italy
| | - Thien Phu Do
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dimos D Mitsikostas
- First Neurology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
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23
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Daghlas I, Vgontzas A, Guo Y, Chasman DI, Saxena R. Habitual sleep disturbances and migraine: a Mendelian randomization study. Ann Clin Transl Neurol 2020; 7:2370-2380. [PMID: 33125193 PMCID: PMC7732254 DOI: 10.1002/acn3.51228] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/09/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Sleep disturbances are associated with increased risk of migraine, however the extent of shared underlying biology and the direction of causal relationships between these traits is unclear. Delineating causality between sleep patterns and migraine may offer new pathophysiologic insights and inform subsequent intervention studies. Here, we used genetic approaches to test for shared genetic influences between sleep patterns and migraine, and to test whether habitual sleep patterns may be causal risk factors for migraine and vice versa. METHODS To quantify genetic overlap, we performed genome-wide genetic correlation analyses using genome-wide association studies of nine sleep traits in the UK Biobank (n ≥ 237,627), and migraine from the International Headache Genetics Consortium (59,674 cases and 316,078 controls). We then tested for potential causal effects between sleep traits and migraine using bidirectional, two-sample Mendelian randomization. RESULTS Seven sleep traits demonstrated genetic overlap with migraine, including insomnia symptoms (rg = 0.29, P < 10-31 ) and difficulty awakening (rg = 0.11, P < 10-4 ). Mendelian randomization analyses provided evidence for potential causal effects of difficulty awakening on risk of migraine (OR [95% CI] = 1.37 [1.12-1.68], P = 0.002), and nominal evidence that liability to insomnia symptoms increased the risk of migraine (1.09 [1.02-1.16], P = 0.02). In contrast, there was minimal evidence for an effect of migraine liability on sleep patterns or disturbances. INTERPRETATION These data support a shared genetic basis between several sleep traits and migraine, and support potential causal effects of difficulty awakening and insomnia symptoms on migraine risk. Treatment of sleep disturbances may therefore be a promising clinical intervention in the management of migraine.
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Affiliation(s)
- Iyas Daghlas
- Broad Institute of MIT and Harvard415 Main StreetCambridgeMassachusetts02142USA
- Center for Genomic MedicineMassachusetts General Hospital185 Cambridge StreetBostonMassachusetts02114USA
- Division of Preventive MedicineDepartment of MedicineBrigham and Women's HospitalHarvard Medical SchoolBostonMassachusetts02115USA
| | - Angeliki Vgontzas
- Department of NeurologyBrigham and Women’s HospitalHarvard Medical SchoolBostonMassachusetts02115USA
| | - Yanjun Guo
- Division of Preventive MedicineDepartment of MedicineBrigham and Women's HospitalHarvard Medical SchoolBostonMassachusetts02115USA
| | - Daniel I. Chasman
- Division of Preventive MedicineDepartment of MedicineBrigham and Women's HospitalHarvard Medical SchoolBostonMassachusetts02115USA
| | - Richa Saxena
- Broad Institute of MIT and Harvard415 Main StreetCambridgeMassachusetts02142USA
- Center for Genomic MedicineMassachusetts General Hospital185 Cambridge StreetBostonMassachusetts02114USA
- Anesthesia, Critical Care and Pain MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusetts02114USA
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Tiseo C, Vacca A, Felbush A, Filimonova T, Gai A, Glazyrina T, Hubalek IA, Marchenko Y, Overeem LH, Piroso S, Tkachev A, Martelletti P, Sacco S. Migraine and sleep disorders: a systematic review. J Headache Pain 2020; 21:126. [PMID: 33109076 PMCID: PMC7590682 DOI: 10.1186/s10194-020-01192-5] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 10/14/2020] [Indexed: 12/14/2022] Open
Abstract
Migraine and sleep disorders are common and often burdensome chronic conditions with a high prevalence in the general population, and with considerable socio-economic impact and costs.The existence of a relationship between migraine and sleep disorders has been recognized from centuries by clinicians and epidemiological studies. Nevertheless, the exact nature of this association, the underlying mechanisms and interactions are complex and not completely understood. Recent biochemical and functional imaging studies identified central nervous system structures and neurotransmitters involved in the pathophysiology of migraine and also important for the regulation of normal sleep architecture, suggesting a possible causative role, in the pathogenesis of both disorders, of a dysregulation in these common nervous system pathways.This systematic review summarizes the existing data on migraine and sleep disorders with the aim to evaluate the existence of a causal relationship and to assess the presence of influencing factors. The identification of specific sleep disorders associated with migraine should induce clinicians to systematically assess their presence in migraine patients and to adopt combined treatment strategies.
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Affiliation(s)
- Cindy Tiseo
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
- Regional Referral Headache Centre, S.S. Filippo e Nicola Hospital, Avezzano, L'Aquila, Italy
| | - Alessandro Vacca
- Headache Center, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Anton Felbush
- Pain Treatment Center, OOO "Vertebra", Samara City, Russia
| | - Tamara Filimonova
- Federal State Budget Educational Institution of Higher Education "Academician Ye. A. Vagner Perm State Medical University" of the Ministry of Healthcare of the Russian Federation, Perm, Russia
| | - Annalisa Gai
- Headache Center, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | | | - Irina Anna Hubalek
- Department of Neurology, Headache Center, Charité University Medicine Berlin, Berlin, Germany
| | - Yelena Marchenko
- V. A. Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Lucas Hendrik Overeem
- Charité - Universitätsmedizin Berlin Charité Centrum Neurologie, Neurochirurgie und Psychiatrie CC, Berlin, Germany
| | - Serena Piroso
- Department of Human Neurosciences, Sapienza University of Rome, Roma, Italy
| | - Alexander Tkachev
- Department of Neurology, Neurosurgery, medical genetics, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Roma, Italy
- Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Simona Sacco
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy.
- Regional Referral Headache Centre, S.S. Filippo e Nicola Hospital, Avezzano, L'Aquila, Italy.
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25
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Rogers J, Spain S. Understanding the most commonly billed diagnoses in primary care: Headache disorders. Nurse Pract 2020; 45:41-47. [PMID: 32956199 DOI: 10.1097/01.npr.0000696912.23907.38] [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: 06/11/2023]
Abstract
This article, part of a series about the most commonly billed diagnoses in primary care, describes the pathophysiologic processes of the three most common types of headache disorders as well as how the clinical manifestations and treatments are linked to the pathogenesis of the disorders.
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26
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Turner DP, Deng H, Houle TT. Bayesian Approaches to Statistical Inferences. Headache 2020; 60:1879-1885. [PMID: 32996136 DOI: 10.1111/head.13952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/14/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Dana P Turner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hao Deng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Timothy T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Song TJ, Kim BS, Chu MK. Therapeutic role of melatonin in migraine prophylaxis: Is there a link between sleep and migraine? PROGRESS IN BRAIN RESEARCH 2020; 255:343-369. [DOI: 10.1016/bs.pbr.2020.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/12/2020] [Accepted: 05/01/2020] [Indexed: 12/13/2022]
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Abstract
This article outlines key features of diagnosis and treatment of migraine in children and adolescents. It emphasizes techniques that can be used by clinicians to optimize history taking in this population, as well as recognition of episodic conditions that may be associated with migraine and present in childhood. Acute treatment strategies include use of over-the-counter analgesics and triptan medications that have been approved by the US Food and Drug Administration for use in children and adolescents. Preventive treatment approach includes lifestyle modifications, behavioral strategies, and consideration of preventive medications with the lowest side effect profiles.
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Affiliation(s)
- Kaitlin Greene
- Department of Neurology, UCSF Pediatric Headache Center, University of California, San Francisco, UCSF Benioff Children's Hospital, Mission Hall Box 0137, 550 16th Street, 4th Floor, San Francisco, CA 94158, USA
| | - Samantha L Irwin
- Department of Neurology, UCSF Pediatric Headache Center, University of California, San Francisco, UCSF Benioff Children's Hospital, Mission Hall Box 0137, 550 16th Street, 4th Floor, San Francisco, CA 94158, USA
| | - Amy A Gelfand
- Department of Neurology, UCSF Pediatric Headache Center, University of California, San Francisco, UCSF Benioff Children's Hospital, Mission Hall Box 0137, 550 16th Street, 4th Floor, San Francisco, CA 94158, USA.
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Sandoe CH, Sasikumar S, Lay C, Lawler V. The Impact of Shift Work on Migraine: A Case Series and Narrative Review. Headache 2019; 59:1631-1640. [DOI: 10.1111/head.13622] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Claire H. Sandoe
- Center for Headache, Division of Neurology, Women’s College Hospital University of Toronto Toronto Canada
| | - Sanskriti Sasikumar
- Center for Headache, Division of Neurology, Women’s College Hospital University of Toronto Toronto Canada
| | - Christine Lay
- Center for Headache, Division of Neurology, Women’s College Hospital University of Toronto Toronto Canada
| | - Valerie Lawler
- Center for Headache, Division of Neurology, Women’s College Hospital University of Toronto Toronto Canada
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Abstract
Migraine with and without aura, cluster headache, hypnic headache, and paroxysmal hemicranias are each reported as intrinsically related to sleep. Chronic migraine, chronic tension-type headache, and medication overuse headache may cause sleep disturbance. Otherwise, both headache and sleep disorder may be manifestations of a same systemic dysfunction. There is a vicious cycle linking sleep disorders and migraine. The poor quality or poor duration of sleep could be a trigger of migraine attack and migraineurs with poor sleep reported a higher headache frequency. Moreover, coping behaviors of migraineurs (e.g., going to sleep early to relieve migraine attacks) can be factors precipitating and perpetuating sleep disturbances themselves. During cluster headache, patients report a poor quality of sleep correlated with the amount of daylight. In particular, it was demonstrated that melatonin levels have influences on cluster headache attacks. Concerning the pathophysiology of hypnic headache, it has been hypothesized a possible role of obstructive sleep apnea in triggering nocturnal attacks: an increased number of apnea episodes has been reported in hypnic headache patients, but a lack of a temporal correlation of headache attacks with the drop of oxygen saturation has been observed. Tension-type headache is the most common headache with sleep dysregulation (lack of sleep or oversleeping) frequently reported as a triggering factor for acute attacks: management of sleep disturbances seems crucial in this form of headache.
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Affiliation(s)
- Luigi Ferini-Strambi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, Milan, Italy.
- "Vita-Salute" San Raffaele University, Milan, Italy.
| | - Andrea Galbiati
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, Milan, Italy
- "Vita-Salute" San Raffaele University, Milan, Italy
| | - Romina Combi
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
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Blake P, Burstein R. Emerging evidence of occipital nerve compression in unremitting head and neck pain. J Headache Pain 2019; 20:76. [PMID: 31266456 PMCID: PMC6734343 DOI: 10.1186/s10194-019-1023-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/10/2019] [Indexed: 02/07/2023] Open
Abstract
Unremitting head and neck pain (UHNP) is a commonly encountered phenomenon in Headache Medicine and may be seen in the setting of many well-defined headache types. The prevalence of UHNP is not clear, and establishing the presence of UHNP may require careful questioning at repeated patient visits. The cause of UHNP in some patients may be compression of the lesser and greater occipital nerves by the posterior cervical muscles and their fascial attachments at the occipital ridge with subsequent local perineural inflammation. The resulting pain is typically in the sub-occipital and occipital location, and, via anatomic connections between extracranial and intracranial nerves, may radiate frontally to trigeminal-innervated areas of the head. Migraine-like features of photophobia and nausea may occur with frontal radiation. Occipital allodynia is common, as is spasm of the cervical muscles. Patients with UHNP may comprise a subgroup of Chronic Migraine, as well as of Chronic Tension-Type Headache, New Daily Persistent Headache and Cervicogenic Headache. Centrally acting membrane-stabilizing agents, which are often ineffective for CM, are similarly generally ineffective for UHNP. Extracranially-directed treatments such as occipital nerve blocks, cervical trigger point injections, botulinum toxin and monoclonal antibodies directed at calcitonin gene related peptide, which act primarily in the periphery, may provide more substantial relief for UHNP; additionally, decompression of the occipital nerves from muscular and fascial compression is effective for some patients, and may result in enduring pain relief. Further study is needed to determine the prevalence of UHNP, and to understand the role of occipital nerve compression in UHNP and of occipital nerve decompression surgery in chronic head and neck pain.
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Affiliation(s)
- Pamela Blake
- University of Texas Health Science Center at Houston, 2711 Ferndale Street, Houston, TX, 77098, USA.
| | - Rami Burstein
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Clinical presentation, diagnosis and polysomnographic findings in children with migraine referred to sleep clinics. Sleep Med 2019; 63:57-63. [PMID: 31606650 DOI: 10.1016/j.sleep.2019.04.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE An association between migraine and sleep disturbances in children was reported, yet limited clinical data exist. The current study addresses the clinical presentation, polysomnographic (PSG) characteristics, and comorbid sleep diagnoses of children with migraine referred to the sleep clinic. PATIENTS A retrospective review was performed of headache center patients evaluated by the sleep center between 2007 and 2017. Children ≤18 years old, diagnosed with migraine headache, and who had PSG within one year of evaluation in the headache clinic, were included. PSG findings, as well as demographics, were compared to a group of controls aged 5-14 years-old. RESULTS In sum, 185 children with a diagnosis of migraine were included: 39% males, 75% Caucasian, mean age 13.5 ± 3.4, and 57% obese. Additionally, 180 children were included in the control group. The common presenting sleep symptoms were snoring (66%), sleep onset and sleep maintenance problems (25%), and excessive daytime sleepiness (20%). For the sleep diagnosis, 40% had obstructive sleep apnea (OSA), 27% had insomnia, 15% had periodic limb movement disorder (PLMD), and 6% had a central disorder of hypersomnolence. In terms of sleep architecture, children with migraine had significantly higher NREM 2 (p < 0.001) and a lower percentage of NREM3 (p < 0.001) compared to controls after adjustment for demographics and the presence of sleep-disordered breathing. CONCLUSIONS Children referred to the sleep clinic who also had migraine, experience various types of sleep complaints. OSA, insomnia, and PLMD were relatively common in this population. Changes in sleep architecture, specifically increased NREM2 and decreased slow wave sleep compared to the control group, were also observed.
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Abstract
Migraine and tension-type headache are highly prevalent. Migraine is associated with significant work- and family-related disability. Migraine is underdiagnosed; it reasonable to err on the side of migraine when choosing between primary headaches. Barriers to appropriate treatment of migraine include lack of access to providers, misdiagnosis, and acute and preventive therapies not being prescribed. Acute, rescue, and preventive treatment options are extensive, and new classes of treatments are either available or in development. This review addresses diagnostic challenges including recognizing migraine with aura. It also summarizes nonpharmacologic, acute, rescue, and preventive treatment options for migraine and treatment of tension-type headache.
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Affiliation(s)
- Rebecca Burch
- Department of Neurology, John R. Graham Headache Center, Brigham and Women's Hospital, Harvard Medical School, 1153 Centre Street, Suite 4H, Jamaica Plain, MA 02130, USA.
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Chu MK. Sleep apnoea and poor sleep quality in patients with chronic migraine. Nat Rev Neurol 2019; 15:130-131. [PMID: 30610215 DOI: 10.1038/s41582-018-0124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Buse DC, Greisman JD, Baigi K, Lipton RB. Migraine Progression: A Systematic Review. Headache 2018; 59:306-338. [PMID: 30589090 DOI: 10.1111/head.13459] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Migraine is a common and often debilitating neurological disease. It can be divided into episodic and chronic subforms based on the number of monthly headache days. Because only a subset of individuals with episodic migraine (EM) progress to chronic migraine (CM) over any given time period, understanding the factors that predict the new onset of CM or "migraine progression" may provide insights into the mechanisms, pathophysiology, prevention, and treatment of CM. In this review, we identify and summarize studies that report risk factors associated with the new onset of CM or related chronic headache diagnoses, group these risk factors and report the strength of evidence for the identified risk factors. OBJECTIVE To conduct a systematic review of studies that identify risk factors for the new onset of CM or related chronic headache diagnoses such as transformed migraine (TM) and chronic daily headache (CDH). METHODS Herein we summarize the findings of studies of risk factors associated with the new onset of CM/TM, CDH, or related diagnoses from the English language literature published before March 2018. The PubMed database was searched for relevant studies. Longitudinal studies with follow-up data and case-control studies were included in this qualitative synthesis. We report methodology, analytic criteria, and results for each manuscript and for the parent study. Next, we review the strength of evidence for each of the identified risk factors using a modified version of AB Hill's criteria for causation and rank evidence as fair, moderate, or strong. We categorized risk factors as nonmodifiable, modifiable and based on putative mechanisms. We further categorized risk factors into sociodemographics, lifestyle factors and habits, headache features, comorbid and concomitant diseases and conditions and pharmacologic treatment-related. Finally, we review theories of the pathophysiology underlying the development of new onset chronic migraine or increasing attack frequency. RESULTS The PubMed search yielded 1870 records after duplicates were removed. Nine additional records were identified through expert consultation and other methods (eg, citations found as references in manuscripts identified in the literature review and through communication with the authors of manuscripts included in the review). The 1879 manuscripts were screened against the inclusion and exclusion criteria and 109 were found to be potentially eligible. Of 109 full-text articles, 17 studies were identified as meeting the prespecified criteria based on the consensus of all authors. Of the 17 full texts, 13 were longitudinal cohort studies and 4 were case-controlled studies. We found strength of evidence ranging from fair to strong for the identified risk factors. The strongest data were found for increased headache day frequency, depression, and medication overuse/high-frequency use. Risk factors for new onset CM and CDH in children and adolescents were similar to those identified in adults. CONCLUSIONS A range of risk factors for the new onset of CM/TM, CDH, or related chronic headache diseases were identified with the strongest data supporting increased headache day frequency, acute medication overuse/high-frequency use and depression, which are potentially modifiable risk factors. Modifiable risk factors may provide targets for intervention. The lack of strong evidence or any evidence does not imply that there is not a relationship between a particular risk factor and new onset CM or related disease; but may indicate little or no research or that research did not have sufficient methodological rigor. In addition, it is likely that additional risk factors exist which have not yet been identified. Putative factors include pro-inflammatory states and pro-thrombotic states. Development of central sensitization and increased activation of the trigeminal nociceptive pathways may be drivers of the new onset of CM or CDH. Future research may include the systematic testing of interventions targeting modifiable risk factors to determine if progression can be prevented as well as continued exploration of the benefits of treating these risk factors among people with CM in an effort to increase rates of remission. Future work should also consider the natural fluctuations in headache day frequency and examine progression in terms of continuous definitions rather than or in addition to a dichotomous boundary.
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Affiliation(s)
- Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jacob D Greisman
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Khosrow Baigi
- Department of Family Medicine, Bronx Care Health System, Bronx, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Rains JC. Sleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders. Headache 2018; 58:1074-1091. [PMID: 30095163 DOI: 10.1111/head.13357] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2018] [Indexed: 12/16/2022]
Abstract
The relationship of sleep and migraine is unequivocal and familiarity with the nature and magnitude of these associations may inform clinical practice. Recent prospective, longitudinal, and time-series analysis has begun to unravel the magnitude and temporal patterns of sleep and migraine. Prospective evidence has shown that sleep variables can trigger acute migraine, precede and predict new onset headache by several years, and indeed, sleep disturbance and snoring are risk factors for chronification. The presence of a sleep disorder is associated with more frequent and severe migraine and portends a poorer headache prognosis. Interestingly, the disorders linked to migraine are quite varied, including insomnia, snoring and obstructive sleep apnea, restless legs, circadian rhythm disorders, narcolepsy, and others. Insomnia is by far the most common sleep disorder in headache patients. In fact, the majority of patients with chronic migraine presenting for treatment have insomnia. Despite a rapidly expanding literature, very few controlled treatment studies have been published to guide clinical practice. This paper focuses on clinical assessment and treatment of sleep disorders. An algorithm is presented for sleep disorders management in the migraine patient, which highlights major sleep disorders and psychiatric comorbidity. Diagnostic procedures are recommended that are conducive to clinical practice. Suggested tools include the sleep history, screening mnemonics, prediction equation, and sleep diary. New developments in treatment have produced abbreviated and cost-effective therapies for insomnia and obstructive sleep apnea that may reach a larger population. Revisions in the diagnostic manuals for sleep and headache disorders enhance recognition of sleep-related headache. Recommendations include behavioral sleep regulation, shown in recent controlled trials to decrease migraine frequency, management for sleep apnea headache, cognitive behavioral therapy (CBT) for insomnia abbreviated for the physician practice setting, sleep-related headache trigger, and others. There is no empirical evidence that sleep evaluation should delay or supersede usual headache care. Rather, sleep management is complimentary to standard headache practice.
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Affiliation(s)
- Jeanetta C Rains
- Center for Sleep Evaluation, Elliot Hospital, Manchester, NH, USA
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