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Peled ZM, Gfrerer L. Introduction to VSI: Migraine surgery in JPRAS open. JPRAS Open 2024; 39:217-222. [PMID: 38293285 PMCID: PMC10827495 DOI: 10.1016/j.jpra.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Ziv M. Peled
- Peled Plastic Surgery, 2100 Webster Street, Suite 109, San Francisco, CA 94115, United States
| | - Lisa Gfrerer
- Surgery Plastic and Reconstructive Surgery Weill Cornell Medicine, 425 East 61st Street, 10th Floor, New York, NY 10065, United States
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Du L, Roy S, Wang P, Li Z, Qiu X, Zhang Y, Yuan J, Guo B. Unveiling the future: Advancements in MRI imaging for neurodegenerative disorders. Ageing Res Rev 2024; 95:102230. [PMID: 38364912 DOI: 10.1016/j.arr.2024.102230] [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: 01/11/2024] [Revised: 02/11/2024] [Accepted: 02/11/2024] [Indexed: 02/18/2024]
Abstract
Neurodegenerative disorders represent a significant and growing global health challenge, necessitating continuous advancements in diagnostic tools for accurate and early detection. This work explores the recent progress in Magnetic Resonance Imaging (MRI) techniques and their application in the realm of neurodegenerative disorders. The introductory section provides a comprehensive overview of the study's background, significance, and objectives. Recognizing the current challenges associated with conventional MRI, the manuscript delves into advanced imaging techniques such as high-resolution structural imaging (HR-MRI), functional MRI (fMRI), diffusion tensor imaging (DTI), and positron emission tomography-MRI (PET-MRI) fusion. Each technique is critically examined regarding its potential to address theranostic limitations and contribute to a more nuanced understanding of the underlying pathology. A substantial portion of the work is dedicated to exploring the applications of advanced MRI in specific neurodegenerative disorders, including Parkinson's disease, Alzheimer's disease, Huntington's disease, and Amyotrophic Lateral Sclerosis (ALS). In addressing the future landscape, the manuscript examines technological advances, including the integration of machine learning and artificial intelligence in neuroimaging. The conclusion summarizes key findings, outlines implications for future research, and underscores the importance of these advancements in reshaping our understanding and approach to neurodegenerative disorders.
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Affiliation(s)
- Lixin Du
- Department of Medical Imaging, Shenzhen Longhua District Central Hospital, Shenzhen Longhua District Key Laboratory of Neuroimaging, Shenzhen 518110, China.
| | - Shubham Roy
- School of Science, Shenzhen Key Laboratory of Flexible Printed Electronics Technology, Shenzhen Key Laboratory of Advanced Functional Carbon Materials Research and Comprehensive Application, Harbin Institute of Technology, Shenzhen 518055, China
| | - Pan Wang
- Department of Medical Imaging, Shenzhen Longhua District Central Hospital, Shenzhen Longhua District Key Laboratory of Neuroimaging, Shenzhen 518110, China
| | - Zhigang Li
- Department of Medical Imaging, Shenzhen Longhua District Central Hospital, Shenzhen Longhua District Key Laboratory of Neuroimaging, Shenzhen 518110, China
| | - Xiaoting Qiu
- Department of Medical Imaging, Shenzhen Longhua District Central Hospital, Shenzhen Longhua District Key Laboratory of Neuroimaging, Shenzhen 518110, China
| | - Yinghe Zhang
- School of Science, Shenzhen Key Laboratory of Flexible Printed Electronics Technology, Shenzhen Key Laboratory of Advanced Functional Carbon Materials Research and Comprehensive Application, Harbin Institute of Technology, Shenzhen 518055, China
| | - Jianpeng Yuan
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China.
| | - Bing Guo
- School of Science, Shenzhen Key Laboratory of Flexible Printed Electronics Technology, Shenzhen Key Laboratory of Advanced Functional Carbon Materials Research and Comprehensive Application, Harbin Institute of Technology, Shenzhen 518055, China.
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Pathak P, Yue L, Gupta S, Fang J, Cheadle MA, Tiwari S, Ferraris M, Joshi P, Thompson J, Shah R, Vo P. Real-world treatment satisfaction with erenumab in migraine: analysis of the US National Health and Wellness Survey. Curr Med Res Opin 2023; 39:1585-1591. [PMID: 36919462 DOI: 10.1080/03007995.2023.2191479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 03/13/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE The treatment landscape for the prevention of migraine has rapidly evolved in recent years with the advent of calcitonin gene-related peptide therapy, including erenumab. The objective of this study was to assess patient-reported treatment satisfaction among erenumab users. METHODS This retrospective, cross-sectional study used data from the 2019 US National Health and Wellness Survey collected during March-July 2019. Respondents self-reporting physician-diagnosed migraine and currently using erenumab were analyzed. Treatment satisfaction was measured on a seven-point Likert scale. Data were further reported by the duration of erenumab treatment. Data on respondents' socio-demographic characteristics and treatment patterns were also collected. RESULTS Overall, 67 respondents using erenumab with or without other migraine preventives for up to 1 year were included in the analysis. The mean (standard deviation) age was 46.7 (12.9) years. Most of the respondents were women (86.6%), White (74.6%), and commercially-insured (67.2%). Notably, 40.3% had ≥1 comorbidity per the Charlson Comorbidity Index. Approximately half of the respondents were college graduates and employed (49.3% each). Among the 67 respondents, 46 received erenumab exclusively. Across both cohorts, the percentage of respondents who were satisfied with erenumab treatment was slightly higher among those with a longer treatment duration (overall erenumab cohort: 63.6%, 69.6%, and 75.8% for 0-<3, 3-<6, and 6-12 months, respectively; erenumab monotherapy cohort: 62.5%, 71.4%, and 87.5% for 0-<3, 3-<6, and 6-12 months, respectively). Treatment patterns before switching to erenumab revealed that most respondents had used ≥1 preventive treatment for migraine (80.6%; 54/67), over two-thirds (33/54) of whom had ≥2 treatment failures owing to nonresponse. CONCLUSION Satisfaction was high among long-term erenumab users, indicating that those using erenumab for a longer duration are more satisfied. Furthermore, this study provided insights on the basic socio-demographics, disease characteristics, and health behaviors of erenumab users as well as their treatment patterns before switching to erenumab.
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Affiliation(s)
| | | | | | | | | | | | | | - Parth Joshi
- Novartis Healthcare Pvt. Ltd, Hyderabad, India
| | | | | | - Pamela Vo
- Novartis Pharma AG, Basel, Switzerland
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Peled ZM, Gfrerer L, Hagan R, Al-Kassis S, Savvides G, Austen G, Valenti A, Chinta M. Anatomic Anomalies of the Nerves Treated during Headache Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5439. [PMID: 38025616 PMCID: PMC10662871 DOI: 10.1097/gox.0000000000005439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Abstract
Background Headache surgery is a well-established, viable option for patients with chronic head pain/migraines refractory to conventional treatment modalities. These operations involve any number of seven primary nerves. In the occipital region, the surgical targets are the greater, lesser, and third occipital nerves. In the temporal region, they are the auriculotemporal and zygomaticotemporal nerves. In the forehead, the supraorbital and supratrochlear are targeted. The typical anatomic courses of these nerves are well established and documented in clinical and cadaveric studies. However, variations of this "typical" anatomy are quite common and relatively poorly understood. Headache surgeons should be aware of these common anomalies, as they may alter treatment in several meaningful ways. Methods In this article, we describe the experience of five established headache surgeons encompassing over 4000 cases with respect to the most common anomalies of the nerves typically addressed during headache surgery. Descriptions of anomalous nerve courses and suggestions for management are offered. Results Anomalies of all seven nerves addressed during headache operations occur with a frequency ranging from 2% to 50%, depending on anomaly type and nerve location. Variations of the temporal and occipital nerves are most common, whereas anomalies of the frontal nerves are relatively less common. Management includes broader dissection and/or transection of accessory injured nerves combined with strategies to reduce neuroma formation such as targeted reinnervation or regenerative peripheral nerve interfaces. Conclusions Understanding these myriad nerve anomalies is essential to any headache surgeon. Implications are relevant to preoperative planning, intraoperative dissection, and postoperative management.
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Affiliation(s)
- Ziv M. Peled
- From the Peled Plastic Surgery, San Francisco, Calif
| | - Lisa Gfrerer
- Department of Plastic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, N.Y
| | | | - Salam Al-Kassis
- Division of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Georgia Savvides
- Department of Medical Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Gerald Austen
- Division of Plastic Surgery, Massachusetts General Hospital, Boston, Mass
| | - Alyssa Valenti
- Department of Plastic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, N.Y
| | - Malini Chinta
- Department of Plastic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, N.Y
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Schwedt TJ, Lee J, Knievel K, McVige J, Wang W, Wu Z, Gillard P, Shah D, Blumenfeld AM. Real-world persistence and costs among patients with chronic migraine treated with onabotulinumtoxinA or calcitonin gene-related peptide monoclonal antibodies. J Manag Care Spec Pharm 2023; 29:1119-1128. [PMID: 37776119 PMCID: PMC10541629 DOI: 10.18553/jmcp.2023.29.10.1119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND: Chronic migraine (CM) is a common neurologic disorder that imposes substantial burden on payers, patients, and society. Low rates of persistence to oral migraine preventive medications have been previously documented; however, less is known about persistence and costs associated with innovative nonoral migraine preventive medications. OBJECTIVE: To evaluate real-world persistence and costs among adults with CM treated with onabotulinumtoxinA (onabotA) or calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs). METHODS: This was a retrospective, longitudinal, observational study analyzing the IBM MarketScan Commercial and Medicare databases. The study sample included adults with CM initiating treatment with either onabotA or a CGRP mAb on or after January 1, 2018. Persistence and costs over 12 months after treatment initiation were evaluated using chi-square and Student's t-tests. Persistence to onabotA was compared with CGRP mAbs as a weighted average of the class and by individual CGRP mAbs. Mean pharmacy (acute and preventive), medical (inpatient, emergency department, and outpatient), and total costs are reported. Multivariate regression analyses were conducted to generate adjusted estimates of persistence and costs after controlling for potential confounders (age, sex, region, insurance type, number of baseline comorbidities, Charlson Comorbidity Index, and number of previously used oral migraine preventive medications). RESULTS: Of 66,303 individuals with onabotA or CGRP mAb claims, 2,697 with CM met the inclusion/exclusion criteria. In the total population, individuals were primarily female (85.5%), lived in the South (48.5%), and had a mean (SD) age of 44 (12) years, which was consistent across the onabotA and CGRP mAb cohorts. Common comorbid conditions included anxiety (23.9%), depression (18.2%), hypertension (16.5%), and sleep disorders (16.9%). After adjusting for potential confounding variables, persistence to onabotA during the 12-month follow-up period was 40.7% vs 27.8% for CGRP mAbs (odds ratio [OR] = 0.683; 95% CI = 0.604-0.768; P < 0.0001). Persistence to erenumab, fremanezumab, and galcanezumab was 25.5% (OR = 0.627; 95% CI = 0.541-0.722; P < 0.0001), 30.3% (OR = 0.746; 95% CI = 0.598-0.912; P = 0.0033), and 33.7% (OR = 0.828; 95% CI = 0.667-1.006; P = 0.058). All-cause ($18,292 vs $18,275; P = 0.9739) and migraine-related ($8,990 vs $9,341; P = 0.1374) costs were comparable between the onabotA and CGRP mAb groups. CONCLUSIONS: Among adults with CM receiving onabotA and CGRP mAbs, individuals initiating onabotA treatment had higher persistence compared with those receiving CGRP mAbs. Total all-cause and migraine-related costs over 12 months were comparable between those receiving onabotA and CGRP mAbs. DISCLOSURES: This study was sponsored by Allergan (prior to its acquisition by AbbVie), they contributed to the design and interpretation of data and the writing, reviewing, and approval of final version. Writing and editorial assistance was provided to the authors by Dennis Stancavish, MS, of Peloton Advantage, LLC, an OPEN Health company, Parsippany, NJ, and was funded by AbbVie. The opinions expressed in this article are those of the authors. The authors received no honorarium/fee or other form of financial support related to the development of this article. Dr Schwedt serves on the Board of Directors for the American Headache Society and the American Migraine Foundation. Within the prior 12 months he has received research support from Amgen, Henry Jackson Foundation, Mayo Clinic, National Institutes of Health, Patient-Centered Outcomes Research Institute, SPARK Neuro, and US Department of Defense. Within the past 12 months, he has received personal compensation for serving as a consultant or advisory board member for AbbVie, Allergan, Axsome, BioDelivery Science, Biohaven, Collegium, Eli Lilly, Ipsen, Linpharma, Lundbeck, and Satsuma. He holds stock options in Aural Analytics and Nocira. He has received royalties from UpToDate. Dr Lee and Ms Shah are employees of AbbVie and may hold AbbVie stock. Dr Gillard was an employee of AbbVie and may hold AbbVie stock. Dr Knievel has served as a consultant for AbbVie, Amgen, Eli Lilly, and Biohaven; conducted research for AbbVie, Amgen, and Eli Lilly; and is on speaker programs for AbbVie and Amgen. Dr McVige has served as a speaker and/or received research support from Allergan (now AbbVie Inc.), Alder, Amgen/Novartis, Avanir, Biohaven, Eli Lilly, Lundbeck, and Teva. Ms Wang and Ms Wu are employees of Genesis Research, which provides consulting services to AbbVie. Dr Blumenfeld, within the past 12 months, has served on advisory boards for Allergan, AbbVie, Aeon, Alder, Amgen, Axsome, BDSI, Biohaven, Impel, Lundbeck, Lilly, Novartis, Revance, Teva, Theranica, and Zosano; as a speaker for Allergan, AbbVie, Amgen, BDSI, Biohaven, Lundbeck, Lilly, and Teva; as a consultant for Allergan, AbbVie, Alder, Amgen, Biohaven, Lilly, Lundbeck, Novartis, Teva, and Theranica; and as a contributing author for Allergan, AbbVie, Amgen, Biohaven, Novartis, Lilly, and Teva. He has received grant support from AbbVie and Amgen. AbbVie is committed to responsible data sharing regarding the clinical trials we sponsor. This includes access to anonymized, individual, and trial-level data (analysis data sets), as well as other information (eg, protocols, clinical study reports, or analysis plans), as long as the trials are not part of an ongoing or planned regulatory submission. This includes requests for clinical trial data for unlicensed products and indications. These clinical trial data can be requested by any qualified researchers who engage in rigorous, independent scientific research, and will be provided following review and approval of a research proposal and Statistical Analysis Plan and execution of a Data Sharing Agreement. Data requests can be submitted at any time after approval in the United States and Europe and after acceptance of this manuscript for publication. The data will be accessible for 12 months, with possible extensions considered. For more information on the process, or to submit a request, visit the following link: https://www.abbvieclinicaltrials.com/hcp/data-sharing/.
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Affiliation(s)
| | | | | | | | | | - Zheng Wu
- Genesis Research LLC, Hoboken, NJ
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Mahon R, Vo P, Pannagl K, Tiwari S, Heemstra H, Ferraris M, Zhao J, Betts KA, Proot P. Assessment of the relative effectiveness of erenumab compared with onabotulinumtoxinA for the prevention of chronic migraine. Curr Med Res Opin 2023; 39:105-112. [PMID: 36189948 DOI: 10.1080/03007995.2022.2131299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To assess the available clinical and economic evidence of erenumab vs onabotulinumtoxinA for chronic migraine (CM) and present de-novo indirect treatment comparisons (ITCs) based on available clinical trial data. METHODS We conducted ITCs based on results from the pivotal 295 trial (NCT02066415) of erenumab vs placebo and published aggregate data from the PREEMPT 1 (NCT00156910) and PREEMPT 2 (NCT00168428) trials of onabotulinumtoxinA vs placebo. ITCs were conducted for CM patients with and without prior administration of onabotulinumtoxinA and among CM patients with ≥3 prior preventive treatment failures. Efficacy was assessed based on responder rates of ≥50% reductions in monthly headache days (MHDs) and monthly migraine days (MMDs) as well as change from baseline in both MHDs and MMDs. RESULTS Among patients with CM, 140 mg erenumab was associated with a reduction of 1.2 MHD (p = .092) and a reduction of 1.0 MMD (p = .174) compared to onabotulinumtoxinA at Week 12. Among onabotulinumtoxinA-naïve patients, erenumab was associated with a reduction of 1.8 MHD (p = .026) and 1.4 MMD (p = .080) at Week 12. Among patients that had received ≥3 prior preventive treatments, the odds ratios comparing erenumab vs onabotulinumtoxinA were 1.7 for ≥50% responder rates based on reductions in MHD (p = .155) and 1.7 for ≥50% responder rates based on reductions in MMD (p = .140). CONCLUSION These findings suggest directional benefits (although not reaching the threshold of statistical significance) associated with erenumab vs onabotulinumtoxinA for the preventive treatment of CM. Evidence from this study may inform healthcare stakeholders in treatment selection and optimization for patients with CM.
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Affiliation(s)
| | - Pamela Vo
- Novartis Pharma AG, Basel, Switzerland
| | | | | | | | | | - Jing Zhao
- Analysis Group, Inc, Los Angeles, CA, USA
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Harpe J, Bernstein C, Harriott A. Migraine and infertility, merging concepts in women's reproductive health: A narrative review. Headache 2022; 62:1247-1255. [PMID: 36200786 DOI: 10.1111/head.14402] [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: 07/11/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective is to examine issues around treating infertility in patients with migraine. BACKGROUND Women outnumber men in migraine diagnosis with a 3:1 ratio; the disease is commonly expressed in women of child-bearing age and is influenced by changes in circulating hormones. Infertility is also common, and the use of treatment options, such as assisted reproductive technology, have expanded exponentially in recent years. METHODS We summarized the literature around the effect of infertility treatments on headache in the general population and migraine population. We also discuss sociobehavioral, economic, and biological factors affecting fertility in patients with migraine, describe infertility protocols, and propose areas of focus for future research. We searched PubMed for the combined key terms in vitro fertilization or assisted reproductive technology AND migraine, or headache. The search included all dates and specified English-language results only. RESULTS Migraine may negatively influence family planning and fertility. Patients face obstacles stemming from the impact of migraine on social relationships and the interference of preventive medications on pregnancy. Migraine may also be associated with an increased prevalence of endocrine disorders which in turn affect fertility. Moreover, infertility treatments are associated with mild headache as a side effect. In addition, we found only one retrospective study demonstrating an increase in headache frequency during in vitro fertilization in the migraine population. CONCLUSIONS We determined that there is little research focused specifically on migraine headache exacerbation and other migraine-associated health outcomes with infertility treatment. This topic merits further interdisciplinary exploration.
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Affiliation(s)
- Jasmin Harpe
- Department of Neurology, Brigham and Women's Faulkner Hospital, Boston, Massachusetts, USA
| | - Carolyn Bernstein
- Department of Neurology, Brigham and Women's Faulkner Hospital, Boston, Massachusetts, USA
| | - Andrea Harriott
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Cho KH, Oh K, Kim S, Kim SR. Relationships among Symptoms, Disability, Type D Personality, and Quality of Life in Patients with Migraine: A Cross-Sectional Study in South Korea. Pain Manag Nurs 2022; 24:180-187. [PMID: 36089468 DOI: 10.1016/j.pmn.2022.08.001] [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: 03/07/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Type D personality as a personality vulnerable to stress consists of negative affectivity and social inhibition, and it is related to symptoms and decreased quality of life in patients with chronic illness. AIM This study aimed to explore the relationships among migraine symptoms, disability, type D personality, and quality of life in patients with migraine. METHODS A convenience sample of 135 patients with migraine was collected at the neurologic outpatient clinics of two tertiary hospitals in South Korea. Frequency and severity of migraine symptoms, Migraine Disability Assessment, type D personality, and quality of life were investigated using a structured questionnaire. A descriptive cross-sectional design was used. RESULTS Sixty-one (45.2%) were classified as type D personality. The intensity of the most severe migraine and Migraine Disability Assessment scores in subjects with type D personality were significantly higher than those in subjects without type D personality. In addition, the quality of life score of subjects with type D personality was significantly lower than in subjects without type D personality. The intensity of the migraine, Migraine Disability Assessment score, and type D personality were significant factors influencing quality of life on stepwise multiple regression analysis. CONCLUSIONS Type D personality was related to migraine symptoms, disability, and quality of life in patients with migraine.
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Affiliation(s)
- Kyung-Hee Cho
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sunho Kim
- College of Nursing, Korea University, Seoul, Republic of Korea
| | - Sung Reul Kim
- College of Nursing, Korea University, Seoul, Republic of Korea.
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Dudeney J, Sharpe L, McDonald S, Menzies RE, McGuire B. Are psychological interventions efficacious for adults with migraine? A systematic review and meta‐analysis. Headache 2022; 62:405-419. [DOI: 10.1111/head.14260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/16/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Joanne Dudeney
- eCentreClinic, School of Psychological Sciences Macquarie University Sydney New South Wales Australia
| | - Louise Sharpe
- School of Psychology The University of Sydney Sydney New South Wales Australia
| | - Sarah McDonald
- Discipline of Clinical Psychology, Graduate School of Health University of Technology Sydney Sydney New South Wales Australia
| | - Rachel E. Menzies
- School of Psychology The University of Sydney Sydney New South Wales Australia
| | - Brian McGuire
- School of Psychology National University of Ireland Galway Ireland
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Migraine Characteristics, Comorbidities, Healthcare Resource Utilization, and Associated Costs of Early Users of Erenumab in the USA: A Retrospective Cohort Study Using Administrative Claims Data. Pain Ther 2021; 10:1551-1566. [PMID: 34533779 PMCID: PMC8586283 DOI: 10.1007/s40122-021-00319-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/02/2021] [Indexed: 10/30/2022] Open
Abstract
INTRODUCTION Erenumab is indicated for migraine preventive treatment in adults. The objective of this study was to provide descriptive information on real-world use of erenumab including patient profile and treatment patterns. METHODS We completed a retrospective review of US data (through May 2019) from the IBM MarketScan® Early View Databases, identifying adult patients newly treated with erenumab with a migraine claim in the year prior to first erenumab claim (index) and at least 1 year of continuous pre-index medical and pharmacy insurance coverage, to assess pre- and post-erenumab migraine characteristics, comorbidities, healthcare resource utilization, and associated costs. All data were summarized using descriptive statistics. RESULTS A total of 9753 patients met inclusion criteria. The average (SD) age was 46 (12) years, 85% of patients were female, and 64% had at least one claim for chronic migraine; 70% of erenumab users had an initial dose of 70 mg; 77% of patients in the 6-month follow-up sample (n = 4437) remained on their initial erenumab dose. Persistence at 6-month follow-up was 47.3% with a mean (95% CI) proportion of days covered of 0.68 (0.67, 0.68). In the post-erenumab period, claims for comorbidities of non-migraine headaches and anxiety were reduced and there was a shift to decreased use of acute and preventive medications. Reductions in overall use and associated cost of healthcare resources such as inpatient hospitalization and outpatient office visits were minimal, with slightly more pronounced reductions in the subgroup of patients that were persistent to erenumab. CONCLUSIONS We observed reductions in claims for important migraine characteristics, comorbidities, and a shift to decreased use of acute and preventive migraine medications-observations indicative of the real-world effectiveness of erenumab. Further examination is required as persistence to erenumab, which may be influenced by dose titration, appears to be an important factor in changes to healthcare resource utilization and costs.
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Newman L, Vo P, Zhou L, Lopez Lopez C, Cheadle A, Olson M, Fang J. Health Care Utilization and Costs in Patients With Migraine Who Have Failed Previous Preventive Treatments. Neurol Clin Pract 2021; 11:206-215. [PMID: 34484888 DOI: 10.1212/cpj.0000000000001076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/23/2021] [Indexed: 12/17/2022]
Abstract
Objective To characterize health care utilization (HCU) and associated costs among patients with migraine categorized by the number of preventive treatment failures (TFs; 1 TF, 2 TFs, and 3+ TFs) using real-world data. Methods This retrospective analysis identified adults with incident migraine diagnosis in the IBM MarketScan Commercial and Medicare Supplemental database between January 1, 2011, and June 30, 2015. TF was defined in the 2 years after the first migraine diagnosis period. One TF, 2 TFs, and 3+ TFs were defined as patients who had received only 2 preventive treatments (PTs), 3 PTs, and 4+ PTs in the 2-year period, respectively. A negative binomial model was used to analyze HCU data, and a 2-part model was used for cost data controlling for the preindex Deyo-Charlson Comorbidity Index. Results Overall, 24,282 patients with incident migraine who had failed at least 1 PT were included in the analysis. Of these, 72.7% (n = 17,653) had 1 TF, 20.2% (n = 4,900) had 2 TFs, and 7.1% (n = 1,729) had 3+ TFs. Adjusted annualized rates of all-cause and migraine-specific HCU increased with an increase in the number of TFs (1.4-4 times higher; all p < 0.0001 vs 1 TF). The mean total all-cause health care costs were higher by $3,732 (95% confidence interval [CI]: $2,708-$4,588) in patients with 2 TFs and by $8,912 (95% CI: $7,141-$10,822) in patients with 3+ TFs vs those with 1 TF. Outpatient costs were the key drivers of differences in health care costs. Conclusions TF in patients with migraine was associated with a substantial resource and cost burden, which increased with the number of TFs.
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Affiliation(s)
- Lawrence Newman
- Headache Division (LW), NYU Langone Medical Center, NY; Novartis Pharma AG (PV, CLL, MO), Basel, Switzerland; KMK Consulting Inc. (LZ), Morristown, NJ; and Novartis Pharmaceuticals Corporation (AC, JF), East Hanover, NJ
| | - Pamela Vo
- Headache Division (LW), NYU Langone Medical Center, NY; Novartis Pharma AG (PV, CLL, MO), Basel, Switzerland; KMK Consulting Inc. (LZ), Morristown, NJ; and Novartis Pharmaceuticals Corporation (AC, JF), East Hanover, NJ
| | - Lujia Zhou
- Headache Division (LW), NYU Langone Medical Center, NY; Novartis Pharma AG (PV, CLL, MO), Basel, Switzerland; KMK Consulting Inc. (LZ), Morristown, NJ; and Novartis Pharmaceuticals Corporation (AC, JF), East Hanover, NJ
| | - Cristina Lopez Lopez
- Headache Division (LW), NYU Langone Medical Center, NY; Novartis Pharma AG (PV, CLL, MO), Basel, Switzerland; KMK Consulting Inc. (LZ), Morristown, NJ; and Novartis Pharmaceuticals Corporation (AC, JF), East Hanover, NJ
| | - Andy Cheadle
- Headache Division (LW), NYU Langone Medical Center, NY; Novartis Pharma AG (PV, CLL, MO), Basel, Switzerland; KMK Consulting Inc. (LZ), Morristown, NJ; and Novartis Pharmaceuticals Corporation (AC, JF), East Hanover, NJ
| | - Melvin Olson
- Headache Division (LW), NYU Langone Medical Center, NY; Novartis Pharma AG (PV, CLL, MO), Basel, Switzerland; KMK Consulting Inc. (LZ), Morristown, NJ; and Novartis Pharmaceuticals Corporation (AC, JF), East Hanover, NJ
| | - Juanzhi Fang
- Headache Division (LW), NYU Langone Medical Center, NY; Novartis Pharma AG (PV, CLL, MO), Basel, Switzerland; KMK Consulting Inc. (LZ), Morristown, NJ; and Novartis Pharmaceuticals Corporation (AC, JF), East Hanover, NJ
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12
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Nie N, Chen L, Li T, Zhou C, Li B, Ji C, Zhou J, Chen Q, Li Q, Liang Y, Fang J. Comparative effect of electroacupuncture with different frequency on headache attacks in migraine outpatients: study protocol for a randomised placebo-controlled trial. Trials 2021; 22:483. [PMID: 34301299 PMCID: PMC8299449 DOI: 10.1186/s13063-021-05429-9] [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: 07/08/2020] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Headache attacks severely impaired life quality and increase the economic burden of migraineurs. Electroacupuncture (EA) has been used worldwidely to treat several pain-related diseases including migraines. However, whether EA with low or high frequency exerts a distinct analgesic effect remains unknown and needs further study. Methods/Design This study is a randomised, single-blinded, placebo-controlled trial with three parallel arms. A total of 144 migraine outpatients will be randomly allocated to the 2 Hz EA group, 100 Hz EA group and placebo control group. The duration of the trial is 20 weeks, including a 4-week-long baseline assessment period (weeks − 4–0), a 4-week-long treatment period (weeks 1–4) and a 12-week-long follow-up period (weeks 5–16). Twelve treatment sessions will be performed over a 4-week period (weeks 1–4). The primary outcome will be measured by the frequency of migraine attacks in the past 4 weeks at the end of week 4 post-randomisation. The secondary outcome will be measured by the frequency of migraine attacks in the past 4 weeks at the end of weeks 8, 12 and16 post-randomisation; number of days with migraine; dosage of ibuprofen; the scores of visual analogue scale (VAS); Self-Rating Anxiety Scale (SAS); Self-Rating Depression Scale (SDS); and Migraine Specific Quality of Life questionnaire (MSQ) in the past 4 weeks at the end of weeks 4, 8, 12 and 16 post-randomisation. Safety assessment, compliance and blinding evaluation will be carried out at the end of week 16 post-randomisation. Discussion The recruitment will be started on 1 June 2021 and expected to finish on 31 May 2023. We aimed to clarify the dominant frequency of EA on headache attacks in a migraineur. Trial registration Chinese Clinical Trial Registry ChiCTR-1800017259. Registered on 20 July 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05429-9.
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Affiliation(s)
- Na Nie
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, No. 219 Moganshan Road, Xihu District, Hangzhou, 310005, Zhejiang Province, China
| | - Le Chen
- The Third School of Clinical Medical, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
| | - Tong Li
- The Third School of Clinical Medical, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
| | - Chuanlong Zhou
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, No. 219 Moganshan Road, Xihu District, Hangzhou, 310005, Zhejiang Province, China
| | - Bangwei Li
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, No. 219 Moganshan Road, Xihu District, Hangzhou, 310005, Zhejiang Province, China
| | - Conghua Ji
- The Clinical Research Institute of Zhejiang Provincial Hospital of TCM, No. 54 Youdian Road, Xihu District, Hangzhou, 310006, Zhejiang Province, China
| | - Jie Zhou
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, No. 219 Moganshan Road, Xihu District, Hangzhou, 310005, Zhejiang Province, China
| | - Qin Chen
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, No. 219 Moganshan Road, Xihu District, Hangzhou, 310005, Zhejiang Province, China
| | - Qiushuang Li
- The Clinical Research Institute of Zhejiang Provincial Hospital of TCM, No. 54 Youdian Road, Xihu District, Hangzhou, 310006, Zhejiang Province, China
| | - Yi Liang
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, No. 219 Moganshan Road, Xihu District, Hangzhou, 310005, Zhejiang Province, China. .,The Third School of Clinical Medical, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China.
| | - Jianqiao Fang
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, No. 219 Moganshan Road, Xihu District, Hangzhou, 310005, Zhejiang Province, China.,The Third School of Clinical Medical, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
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13
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Alwhaibi M, Meraya AM, AlRuthia Y. Healthcare Expenditures Associated With Comorbid Anxiety and Depression Among Adults With Migraine. Front Neurol 2021; 12:658697. [PMID: 34093408 PMCID: PMC8177687 DOI: 10.3389/fneur.2021.658697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/13/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction: Depression and anxiety are common among patients with migraine and usually associated with a humanistic and financial burden. This study aims to examine the direct healthcare expenditures among adults with migraine alone or with comorbid anxiety and/or depression. Methods: This was a retrospective cross-sectional study using 2012, 2014, and 2016 Medical Expenditure Panel Survey data. Adult patients aged ≥22 years with migraine headache were included in the study. The direct healthcare expenditures of four migraine groups (migraine alone, migraine and anxiety, migraine and depression, and migraine and both conditions) were compared. Results: There were 1,556 patients who met the inclusion criteria and eventually enrolled in the study. Approximately 42% of the study sample had migraine with comorbid depression and/or anxiety (16.1% have depression, 12.3% have anxiety disorder, and 13.9% have both). The mean total healthcare expenditures of adults with migraine alone ($6,461) were significantly lower than those with comorbid depression and anxiety ($11,102), comorbid anxiety ($10,817), and comorbid depression ($14,577). Migraine with comorbid anxiety and depression was significantly associated with incremental costs of $1,027 in outpatient and $662 emergency room healthcare expenditures and prescription drug compared to the migraine alone group. Conclusions: The healthcare expenditures associated with migraine with comorbid depression and/or anxiety are significantly higher than those without mental health comorbidities. Therefore, regular depression and anxiety screening for patients with migraine may help reduce the healthcare expenditures associated with depression and/or anxiety comorbidities and improve the quality of care.
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Affiliation(s)
- Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdulkarim M Meraya
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jizan, Saudi Arabia.,Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jizan, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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14
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Real-World Treatment Profiles, Clinical Outcomes, and Healthcare Resource Utilization of Patients with Migraine Prescribed Erenumab: A Multicenter Chart-Review Study of US Headache Centers. Neurol Ther 2021; 10:293-306. [PMID: 33856626 PMCID: PMC8140045 DOI: 10.1007/s40120-021-00245-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/17/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction Erenumab, a first-in-class monoclonal antibody targeting the calcitonin gene-related peptide pathway, was approved by the US Food and Drug Administration in 2018 for the prevention of migraine in adults. There is limited data available on its impact in real-world settings. The study aim was to characterize the real-world treatment profiles, clinical outcomes, and healthcare resource utilization of patients prescribed erenumab from select major US headache centers. Methods A retrospective chart review of patients with migraine treated with erenumab for at least 3 months across five major headache centers was conducted. Data was collected from patient charts between April 2019 and April 2020 and included patient and clinical characteristics, migraine medication use, and outpatient visits. The date of the first prescription fill of erenumab was defined as the index date. The baseline period comprised the 3 months prior to the index date and the study period comprised the at least 3 months on erenumab treatment. Results Data from a total of 1034 patients with chronic migraine with a mean of 9.3 months of erenumab treatment were analyzed. Patients were on average 48 years old, 86% were female, and 79% were white. Patients had a mean of 5 preventive treatment failures prior to erenumab initiation. Patients used a mean of 2 preventive treatments (excluding erenumab) and 2 acute treatments during baseline and study periods. Among patients with effectiveness data, 45% of patients had improvement in physician-reported migraine severity and 35% experienced at least 50% reduction in mean headache/migraine days per month. The average number of monthly outpatient visits was 0.43 and 0.30 before and after erenumab initiation, respectively. Conclusion In this predominantly refractory chronic migraine population treated in select headache centers, patients had fewer headache/migraine days per month and outpatient visits after initiating erenumab. However, patients largely continued to be managed via a polypharmacy approach after erenumab initiation.
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15
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Buse DC, Yugrakh MS, Lee LK, Bell J, Cohen JM, Lipton RB. Burden of Illness Among People with Migraine and ≥ 4 Monthly Headache Days While Using Acute and/or Preventive Prescription Medications for Migraine. J Manag Care Spec Pharm 2020; 26:1334-1343. [PMID: 32678721 PMCID: PMC10391061 DOI: 10.18553/jmcp.2020.20100] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Migraine is a chronic disease that reduces health-related quality of life. Little is known about the burden of migraine in individuals who are potential candidates for preventive treatment with ≥ 4 monthly headache days currently using migraine medications. OBJECTIVE To characterize the burden of migraine among patients reporting ≥ 4 monthly headache days while taking acute and/or preventive migraine medications. METHODS In this retrospective, cross-sectional study, data from the 2016 U.S. National Health and Wellness Survey (N = 97,503) compared the burden of migraine among individuals self-reporting a diagnosis of migraine by a health care professional and ≥ 4 monthly headache days while using acute and/or preventive prescription migraine medications to matched nonmigraine controls. Propensity score matching across different variables (e.g., age, gender, and body mass index) was used to identify matched controls from respondents who did not self-report a diagnosis of migraine. Migraine-associated burden was measured by impairment in work productivity and daily activities (Work Productivity and Activity Impairment questionnaire), all-cause health care resource utilization (HRU), and all-cause direct and indirect costs. RESULTS This analysis included 197 treated migraine patients with ≥ 4 monthly headache days and 197 matched nonmigraine controls. Greater proportions of treated migraine patients reported comorbid depression (58.4% vs. 27.9%, P < 0.001) or generalized anxiety disorder (15.2% vs. 8.6%, P = 0.043) and were on long-term disability (13.7% vs. 5.6%, P = 0.003). Absenteeism (11.8% vs. 6.3%, P = 0.030); presenteeism (36.0% vs. 17.5%, P < 0.001); overall work impairment (41.0% vs. 20.9%, P < 0.001); and activity impairment (45.4% vs. 25.4%, P < 0.001) were greater in treated migraine patients versus nonmigraine controls. Treated migraine patients had higher all-cause HRU and higher all-cause direct ($24,499.90 vs. $15,318.91, P = 0.013) and indirect ($14,770.57 vs. $5,764.93, P < 0.001) costs than nonmigraine controls. CONCLUSIONS Treated migraine patients with ≥ 4 monthly headache days reported significantly reduced work productivity and increased all-cause HRU and cost despite migraine treatment compared with nonmigraine controls. These findings highlight unmet needs in the treatment and management of migraine. DISCLOSURES This study was funded by Teva Pharmaceutical Industries (Petach Tikva, Israel). Cohen is an employee of Teva Branded Pharmaceutical Products R&D (USA); Bell was an employee of Teva Pharmaceutical Industries at the time of this study and holds stock/stock options in Teva Pharmaceutical Industries. Lee is an employee of Kantar, which received funding from Teva Pharmaceutical Industries for data analyses performed for this study. Buse has served as a paid consultant to Amgen/Novartis, Allergan, Biohaven, Eli Lilly, Promius/Dr. Reddy's, and Teva Pharmaceuticals, but she was not compensated financially for work on this study. Yugrakh has received research support from Teva Pharmaceuticals and Cefaly Technology. Lipton has received research support from the NIH, the Migraine Research Foundation, and the National Headache Foundation; holds stock options in eNeura Therapeutics and Biohaven Holdings; serves as consultant, advisory board member, or has received honoraria from the American Academy of Neurology, Alder, Allergan, the American Headache Society, Amgen, Autonomic Technologies, Avanir, Biohaven, BioVision, Boston Scientific, Dr. Reddy's, electroCore, Eli Lilly, eNeura Therapeutics, GlaxoSmithKline, Merck, Pernix, Pfizer, Supernus, Teva, Trigemina, Vector, and Vedanta. This study was presented as a poster at the American Academy of Neurology 2018 Annual Meeting, April 21-27, 2018, in Los Angeles, CA; PAINWeek 2018, September 4-8, 2018, in Las Vegas, NV; and the 2017 European Headache Federation (EHF) Congress, December 1-3, 2017, in Rome, Italy.
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Affiliation(s)
- Dawn C. Buse
- Albert Einstein College of Medicine, Bronx, New York
| | - Marianna S. Yugrakh
- Department of Neurology, Columbia University Medical Center, New York, New York
| | | | - Jvawnna Bell
- Teva Branded Pharmaceutical Products R&D, West Chester, Pennsylvania
| | - Joshua M. Cohen
- Teva Branded Pharmaceutical Products R&D, West Chester, Pennsylvania
| | - Richard B. Lipton
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
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16
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Kikui S, Chen Y, Todaka H, Asao K, Adachi K, Takeshima T. Burden of migraine among Japanese patients: a cross-sectional National Health and Wellness Survey. J Headache Pain 2020; 21:110. [PMID: 32912187 PMCID: PMC7488335 DOI: 10.1186/s10194-020-01180-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Limited studies have measured the burden of migraine in Japan. This study aimed at estimating the disease burden of migraine in Japan and identifying factors associated with the burden using the 2017 National Health and Wellness Survey. METHODS Migraine patients were defined by ICHD-3 like criteria with ≥4 monthly headache days (MHDs), and non-migraine respondents were selected using 1:4 propensity score matching. Multivariate analyses were conducted to compare Health-related Quality of Life (HRQoL), work productivity and activity impairment (WPAI), healthcare resource utilization (HRU) and costs between the two groups, and to identify factors associated with these outcomes in migraine patients. RESULTS In 30,001 respondents, 378 migraine patients were identified. Compared to matched controls (N = 1512), migraine patients had lower physical (45.17 vs. 49.89), mental (42.28 vs. 47.71) and role/social (37.91 vs. 44.19) component summary scores (p < 0.001). Migraine patients had higher absenteeism (6.4% vs. 2.2%), presenteeism (40.2% vs. 22.5%), total work productivity impairment (44.3% vs. 24.5%), total activity impairment (45.0% vs. 23.9%), indirect costs (1,492,520 JPY vs. 808,320 JPY) and more visits to healthcare providers in the past 6 months (7.23 vs. 3.96) (p < 0.001). More MHDs was associated with worse HRQoL, and higher HRU and indirect costs. CONCLUSIONS Japanese migraine patients experience an incremental burden. This demonstrates the unmet needs among Japanese migraine patients.
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Affiliation(s)
- Shoji Kikui
- Department of Neurology & Headache Center, Tominaga Hospital, 1-4-48 Minatomiachi, Naniwa-ku, Osaka, 556-0017, Japan
| | - Yirong Chen
- Kantar, Health Division, 50 Scotts Road, #02-01, Singapore, 228242, Singapore
| | - Hiroshi Todaka
- Amgen K.K., Midtown Tower, 9-7-1 Akasaka, Minato-ku, Tokyo, 107-6239, Japan
| | - Keiko Asao
- Amgen K.K., Midtown Tower, 9-7-1 Akasaka, Minato-ku, Tokyo, 107-6239, Japan
| | - Kenji Adachi
- Amgen K.K., Midtown Tower, 9-7-1 Akasaka, Minato-ku, Tokyo, 107-6239, Japan
| | - Takao Takeshima
- Department of Neurology & Headache Center, Tominaga Hospital, 1-4-48 Minatomiachi, Naniwa-ku, Osaka, 556-0017, Japan.
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Baker VB, Sowers CB, Hack NK. Lost productivity associated with headache and depression: a quality improvement project identifying a patient population at risk. J Headache Pain 2020; 21:50. [PMID: 32393164 PMCID: PMC7216618 DOI: 10.1186/s10194-020-01107-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This quality improvement project was implemented in order to highlight the association between headache, mTBI and depression on lost productivity and resource utilization. BACKGROUND Mood disorders, environment and traumatic brain injury are common in patients with headache, and have been shown to influence clinical course, treatment response and outcome. Although widely recognized, the association of these factors on clinical outcomes, resource utilization and productivity is not well understood. METHODS All patients presenting to a military referral center for migraines are assessed for presence of traumatic brain injury, Headache Impact Score (HIT-6) and Patient Depression Questionnaire (PHQ-9). Based on screening, patients are offered referral to mental health and a multidisciplinary headache education course. RESULTS 237 patients were seen for headache or migraine. 180 patients had severely disabling headaches. These patients accounted for 146 emergency room visits over the course of one year. Of headache patients, 65% met criteria for depression and 15% of patients had severe depression. Only 37% of these patients carried a formal diagnosis of depression and 38% had been seen by mental health. Lost productivity and duty limitations were significantly associated with severity of depression. In service members screening positively for mild, moderate or severe depression, duty restrictions had been placed on 8.3%, 32.5% and 53.8%, respectively. Only 3.8% of patients who did not screen for depression had similar duty limitations. A history of mTBI strongly correlated with comorbid depression. Lost productivity and duty limitations were not impacted by other headache characteristics or HIT-6 scores. CONCLUSIONS This quality improvement project identified a practice gap for treatment of comorbid depression in patients presenting to Neurology for headache. Depression strongly correlated with productivity loss, highlighting a possible target for the economic burden of headache.
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Affiliation(s)
- Virginia B Baker
- Walter Reed National Military Medical Center, Neurology Department, 8901 Rockville Pike, Bethesda, MD, 20889, USA.
| | | | - Nawaz K Hack
- Walter Reed National Military Medical Center, Neurology Department, 8901 Rockville Pike, Bethesda, MD, 20889, USA
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18
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Hoekman J, Ray S, Aurora SK, Shrewsbury SB. The Upper Nasal Space—A Novel Delivery Route Ideal for Central Nervous System Drugs. ACTA ACUST UNITED AC 2020. [DOI: 10.17925/usn.2020.16.1.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Oliveira AB, Queiroz LP, Sampaio Rocha-Filho P, Sarmento EM, Peres MFP. Annual indirect costs secondary to headache disability in Brazil. Cephalalgia 2019; 40:597-605. [DOI: 10.1177/0333102419889357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Disability imposed by headache disorders constitutes an expressive economic burden, mostly from indirect costs due to absenteeism and presenteeism. Objective To estimate indirect costs from absenteeism and presenteeism due to headache disorders in Brazil. Methods In a secondary, descriptive analysis of two nationwide databases, we estimated indirect costs based on headache-related disability and socioeconomic data. Results In the first database analyzed (n = 3838), 12.8% of the employed population with headache disorders missed at least 1 day of work in the last 3 months (mean, 95% CI = 4.2 days [3.7–4.6]). Based on the prevalence of headache disorders, days lost due to headaches and income data, R$ 40.4 billion (Int$ 20 billion) are lost due to headache-related absenteeism annually. For presenteeism, 26.2% of the employed population with headache disorders worked at least 1 day in the last 3 months with 50% reduced productivity (mean, 95% CI = 5.7 days [5.3–6.2]), amounting to R$ 27.3 billion (Int$ 13.5 billion) of financial loss annually. In the other database analysed (n = 205,546), 14,052 (6.8%) respondents missed work/school or household duties in the past 2 weeks due to some disease. Of these, 4.7% attributed their days lost to headaches disorders in the economically active population, which ranked 4th as main cause of days lost due to disease, among 23 common diseases. Conclusions The economic burden of headache disorders in Brazil, mostly due to migraine (55.4%), may cost up to R$ 67.6 billion (Int$ 33.5 billion) annually, and headache disorders represent a leading cause of absenteeism due to disease.
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Affiliation(s)
- Arão Belitardo Oliveira
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Pedro Sampaio Rocha-Filho
- Departamento de Neuropsiquiatria, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
- Clínica de Cefaleias, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco (UPE), Recife, Brazil
| | - Elder Machado Sarmento
- Centro Universitário de Volta Redonda – UniFOA, Volta Redonda, Brazil
- Santa Casa de Misericórdia de Barra Mansa, Barra Mansa, Brazil
| | - Mario FP Peres
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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20
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Silberstein SD, Shrewsbury SB, Hoekman J. Dihydroergotamine (DHE) - Then and Now: A Narrative Review. Headache 2019; 60:40-57. [PMID: 31737909 PMCID: PMC7003832 DOI: 10.1111/head.13700] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To provide a narrative review of clinical development programs for non-oral, non-injectable formulations of dihydroergotamine (DHE) for the treatment of migraine. BACKGROUND Dihydroergotamine was one of the first "synthetic drugs" developed in the 20th century for treating migraine. It is effective and recommended for acute migraine treatment. Since oral DHE is extensively metabolized, it must be given by a non-oral route. Intravenous DHE requires healthcare personnel to administer, subcutaneous/intramuscular injection is challenging to self-administer, and the approved nasal spray formulation exhibits low bioavailability and high variability that limits its efficacy. Currently there are several attempts underway to develop non-oral, non-injected formulations of DHE. METHOD A systematic search of MEDLINE/PubMed and ClinicalTrials.gov databases, then narrative review of identified reports, focusing on those published in the last 10 years. RESULTS Of 1881 references to DHE from a MEDLINE/PubMed search, 164 were from the last 10 years and were the focus of this review. Further cross reference was made to ClinicalTrials.gov for 19 clinical studies, of which some results have not yet been published, or are studies that are currently underway. Three nasal DHE products are in clinical development, reawakening interest in this route of delivery for migraine. Other routes of DHE administration have been, or are being, explored. CONCLUSION There is renewed appreciation for DHE and the need for non-oral, non-injected delivery is now being addressed.
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21
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Law EF, Palermo TM, Zhou C, Groenewald CB. Economic Impact of Headache and Psychiatric Comorbidities on Healthcare Expenditures Among Children in the United States: A Retrospective Cross-Sectional Study. Headache 2019; 59:1504-1515. [PMID: 31520418 DOI: 10.1111/head.13639] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the annual healthcare expenditures associated with childhood headache in the United States, and to evaluate whether psychiatric comorbidities increase the impact of headache on expenditures. BACKGROUND Headache is prevalent in childhood and co-occurs with anxiety disorders, depressive disorders, and attention deficit/hyperactivity disorder (ADHD), which may increase cost of illness. METHODS We conducted a secondary data analysis using a nationally representative sample of 34,633 children ages 2-17 from the 2012-2015 Medical Expenditure Panel Surveys (MEPS), of which 779 (weighted 2.6%) were identified as having headache based on health service use associated with headache. Using a comprehensive cost-of-illness approach, we assessed the incremental expenditures associated with headache and determined excess expenditures associated with psychiatric comorbidities using standard adjusted 2-part expenditure models. RESULTS Annual total healthcare expenditures were estimated to be 24.3% higher, 95% CI [1,55], in our headache group ($3036, 95% CI [2374,3699] vs $2350, 95% CI [2140,2559]). Total national expenditures associated with pediatric headache in the United States were estimated at $1.1 billion annually, 95% CI [.04, 2.2 billion]. Depression and ADHD were associated with higher incremental expenditures for the headache group (depression: $1815, 95% CI[676,2953] vs $1409, 95% CI[697,2112]; ADHD: $4742, 95% CI[1659,7825] vs $2935, 95% CI[1977,3894]); however, interactions between psychiatric comorbidities and headache did not reach statistical significance. CONCLUSION Youth with headache exert a considerable economic burden on families, healthcare systems, and society. Due to the limitations in methods used to classify youth with headache in MEPS, our findings may underestimate the true prevalence and cost of pediatric headache in the United States. Further research with larger sample sizes is needed to understand the impact of psychiatric comorbidities on healthcare expenditures in this population.
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Affiliation(s)
- Emily F Law
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Chuan Zhou
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Cornelius B Groenewald
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA
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Vo P, Gao W, Zichlin ML, Fuqua E, Fadli E, Aguirre Vazquez M, Tarancón T, Mahieu N, Maier-Peuschel M, Rossi S, Naclerio M, Ritrovato D, Swallow E. Migraine-related healthcare resource use in the emergency department setting: a panel-based chart review in France, Germany, Italy, and Spain. J Med Econ 2019; 22:960-966. [PMID: 31234676 DOI: 10.1080/13696998.2019.1636052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Migraine is a common, disabling condition typically characterized by severe headache, nausea, and/or light and sound sensitivity. This study assessed migraine-related health resource utilization (HRU) occurring in the emergency room/accident & emergency department (ER/A&E) setting among European patients with 4 or more migraine days per month. Methods: Patient-level clinical and HRU data were collected via chart extraction by ER/A&E physicians in France, Germany, Italy, and Spain. Eligible patients had 4 or more migraine days in the month prior to a migraine-related ER/A&E visit and a history of migraine, among other criteria. The index date for each patient was defined as the date of an ER/A&E visit for migraine on or after January 1, 2013. Physician and ER/A&E characteristics, patient and disease characteristics, treatment history, migraine-medication used, and migraine-related HRU (i.e. procedures) during the ER/A&E visit were assessed. Descriptive analyses were conducted in the pooled population, and a sensitivity analysis was performed by country. Results: A total of 467 eligible patient's charts (120 in France, 120 in Germany, 107 in Italy, and 120 in Spain) were provided by 136 physicians (36 in France, 36 in Germany, 28 in Italy, and 36 in Spain). On average, patients spent nearly 8 hours in the ER/A&E. Approximately 82% of patients received a blood test, 62% received an electrocardiography, and 46% received a cranial computerized tomography scan. Despite the majority of patients already using acute or prophylactic treatment upon visiting the ER/A&E, almost all patients were administered or prescribed migraine treatment during the visit. Approximately 21% of patients were admitted to the hospital, and over half of patients were referred to a neurologist or headache specialist. Conclusions: European patients who had four or more migraine days in the month prior to a migraine-related ER/A&E visit had high HRU associated with the visit.
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Affiliation(s)
- Pamela Vo
- a Novartis Pharma AG , Basel , Switzerland
| | - Wei Gao
- b Analysis Group, Inc , Boston , MA , USA
| | | | | | - Ela Fadli
- b Analysis Group, Inc , Boston , MA , USA
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Ford JH, Ye W, Nichols RM, Foster SA, Nelson DR. Treatment patterns and predictors of costs among patients with migraine: evidence from the United States medical expenditure panel survey. J Med Econ 2019; 22:849-858. [PMID: 30977712 DOI: 10.1080/13696998.2019.1607358] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Aim: Within a treated migraine population, to evaluate if the sub-group meeting criteria for high disease-specific total costs is significantly different to the sub-group with medium and/or low-costs, and to identify the associated risk factors. Methods: Data from the Household Component of Medical Expenditure Panel Survey (MEPS-HC, 2008-2012), a nationally representative survey of non-institutionalized civilians in the US, were analyzed. Key inclusion criteria were migraine diagnosis (ICD-9 code: 346.XX) and prescribed treatment for migraine. Patients were categorized into high (>top 10th percentile), low (<bottom 10th percentile), and medium (between high and low) cost sub-groups per migraine-specific total costs. Logistic regression models were applied to identify predictors of high vs medium and medium vs low-costs. Preventive eligibility, defined as (i) past/current use of migraine preventives or (ii) overuse of acute medications, was compared to non-preventive eligibility. Results: Within the treated migraine cohort (n = 1,735), the mean age was 39 years, 80% were female, and the majority were in the medium-cost sub-group (n = 1,360) (low-cost n = 190, high-cost n = 195). Significant predictors of high vs medium-costs were low SF-12 Physical Composite Scores (OR = 0.95; 95% CI = 0.92-0.97), low SF-6D health utility index scores (OR = 0.019; 95% CI = 0.002-0.193), preventive eligibility-i (OR = 0.019; 95% CI = 0.002-0.193), and preventive-eligibility-ii (OR = 3.10; 95% CI = 1.62-5.91). Statistically significant (p < 0.05) predictors of medium vs low-costs included anxiety, Fleishman score, preventive-eligible-i, and preventive-eligible-ii. Conclusions: Among patients treated for migraine, distinct characteristics, including patient-functioning measures and comorbidities, are predictive of high vs medium-costs, and medium vs low-costs. Preventive eligibility is a predictor of being in the higher cost sub-groups; however, preventive treatments that improve functioning and reduce acute medication use have the potential to reduce migraine-specific costs. Limitations: The results are limited to a population that is diagnosed and treated for migraine. Over-the-counter medication use, and migraine headache frequency and severity were not captured.
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Affiliation(s)
- Janet H Ford
- a Eli Lilly and Company , Indianapolis , IN , USA
| | - Wenyu Ye
- a Eli Lilly and Company , Indianapolis , IN , USA
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Vo P, Gao W, Zichlin ML, Fuqua E, Fadli E, Aguirre Vazquez M, Tarancón T, Mahieu N, Maier-Peuschel M, Rossi S, Naclerio M, Ritrovato D, Swallow E. Real-world healthcare resource utilization related to migraine treatment failure: a panel-based chart review in France, Germany, Italy, and Spain. J Med Econ 2019; 22:953-959. [PMID: 31234672 DOI: 10.1080/13696998.2019.1636051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Aims: This retrospective chart review examined the six-month migraine-related healthcare resource use (HRU) among European patients who had ≥4 migraine days per month and previously failed at least two prophylactic migraine treatments. Methods: Neurologists, headache specialists, and pain specialists in France, Germany, Italy, and Spain who treated ≥10 patients with migraine in 2017 were recruited (April-June 2018) to extract anonymized patient-level data. Eligible physicians randomly selected charts of up to five adult patients with clinically-confirmed migraine, ≥4 migraine days in the month prior to the index date, and had previously failed at least two prophylactic migraine treatments. Treatment failure was defined as discontinuation due to lack of efficacy and/or tolerability. Demographic and disease characteristics as of the index date, and migraine-related HRU incurred during the 6-month study period, were recorded. Results: A total of 104 physicians contributed 168 charts for patients (63% female). On average, patients were 38 years old and failed 2.3 prophylactic treatments as of the index date. During the study period, 83% of patients had ≥1 outpatient visit for migraine in the physician's office, and 27% went to the ER/A&E. Approximately 5% of patients were hospitalized for migraine, with an average of one hospitalization and an average length of stay of 3 days. Approximately 39% of patients had ≥1 blood test, 22% had ≥1 magnetic resonance imaging, 17% had ≥1 electroencephalogram, and 13% had ≥1 computerized tomography scan. Visits to other healthcare providers were common. Limitations: This study is subject to the limitations of chart review studies, such as errors in data entry. Conclusions: Across four European countries, the HRU burden of migraine among patients who previously failed at least two prophylactic treatments was high, indicating a need for more effective prophylactic treatments to appropriately manage migraine and reduce the HRU burden attributable to this common disorder.
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Affiliation(s)
- Pamela Vo
- a Novartis Pharma AG , Basel , Switzerland
| | - Wei Gao
- b Analysis Group, Inc , Boston , MA
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25
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Acupuncture versus propranolol in migraine prophylaxis: an indirect treatment comparison meta-analysis. J Neurol 2019; 267:14-25. [DOI: 10.1007/s00415-019-09510-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 01/21/2023]
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Speck RM, Shalhoub H, Ayer DW, Ford JH, Wyrwich KW, Bush EN. Content validity of the Migraine-Specific Quality of Life Questionnaire version 2.1 electronic patient-reported outcome. J Patient Rep Outcomes 2019; 3:39. [PMID: 31297622 PMCID: PMC6624220 DOI: 10.1186/s41687-019-0138-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 06/19/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose A concept elicitation, cognitive debriefing, and usability study was undertaken to: 1) ascertain the migraine experience with a particular focus on the impact on roles and daily functioning; 2) determine the comprehensiveness and comprehensibility of the Migraine-Specific Quality of Life Questionnaire version 2.1 electronic patient-reported outcome Role Function-Restrictive (MSQ v2.1 ePRO RFR) domain items, and the appropriateness and understanding of the recall period, response options, and instructions; and 3) assess the usability on an electronic tablet device. Methods Eleven US English-speaking people with episodic or chronic migraine were recruited to participate in one-on-one interviews, encompassing methods appropriate for concept elicitation, cognitive debriefing, and usability testing. Interviews were audio-recorded, transcribed, and analyzed following the constant comparative method. Results Participants (seven episodic and four chronic) had a mean age of 34.8 years, and nine were female. Through spontaneous mention or probing, the concepts of the MSQ v2.1 ePRO RFR domain items were described and endorsed by all participants as day-to-day functioning restrictions; except for item 5 (ability to concentrate), which was endorsed by 10 of 11 participants. Cognitive interviewing confirmed the MSQ v2.1 ePRO instructions were clear, meaningful, and important to assess as daily functioning impacts experienced as a result of migraine. Overall impressions of the ePRO device were favorable, and no participants reported any difficulties with use. Conclusions The MSQ v2.1 ePRO RFR domain is content-valid and appropriate for inclusion in future studies designed to measure the functional impact of episodic or chronic migraine on the performance of day-to-day activities.
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Affiliation(s)
- Rebecca M Speck
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA.
| | - Huda Shalhoub
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | - David W Ayer
- Eli Lilly & Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA
| | - Janet H Ford
- Eli Lilly & Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA
| | - Kathleen W Wyrwich
- Eli Lilly & Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA
| | - Elizabeth N Bush
- Eli Lilly & Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA
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Marques AP, Macedo AF, Lima Ramos P, Moreno LH, Butt T, Rubin G, Santana R. Productivity Losses and Their Explanatory Factors Amongst People with Impaired Vision. Ophthalmic Epidemiol 2019; 26:378-392. [PMID: 31280630 DOI: 10.1080/09286586.2019.1632904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To estimate productivity losses amongst people with impaired vision in Portugal and to investigate explanatory factors associated with non-participation in the labour market.Methods: A total of 546 visually impaired individuals participated in face-to-face interviews. Participants were asked about their workforce participation to determine productivity (employment status questionnaire), their health-related quality of life - HRQoL (EQ-5D) and their visual acuity and visual ability (Activity Inventory). Productivity losses included absenteeism and reduction in workforce participation. Logistic regression was used to determine independent factors associated with participation in the labour market.Results: From the 546 participants, 50% were retired, 47% were of working age and 3% were students. The employment rate was 28%, and the unemployment rate was 21% for the working age sample. For those of working age, productivity losses were estimated at €1.51 million per year, mean of €5496 per participant. The largest contributor to productivity losses was reduced workforce participation, estimated from 159 early retired or unemployed participants. After controlling for visual acuity and ability, younger individuals, with more years of education, without comorbidities and high HRQoL had a higher probability of being employed.Conclusions: Our findings show a high unemployment rate and high productivity losses amongst people with impaired vision. The probability of being employed was associated with education, HRQoL and comorbidities. We speculate that promoting education and health through effective visual rehabilitation programs may help to increase participation in the labour market. These findings can inform decisions to intervene to reduce the burden of vision loss.
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Affiliation(s)
- Ana Patricia Marques
- National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal.,Public Health Research Center, National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - Antonio Filipe Macedo
- Department of Medicine, Optometry Linnaeus University Kalmar, Kalmar, Sweden.,Low Vision and Visual Rehabilitation Lab, Department and Center of Physics-Optometry and Vision Science, University of Minho Braga, Braga, Portugal
| | - Pedro Lima Ramos
- Department of Medicine, Optometry Linnaeus University Kalmar, Kalmar, Sweden.,Low Vision and Visual Rehabilitation Lab, Department and Center of Physics-Optometry and Vision Science, University of Minho Braga, Braga, Portugal
| | - Laura Hernandez Moreno
- Low Vision and Visual Rehabilitation Lab, Department and Center of Physics-Optometry and Vision Science, University of Minho Braga, Braga, Portugal
| | - Thomas Butt
- National School of Development, Peking University, Beijing, China.,Institute of Ophthalmology, University College London, London, UK
| | - Gary Rubin
- Institute of Ophthalmology, University College London, London, UK
| | - Rui Santana
- National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal.,Public Health Research Center, National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
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Rashed A, Mazer-Amirshahi M, Pourmand A. Current Approach to Undifferentiated Headache Management in the Emergency Department. Curr Pain Headache Rep 2019; 23:26. [PMID: 30868276 DOI: 10.1007/s11916-019-0765-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW To discuss pharmacological interventions in the emergency department (ED) setting for the management of acute primary headache. RECENT FINDINGS Acute headache treatment in the ED has seen an expansion in terms of possible pharmacological interventions in recent years. After a thorough evaluation ruling out dangerous causes of headache, providers should take the patient's history, comorbidities, and prior therapy into consideration. Antidopaminergics have an established role in the management of acute, severe, headache with manageable side-effect profiles. However, recent studies suggest anesthetic and anti-epileptic drugs may play roles in headache treatment in the ED. Current literature also suggest steroids as a promising tool for emergency department clinicians combating the readmission of patients with recurrent headaches. Emergency medicine providers must be cognizant of these traditional and emerging therapies in order to optimize the care of headache patients.
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Affiliation(s)
- Amir Rashed
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L St., Washington, DC, 20037, USA
| | - Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, USA.,School of Medicine, Georgetown University, Washington, DC, USA
| | - Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L St., Washington, DC, 20037, USA.
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Shrewsbury SB, Jeleva M, Satterly KH, Lickliter J, Hoekman J. STOP 101: A Phase 1, Randomized, Open-Label, Comparative Bioavailability Study of INP104, Dihydroergotamine Mesylate (DHE) Administered Intranasally by a I123 Precision Olfactory Delivery (POD ® ) Device, in Healthy Adult Subjects. Headache 2019; 59:394-409. [PMID: 30659611 DOI: 10.1111/head.13476] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Investigate the safety and pharmacokinetics (PK) of INP104, intranasal dihydroergotamine mesylate (DHE) administered via a Precision Olfactory Delivery (POD® ) device, (Impel NeuroPharma, Seattle, WA) vs intravenous (IV) DHE and DHE nasal spray (Migranal® ) in healthy adult subjects. METHODS This was a Phase 1, open-label, randomized, single-dose, 3-period, 3-way crossover study. Subjects received a single dose of A) INP104 1.45 mg (a drug-device combination product composed of DHE and the I123 POD device); B) DHE 45® Injection (IV) 1.0 mg; and C) DHE by Migranal® Nasal Spray 2.0 mg. Plasma levels of DHE and the major bioactive metabolite, 8'OH-DHE, were measured, and PK parameters were determined for both. Comparative bioavailability (BA) was assessed by calculating the ratio of the geometric means between treatments for Cmax and AUC0-inf on the ln-transformed data. Safety was assessed from adverse events, vital signs, electrocardiograms, and clinical laboratory values. RESULTS Thirty-eight subjects were enrolled, 36 were dosed with at least 1 IP and 27 were included in the evaluation of PK and comparative BA. DHE plasma levels following INP104 1.45 mg administration reached 93% of Cmax by 20 minutes and were comparable to IV DHE 1.0 mg by 30 minutes (1219 ng/mL for INP104 vs 1224 ng/mL for IV DHE), which was the Tmax for INP104. From 30 minutes onward, DHE levels for INP104 closely matched those of IV DHE to 48 hours, the last time point measured. In comparison, the Cmax for Migranal was 299.6 pg/mL (approximately 4-fold less than INP104) and occurred at 47 minutes, 17 minutes later than INP104. Plasma DHE AUC0-inf were 6275, 7490, and 2199 h*pg/mL for INP104, IV DHE, and Migranal, respectively. Variability (coefficient of variation [CV%]) for Cmax and AUC0-inf for INP104 compared to Migranal indicated more consistent delivery with INP104. In the BA comparison using the PK population (subjects who had received all 3 treatments), the ratios of geometric means (percent) for Cmax and AUC0-inf were 7.9% and 74.2%, respectively, for INP104: IV DHE, and 445% and 308% for INP104: Migranal. Mean plasma concentration profiles for 8'-OH-DHE were proportionately lower and followed a similar profile to the parent compound, regardless of route of administration (IN vs IV) or delivery system (Migranal vs INP104). Treatment emergent AEs (TEAEs), of mostly mild intensity, were reported by 15/31 (48.4%), 21/32 (65.6%), and 14/34 (41.2%) subjects after INP104, IV DHE, and Migranal, respectively. Treatment-related TEAEs occurred in 6/31 (19.4%), 16/32 (50.0%), and 4/34 (11.8%) subjects after INP104, IV DHE, and Migranal, respectively. CONCLUSION INP104 met the predefined statistical criteria for comparative bioavailability with IV DHE and Migranal. The shorter time to reach Cmax and at 4 times the plasma concentration of DHE in comparison to Migranal combined with a favorable tolerability profile support further investigation of INP104 as an effective, well tolerated, and non-invasive treatment for acute episodic migraine.
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Silberstein SD, Lee L, Gandhi K, Fitzgerald T, Bell J, Cohen JM. Health care Resource Utilization and Migraine Disability Along the Migraine Continuum Among Patients Treated for Migraine. Headache 2018; 58:1579-1592. [DOI: 10.1111/head.13421] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2018] [Indexed: 01/03/2023]
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Burden of Migraine in Europe Using Self-Reported Digital Diary Data from the Migraine Buddy© Application. Neurol Ther 2018; 7:321-332. [PMID: 30293098 PMCID: PMC6283800 DOI: 10.1007/s40120-018-0113-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction Migraine is a neurological disease characterized by recurring attacks that can cause severe disabling pain. This study described the burden of migraine as reported by individuals with migraine in the real world using a mobile application. Methods A retrospective, cross-sectional analysis was conducted using data captured through the Migraine Buddy© smartphone application from adult, self-diagnosed individuals with migraine in 17 European countries. Data were analyzed descriptively for the most recent 28-day period reported by users (n = 3900) during the study period (June 2015–July 2016) who were randomly selected on the basis of data completeness (completion rates > 70%) and stratified by migraine headache days/month: 4–7 episodic migraine (EM; n = 1500), 8–14 EM (n = 1500), and chronic migraine (≥ 15; CM; n = 900). Results More than 95% of users reported that migraine negatively affected their daily activities during at least one migraine attack. Attacks affected 50.5% (184.4 days/year), 26.9% (98 days/year), and 14.5% (53 days/year) of the year among CM, 8–14 EM, and 4–7 EM groups, respectively. On average, 44.8% CM, 40.9% 8–14 EM, and 34.7% of 4–7 EM sufferers, respectively, reported anxiety and/or depression symptoms during migraine attacks. Social or home activities, productivity, and sleep were highly affected, regardless of migraine frequency. Employed respondents (n = 3106) reported an average of 2.3 workdays missed per month and that at least one in four migraines led to work absenteeism; these migraines were commonly reported to have at least moderate to severe levels of pain, corresponding to the inability of persons to perform some or even any activities. Triptans (68%), opioids (46%), and nonsteroidal anti-inflammatory drugs (45%) were self-reported as the most common medicines used. Conclusions This study, leveraging patient-reported data collected through a mobile application, demonstrates the high burden and impact of migraine on health-related quality of life, work productivity, and overall well-being of individuals suffering from migraines. Funding Novartis Pharma AG, Switzerland.
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Stauffer VL, Sides R, Lanteri-Minet M, Kielbasa W, Jin Y, Selzler KJ, Tepper SJ. Comparison between prefilled syringe and autoinjector devices on patient-reported experiences and pharmacokinetics in galcanezumab studies. Patient Prefer Adherence 2018; 12:1785-1795. [PMID: 30271122 PMCID: PMC6147689 DOI: 10.2147/ppa.s170636] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The aim of this study was to compare the usability and patient-rated experiences of an autoinjector with a prefilled syringe in patients with migraine, who self-administered galcanezumab, and to compare pharmacokinetic parameters between these devices. MATERIALS AND METHODS Patient-rated experiences with an investigational autoinjector and a prefilled syringe were compared in an open-label, 12-month study of once-monthly injections of galcanezumab 120 or 240 mg (NCT02614287). Patient-rated ease of usability was assessed with the Subcutaneous Administration Assessment Questionnaire (SQAAQ) and compared between devices. Positive responses on the SQAAQ were rated as "agree or strongly agree" to 12 statements. Tolerability was assessed by the frequency of injection-site-related adverse events (AEs) by device and injection location. In a separate study, galcanezumab pharmacokinetics in healthy subjects was compared between the devices (NCT02836613). RESULTS In the open-label clinical trial, 179 patients used both the prefilled syringe and autoinjector at least once. The majority of patients (91%-97%) had positive responses on the SQAAQ to the use of autoinjector across the items assessed. There were 23 injection-site-related AEs with the first self-administered injection with the prefilled syringe (N=7) or autoinjector (N=16; P=0.061), with the most common AE for either device being injection-site pain. There were no significant between-device differences in injection-site-related AEs. For pharmacokinetics, the 90% CI for the ratio (autoinjector/prefilled syringe) of geometric least-square means for the galcanezumab area under the curve (AUC) concentration and maximum concentration (Cmax) was between 0.8 and 1.25, indicating no statistically significant difference in the galcanezumab concentrations regardless of the device used. CONCLUSION The ease of usability with either device was comparable, and there were no significant differences in tolerability between the prefilled syringe and autoinjector with the first self-administration; however, the analysis was not powered to detect a clinically significant difference. Galcanezumab pharmacokinetics were comparable between devices.
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Affiliation(s)
| | - Ryan Sides
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA,
| | - Michel Lanteri-Minet
- Pain Department, CHU Nice, Nice, France
- Université Cote d'Azur, FHU InovPain, CHU de Nice, Nice, France
| | - William Kielbasa
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA,
| | - Yan Jin
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA,
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Davidson I, Crooks K, Newington L, Pilling M, Todd C. Assessing the feasibility of mobilisation of C0–C3 cervical segments to reduce headache in migraineurs. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.8.382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Ian Davidson
- Senior lecturer in physiotherapy, Manchester Metropolitan University
| | - Kathryn Crooks
- Research assistant, School of Nursing, Midwifery and Social Work, University of Manchester
| | - Lisa Newington
- Senior physiotherapist, Chelsea and Westminster Hospital NHS Foundation Trust, London
| | - Mark Pilling
- Senior research associate in statistics, Institute of Public Health, University of Cambridge
| | - Christopher Todd
- Professor of primary care and community health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre and Manchester University NHS Foundation Trust
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Abstract
PURPOSE OF REVIEW The migraine postdrome is the least studied and least understood phase of migraine. This article covers the salient features of the migraine postdrome and provides insight into the history, clinical symptoms, and future implications of this phase of migraine. RECENT FINDINGS Prospective electronic diary studies have shown that patients are left disabled with various nonheadache symptoms in the migraine postdrome, and 81% of patients report at least one nonheadache symptom in the postdrome. Hence, it is important to understand this phase better and ensure that more effective treatments become available in the future to lessen the morbidity associated with this phase. Functional imaging shows widespread reduction in brain-blood flow in the postdrome, which explains the multitudes of symptoms experienced by patients. SUMMARY The disability related to migraine is not exclusive to the headache phase but extends into the postdrome phase and is associated with several nonheadache symptoms that prolong the symptoms experienced by patients with migraine. Further research into the postdrome is crucial to improve our overall understanding of migraine mechanisms. This knowledge may also help to treat the concurrent nonheadache symptoms better in the future. Novel neuroimaging techniques provide a valuable noninvasive tool to push the frontiers in the understanding of migraine pathophysiology. These methods may help shed further light onto the possible links between key brain structures and networks that could be implicated in the pathophysiology of the various migraine phases.
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Lipton RB, Brennan A, Palmer S, Hatswell AJ, Porter JK, Sapra S, Villa G, Shah N, Tepper S, Dodick D. Estimating the clinical effectiveness and value-based price range of erenumab for the prevention of migraine in patients with prior treatment failures: a US societal perspective. J Med Econ 2018; 21:666-675. [PMID: 29571276 DOI: 10.1080/13696998.2018.1457533] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Frequent migraine with four or more headache days per month is a common, disabling neurovascular disease. From a US societal perspective, this analysis models the clinical efficacy and estimates the value-based price (VBP) for erenumab, a fully human monoclonal antibody that inhibits the calcitonin gene-related peptide receptor. METHODS A Markov health state transition model was developed to estimate the incremental costs, quality-adjusted life-years (QALYs), and value-based price range for erenumab in migraine prevention. The model comprises "on preventive treatment", "off preventive treatment", and "death" health states across a 10-year time horizon. The evaluation compared erenumab to no preventive treatment in episodic and chronic migraine patients that have failed at least one preventive therapy. Therapeutic benefits are based on estimated changes in monthly migraine days (MMD) from erenumab pivotal clinical trials and a network meta-analysis of migraine studies. Utilities were estimated using previously published mapping algorithms. A VBP analysis was performed to identify maximum erenumab annual prices at willingness-to-pay (WTP) thresholds of $100,000-$200,000 per QALY. Estimates of VBP under different scenarios such as choice of different comparators, assumptions around inclusion of placebo effect, and exclusion of work productivity losses were also generated. RESULTS Erenumab resulted in incremental QALYs of 0.185 vs supportive care (SC) and estimated cost offsets due to reduced MMD of $8,482 over 10 years, with an average duration of treatment of 2.01 years. The estimated VBP at WTP thresholds of $100,000-$200,000 for erenumab compared to SC ranged from $14,238-$23,998. VBP estimates including the placebo effect and excluding work productivity ranged from $7,445-$13,809; increasing to $12,151-$18,589 with onabotulinumtoxinA as a comparator in chronic migraine. CONCLUSION Erenumab is predicted to reduce migraine-related direct and indirect costs, and increase QALYs compared to SC.
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Affiliation(s)
| | - Alan Brennan
- b ScHARR, University of Sheffield , Sheffield , UK
| | - Stephen Palmer
- c Centre for Health Economics, University of York , York , UK
| | | | - Joshua K Porter
- e Economic Modeling Center of Excellence, Global Health Economics, Amgen (Europe) GmbH , Zug , Switzerland
| | - Sandhya Sapra
- f Global Health Economics, Amgen Inc. , Thousand Oaks , CA , USA
| | - Guillermo Villa
- e Economic Modeling Center of Excellence, Global Health Economics, Amgen (Europe) GmbH , Zug , Switzerland
| | - Neel Shah
- f Global Health Economics, Amgen Inc. , Thousand Oaks , CA , USA
| | - Stewart Tepper
- g Geisel School of Medicine at Dartmouth, Headache Center, Neurology Department , Dartmouth Hitchcock Medical Center, 1 Medical Center Drive , Lebanon , NH , United States
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Liu L, Zhao LP, Zhang CS, Zeng L, Wang K, Zhao J, Wang L, Jing X, Li B. Acupuncture as prophylaxis for chronic migraine: a protocol for a single-blinded, double-dummy randomised controlled trial. BMJ Open 2018; 8:e020653. [PMID: 29858418 PMCID: PMC5988062 DOI: 10.1136/bmjopen-2017-020653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Approximately 1.4%-2.2% of the global population suffers from chronic migraine. Acupuncture may serve as an alternative management for chronic migraine, where pharmacological prophylaxis is not suitable. However, the effects of acupuncture as migraine prophylaxis have not been confirmed. This study is designed as a single-blinded, double-dummy randomised controlled trial to evaluate the efficacy and safety of acupuncture compared with topiramate in patients with chronic migraine. METHODS AND ANALYSIS A total of 60 participants will be randomly assigned to two different groups. Participants will receive verum acupuncture and placebo medicine in the treatment group, while participants in the control group will be treated with sham acupuncture and real medicine (topiramate). All participants will receive a 12-week treatment and then be followed up for another 12 weeks. The primary outcome is the reduction of monthly headache days, and the secondary outcomes include the reduction of the number of days with acute headache medications, and changes of Migraine Disability Assessment, Migraine-Specific Quality of Life Questionnaire, Headache Impact Test, State-Trait Anxiety Inventory-trait, and Beck Depression Inventory-II scores from baseline to endpoints. ETHICS AND DISSEMINATION Ethical approval of this study was granted by the Research Ethical Committee of Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University (2017BL-045-01). Written informed consent will be obtained from all participants. Outcomes of the trial will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN13563102; Pre-results.
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Affiliation(s)
- Lu Liu
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Luo-Peng Zhao
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
- Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Beijing Institute of Traditional Chinese Medicine, Beijing, China
| | - Claire Shuiqing Zhang
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Lin Zeng
- Peking University Third Hospital, Research Centre of Clinical Epidemiology, Beijing, China
| | - Kelun Wang
- Department of Health Science and Technology, Centre for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg, Denmark
| | - Jingxia Zhao
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
- Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Beijing Institute of Traditional Chinese Medicine, Beijing, China
| | - Linpeng Wang
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Xianghong Jing
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bin Li
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
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Hurwitz EL, Vassilaki M, Li D, Schneider MJ, Stevans JM, Phillips RB, Phelan SP, Lewis EA, Armstrong RC. Variations in Patterns of Utilization and Charges for the Care of Headache in North Carolina, 2000-2009: A Statewide Claims' Data Analysis. J Manipulative Physiol Ther 2018; 39:229-39. [PMID: 27166404 DOI: 10.1016/j.jmpt.2016.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 11/01/2015] [Accepted: 01/01/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of the study was to compare patterns of utilization and charges generated by medical doctors (MDs), doctors of chiropractic (DCs), and physical therapists (PTs) for the treatment of headache in North Carolina. METHODS Retrospective analysis of claims data from the North Carolina State Health Plan for Teachers and State Employees from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the North Carolina State Health Plan using International Classification of Diseases, Ninth Revision, diagnostic codes for headache. The claims were separated by individual provider type, combination of provider types, and referral patterns. RESULTS The majority of patients and claims were in the MD-only or MD plus referral patterns. Chiropractic patterns represented less than 10% of patients. Care patterns with single-provider types and no referrals incurred the least charges on average for headache. When care did not include referral providers or services, MD with DC care was generally less expensive than MD care with PT. However, when combined with referral care, MD care with PT was generally less expensive. Compared with MD-only care, risk-adjusted charges (available 2006-2009) for patients in the middle risk quintile were significantly less for DC-only care. CONCLUSIONS Utilization and expenditures for headache treatment increased from 2000 to 2009 across all provider groups. MD care represented the majority of total allowed charges in this study. MD care and DC care, alone or in combination, were overall the least expensive patterns of headache care. Risk-adjusted charges were significantly less for DC-only care.
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Affiliation(s)
- Eric L Hurwitz
- Professor, Office of Public Health Studies, University of Hawaii at Mānoa, Honolulu, HI.
| | - Maria Vassilaki
- Research Associate, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Dongmei Li
- Associate Professor, Clinical and Translational Science Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Michael J Schneider
- Associate Professor, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Joel M Stevans
- Assistant Professor, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | | | - Shawn P Phelan
- Doctor of Chiropractic, Private Practice of Chiropractic, Wake Forest, NC
| | - Eugene A Lewis
- Doctor of Chiropractic, Private Practice of Chiropractic, Greensboro, NC
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Bonafede M, Sapra S, Shah N, Tepper S, Cappell K, Desai P. Direct and Indirect Healthcare Resource Utilization and Costs Among Migraine Patients in the United States. Headache 2018; 58:700-714. [DOI: 10.1111/head.13275] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Machaon Bonafede
- Truven Health Analytics, an IBM Company; Cambridge, MA, USA (M. Bonafede, K. Cappell)
| | - Sandhya Sapra
- Amgen, Inc., Thousand Oaks, CA, USA (S. Sapra, N. Shah, and P. Desai)
| | - Neel Shah
- Amgen, Inc., Thousand Oaks, CA, USA (S. Sapra, N. Shah, and P. Desai)
| | - Stewart Tepper
- Geisel School of Medicine at Dartmouth; Hanover, NH, USA (S. Tepper)
| | - Katherine Cappell
- Truven Health Analytics, an IBM Company; Cambridge, MA, USA (M. Bonafede, K. Cappell)
| | - Pooja Desai
- Amgen, Inc., Thousand Oaks, CA, USA (S. Sapra, N. Shah, and P. Desai)
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Takaki H, Onozuka D, Hagihara A. Migraine-preventive prescription patterns by physician specialty in ambulatory care settings in the United States. Prev Med Rep 2017; 9:62-67. [PMID: 29340272 PMCID: PMC5766757 DOI: 10.1016/j.pmedr.2017.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 12/23/2022] Open
Abstract
Many adults with migraine who require preventive therapy are often not prescribed the proper medications. The most likely reason is that primary care physicians are unacquainted with preventive medications for migraine. The present study assessed the migraine-preventive prescription patterns in office visits using data from the National Ambulatory Medical Care Survey from 2006 to 2009 in the United States. Patients who were 18 years or older and diagnosed with migraine were included in the analysis. In accordance with the recommendations of the headache guidelines, we included beta-blockers, antidepressants, triptans for short-term prevention of menstrual migraine, and other triptans for acute treatment. Weighted visits of adults with migraine prescribed with preventive medication ranged from 32.8% in 2006 to 38.6% in 2009. Visits to primary care physicians accounted for 72.6% of the analyzed adult migraine visits. Anticonvulsants (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.14–0.57, p < 0.001) and triptans for menstrual migraine (OR 0.50, 95% CI 0.28–0.91, p = 0.025) were less frequently prescribed by primary care physicians compared with specialty care physicians, such as neurologists and psychiatrists. There were no significant differences in the prescription patterns of antidepressants and beta-blockers between primary and specialty care physicians. Beta-blockers were prescribed to patients with comorbidity of hypertension, and antidepressants were used by patients with comorbidity of depression. There are differences in the prescription patterns of certain type of preventive medications between primary care physicians and specialty care physicians. Anticonvulsants were less used by primary care physicians than specialty care physicians. Triptans for prevention were also less used by primary care physicians. No differences were found in patterns of antidepressants and beta-blockers. Beta-blockers were used for patients with comorbidity of hypertension. Antidepressants were used for patients with comorbidity of depression.
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Affiliation(s)
- Hiroko Takaki
- Department of Clinical Pharmacy and Pharmaceutical care, Kyushu University Graduate School of Pharmaceutical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Daisuke Onozuka
- Department of Health Communication, Kyushu University Graduate School of Medicine, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Akihito Hagihara
- Department of Health Services Management and Policy, Kyushu University Graduate School of Medicine, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Yuan H, Silberstein SD. Histamine and Migraine. Headache 2017; 58:184-193. [PMID: 28862769 DOI: 10.1111/head.13164] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Histamine is an ancient "tissue amine" preceding multicellular organisms. In the central nervous system (CNS), its fibers originate solely from the tuberomammillary nucleus and travel throughout the brain. It is mainly responsible for wakefulness, energy homeostasis, and memory consolidation. Recently, several studies suggest a potential role of histamine in migraine pathogenesis and management. METHODS Narrative review of current literature regarding histamine and migraine. RESULTS Histamine plays a crucial role in migraine pathogenesis: sustaining the neurogenic inflammation pathway. Interaction between mast cells (MC) and calcitonin-gene related protein (CGRP) results in sensitization of trigeminal afferents and trigeminal ganglia (TG). Histamine binds with differing affinities to four different histaminergic G-protein coupled receptors, activating protein kinases, or triggering calcium release with subsequent mode of actions. Histamine 1 receptor (H1 R) and histamine 2 receptor (H2 R) antagonists are frequently used for the treatment of allergy and gastric acid secretion, respectively, but their antagonism is probably ineffective for migraine. Histamine 3 receptor (H3 R) and histamine 4 receptor (H4 R) have a threefold higher affinity than H1 R/H2 R for histamine and are found almost exclusively on neurons and immune tissues, respectively. H3 R acts as an autoreceptor or as a heteroreceptor, lowering the release of histamine and other neurotransmitters. This is a potential target for anti-nociception and anti-neurogenic inflammation. To date, several small clinical trials using low dose histamine or Nα -methylhistamine have demonstrated migraine prophylactic efficacy, probably via H3 R or other undetermined pathways. CONCLUSION The histamine system interacts with multiple regions in the CNS and may hypothetically modulate the migraine response. Low dose histamine may be a promising option for migraine prevention.
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Affiliation(s)
- Hsiangkuo Yuan
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
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Al-Quliti KW, Assaedi ES. New advances in prevention of migraine. Review of current practice and recent advances. ACTA ACUST UNITED AC 2017; 21:207-14. [PMID: 27356650 PMCID: PMC5107285 DOI: 10.17712/nsj.2016.3.20150506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite being one of the most common disabling primary headaches, migraine continues to be under-diagnosed and under-treated. A migraine challenges not only the patient suffering from the migraine, but also physicians; especially in recognizing candidates for prophylaxis and selecting the appropriate preventive medication. Recently, there have been major advances in the diagnosis and treatment of migraine, with different guidelines of migraine management across the world. Here, we review migraine’s abortive and prophylactic medications, based on their pharmacologic category, citing their recommended doses, efficacy, and side effects. Additionally, we highlight the prophylactic treatment of specific patient populations and present suggested treatment approaches in view of recent international treatment guidelines that consider factors other than drug efficacy when choosing the optimal preventive therapy. Finally, we introduce drugs in different stages of development, which have novel mechanisms of action or have new therapeutic targets.
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Affiliation(s)
- Khalid W Al-Quliti
- Section of Neurology, Department of Medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia. E-mail:
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Xu XM, Yang C, Liu Y, Dong MX, Zou DZ, Wei YD. Efficacy and feasibility of antidepressants for the prevention of migraine in adults: a meta-analysis. Eur J Neurol 2017; 24:1022-1031. [PMID: 28557171 DOI: 10.1111/ene.13320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 04/06/2017] [Indexed: 01/03/2023]
Affiliation(s)
- X.-M. Xu
- Department of Neurology; First Affiliated Hospital of Chongqing Medical University; Chongqing China
- Chongqing Key Laboratory of Neurobiology; Chongqing China
| | - C. Yang
- Department of Burn and Plastic Surgery; First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Y. Liu
- Department of Neurology; First Affiliated Hospital of Chongqing Medical University; Chongqing China
- Chongqing Key Laboratory of Neurobiology; Chongqing China
| | - M.-X. Dong
- Department of Neurology; First Affiliated Hospital of Chongqing Medical University; Chongqing China
- Chongqing Key Laboratory of Neurobiology; Chongqing China
| | - D.-Z. Zou
- Department of Neurology; First Affiliated Hospital of Chongqing Medical University; Chongqing China
- Chongqing Key Laboratory of Neurobiology; Chongqing China
| | - Y.-D. Wei
- Department of Neurology; First Affiliated Hospital of Chongqing Medical University; Chongqing China
- Chongqing Key Laboratory of Neurobiology; Chongqing China
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Thompson DF, Saluja HS. Prophylaxis of migraine headaches with riboflavin: A systematic review. J Clin Pharm Ther 2017; 42:394-403. [PMID: 28485121 DOI: 10.1111/jcpt.12548] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/05/2017] [Indexed: 12/21/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Migraine headache is a relatively common, debilitating condition that costs our healthcare system over 78 billion dollars per year. Riboflavin has been advocated as a safe, effective prophylactic therapy for the prevention of migraines. The purpose of this study was to provide a systematic review of the current role of riboflavin in the prophylaxis of migraine headache. METHODS A MEDLINE literature search inclusive of the dates 1966-2016 was performed using the search terms: riboflavin and migraine disorders. Excerpta Medica was searched from 1980 to 2016 using the search terms: riboflavin and migraine. Additionally, Web of Science was searched using the terms riboflavin and migraine inclusive of 1945-2016. Bibliographies of all relevant papers were reviewed for additional citations. We utilized the PRISMA guidelines to select English language, human, clinical trials of riboflavin as a single entity or in combination, review articles, and supporting pharmacokinetic and pharmacogenomic data assessing the efficacy and mechanism of riboflavin therapy in the prophylactic treatment of migraine headache. RESULTS AND DISCUSSION A total of 11 clinical trials reveal a mixed effect of riboflavin in the prophylaxis of migraine headache. Five clinical trials show a consistent positive therapeutic effect in adults; four clinical trials show a mixed effect in paediatric and adolescent patients, and two clinical trials of combination therapy have not shown benefit. Adverse reactions with riboflavin have generally been mild. WHAT IS NEW AND CONCLUSION Riboflavin is well tolerated, inexpensive and has demonstrated efficacy in the reduction of adult patient's migraine headache frequency. Additional data are needed, however, to resolve questions involving pharmacokinetic issues and pharmacogenomic implications of therapy.
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Affiliation(s)
- D F Thompson
- Pharmaceutical Sciences, College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK, USA
| | - H S Saluja
- Pharmaceutical Sciences, College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK, USA
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National Trends in Direct Health Care Expenditures Among US Adults With Migraine: 2004 to 2013. THE JOURNAL OF PAIN 2017; 18:96-107. [DOI: 10.1016/j.jpain.2016.10.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 11/18/2022]
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Woldeamanuel YW, Cowan RP. Migraine affects 1 in 10 people worldwide featuring recent rise: A systematic review and meta-analysis of community-based studies involving 6 million participants. J Neurol Sci 2017; 372:307-315. [PMID: 28017235 DOI: 10.1016/j.jns.2016.11.071] [Citation(s) in RCA: 234] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/19/2016] [Accepted: 11/29/2016] [Indexed: 12/30/2022]
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Hepp Z, Dodick DW, Varon SF, Chia J, Matthew N, Gillard P, Hansen RN, Devine EB. Persistence and switching patterns of oral migraine prophylactic medications among patients with chronic migraine: A retrospective claims analysis. Cephalalgia 2016; 37:470-485. [PMID: 27837173 PMCID: PMC5405847 DOI: 10.1177/0333102416678382] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Migraine prevention guidelines recommend oral prophylactic medications for patients with frequent headache. This study examined oral migraine preventive medication (OMPM) treatment patterns by evaluating medication persistence, switching, and re-initiation in patients with chronic migraine (CM). Methods A retrospective US claims analysis (Truven Health MarketScan® Databases) evaluated patients ≥18 years old diagnosed with CM who had initiated an OMPM between 1 January, 2008 and 30 September, 2012. Treatment persistence was measured at six and 12 months' follow-up. Time-to-discontinuation was assessed for each OMPM and compared using Cox regression models. Among those who discontinued, the proportion that switched OMPMs within 60 days or re-initiated treatment between 61 to 365 days, and their associated persistence rates, were also assessed. Results A total of 8707 patients met the inclusion/exclusion criteria. Persistence to the initial OMPM was 25% at six months and 14% at 12 months. Based on Kaplan-Meier curves, a sharp decline of patients discontinuing was observed by 30 days, and approximately half discontinued by 60 days. Similar trends in time-to-discontinuation were seen following the second or third OMPM. Amitriptyline, gabapentin, and nortriptyline had significantly higher likelihood of non-persistence compared with topiramate. Among patients who discontinued, 23% switched to another prophylactic and 41% re-initiated therapy within one year. Among patients who switched, persistence was between 10 to 13% and among re-initiated patients, persistence was between 4 to 8% at 12 months. Conclusions Persistence to OMPMs is poor at six months and declines further by 12 months. Switching between OMPMs is common, but results indicate that persistence worsens as patients cycle through various OMPMs.
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Allais G, Benedetto C. Spotlight on frovatriptan: a review of its efficacy in the treatment of migraine. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:3225-3236. [PMID: 27757013 PMCID: PMC5055118 DOI: 10.2147/dddt.s105932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Migraine is a common neurovascular disorder, affecting millions of people worldwide. Current guidelines recommend triptans as first-line treatment for moderate-to-severe migraine attacks. Frovatriptan is a second-generation triptan with a longer terminal elimination half-life in blood than other triptans (~26 hours). Three double-blind, randomized crossover preference studies have been recently conducted, assessing efficacy and safety of frovatriptan versus rizatriptan, zolmitriptan, and almotriptan, respectively. Frovatriptan showed favorable tolerability and sustained effect, with a significantly lower rate of relapse over 48 hours versus the other triptans. These findings were confirmed in a series of analyses of patient subsets from the three studies, including patients with menstrually related and oral contraceptive-induced migraine, hypertension, obesity, weekend migraine, as well as patients with migraine with aura. In all patient subsets analyzed, lower headache recurrence rates were observed versus the comparator triptans, indicating a more sustained pain-relieving effect on migraine symptoms. A further randomized, double-blind study demonstrated that frovatriptan given in combination with the fast-acting cyclooxygenase inhibitor dexketoprofen provided improved migraine pain-free activity at 2 hours, and gave more sustained pain-free activity at 24 hours, versus frovatriptan alone. These benefits were observed both when the combination was administered early (<1 hour after symptom onset) or late (>1 hour after onset). Different pharmacokinetic, but synergistic, properties between frovatriptan and dexketoprofen may make the combination of these agents particularly effective in migraine treatment, with rapid onset of action and sustained effect over 48 hours. These benefits, together with potential cost-effectiveness advantages versus other triptans could drive selection of the most appropriate treatment for acute migraine attacks.
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Affiliation(s)
- Gianni Allais
- Department of Surgical Sciences, Women's Headache Center, University of Turin, Turin, Italy
| | - Chiara Benedetto
- Department of Surgical Sciences, Women's Headache Center, University of Turin, Turin, Italy
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Omranifard M, Abdali H, Ardakani MR, Talebianfar M. A comparison of outcome of medical and surgical treatment of migraine headache: In 1 year follow-up. Adv Biomed Res 2016; 5:121. [PMID: 27563631 PMCID: PMC4976529 DOI: 10.4103/2277-9175.186994] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 10/26/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND This study was designed to compare the efficacy of the medical treatment versus the surgical treatment approach to decompression of trigger point nerves in patients with migraine headaches. MATERIALS AND METHODS Fifty volunteers were randomly assigned to the medical treatment group (n = 25) or the surgical treatment group (n = 25) after examination by the team neurologist to ensure a diagnosis of migraine headache. All patients received botulinum toxin type A to confirm the trigger sites. The surgical treatment group underwent surgical deactivation of the trigger site(s). The medical treatment group underwent prophylactic pharmacologic interventions by the neurologist. Pretreatment and 12-month posttreatment migraine headache frequency, duration, and intensity were analyzed and compared to determine the success of the treatments. RESULTS Nineteen of the 25 patients (76%) in the surgical treatment group and 10 of the 25 patients (40%) in the medical treatment group experienced a successful outcome (at least a 50% decrease in migraine frequency, duration, or intensity) after 1 year from surgery. Surgical treatment had a significantly higher success rate than medical treatment (P < 0.001). Nine patients (36%) in the surgical treatment group and one patient (4%) in the medical treatment group experienced cessation of migraine headaches. The elimination rate was significantly higher in the surgical treatment group than in the medical treatment group (P < 0.001). CONCLUSIONS Based on the 1-year follow-up data, there is strong evidence that surgical manipulation of one or more migraine trigger sites can successfully eliminate or reduce the frequency, duration, and intensity of migraine headaches in a lasting manner.
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Affiliation(s)
- Mahmood Omranifard
- Department of Aesthetic, Plastic and Reconstructive Surgery, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Hossein Abdali
- Department of Aesthetic, Plastic and Reconstructive Surgery, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Mehdi Rasti Ardakani
- Department of Aesthetic, Plastic and Reconstructive Surgery, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Mohsen Talebianfar
- Department of Aesthetic, Plastic and Reconstructive Surgery, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
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Law S, Derry S, Moore RA. Sumatriptan plus naproxen for the treatment of acute migraine attacks in adults. Cochrane Database Syst Rev 2016; 4:CD008541. [PMID: 27096438 PMCID: PMC6485397 DOI: 10.1002/14651858.cd008541.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND This is an updated version of the original Cochrane review published in October 2013 on 'Sumatriptan plus naproxen for acute migraine attacks in adults'.Migraine is a common disabling condition and a burden for the individual, health services, and society. It affects two to three times more women than men, and is most common in the age range 30 to 50 years. Effective abortive treatments include the triptan and non-steroidal anti-inflammatory classes of drugs. These drugs have different mechanisms of action and combining them may provide better relief. Sumatriptan plus naproxen is now available in combination form for the acute treatment of migraine. OBJECTIVES To determine the efficacy and tolerability of sumatriptan plus naproxen, administered together as separate tablets or taken as a fixed-dose combination tablet, compared with placebo and other active interventions in the treatment of acute migraine attacks in adults. SEARCH METHODS For this update we searched the Cochrane Central Register of Controlled Trials (CENTRAL) via The Cochrane Register of Studies Online (CRSO) to 28 October 2015, MEDLINE (via Ovid) from 1946 to 28 October 2015, and EMBASE (via Ovid) from 1974 to 28 October 2015, and two online databases (www.gsk-clinicalstudyregister.com and www.clinicaltrials.gov). We also searched the reference lists of included studies and relevant reviews. SELECTION CRITERIA We included randomised, double-blind, placebo- or active-controlled studies, with at least 10 participants per treatment arm, using sumatriptan plus naproxen to treat a migraine headache episode. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We used numbers of participants achieving each outcome to calculate risk ratio and numbers needed to treat for an additional beneficial outcome (NNT) or for an additional harmful outcome (NNH) compared with placebo or a different active treatment. MAIN RESULTS For this update we identified one new study (43 participants), but it did not contribute any data for analysis. The review included 13 studies using sumatriptan 85 mg or 50 mg plus naproxen 500 mg to treat attacks of mild, moderate, or severe pain intensity. Twelve studies contributed data for analyses: 3663 participants received combination treatment, 3682 placebo, 964 sumatriptan, and 982 naproxen. We judged only one small study to be at high risk of bias for any of the criteria evaluated; it did not contribute to any analyses.Overall, the combination was better than placebo for the primary outcomes of pain-free and headache relief at two hours. The NNT for pain-free at two hours was 3.1 (95% confidence interval 2.9 to 3.5) when the baseline pain was mild (50% response with sumatriptan plus naproxen compared with 18% with placebo), and 4.9 (4.3 to 5.7) when baseline pain was moderate or severe (28% with sumatriptan plus naproxen compared with 8% with placebo) (high quality evidence). Using 50 mg of sumatriptan, rather than 85 mg, in the combination did not significantly change the result. Treating early, when pain was still mild, was significantly better than treating once pain was moderate or severe for pain-free responses at two hours and during the 24 hours post dose. Adverse events were mostly mild or moderate in severity and rarely led to withdrawal; they were more common with the combination than with placebo (moderate quality evidence).Where the data allowed direct comparison, combination treatment was superior to either monotherapy, but adverse events were less frequent with naproxen than with sumatriptan (moderate quality evidence). AUTHORS' CONCLUSIONS The conclusions of this review were not changed. Combination treatment was effective in the acute treatment of migraine headaches. The effect was greater than for the same dose of either sumatriptan or naproxen alone, but additional benefits over sumatriptan alone were not large. More participants achieved good relief when medication was taken early in the attack, when pain was still mild. Adverse events were more common with the combination and sumatriptan alone than with placebo or naproxen alone.
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Affiliation(s)
- Simon Law
- Pain Relief Unit, The Churchill Hospital, Oxford, UK, OX3 7LE
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Anatomic and Compression Topography of the Lesser Occipital Nerve. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e639. [PMID: 27257569 PMCID: PMC4874283 DOI: 10.1097/gox.0000000000000654] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 02/02/2016] [Indexed: 01/03/2023]
Abstract
Background: The surgical treatment of occipital headaches focuses on the greater, lesser, and third occipital nerves. The lesser occipital nerve (LON) is usually transected with relatively limited available information regarding the compression topography thereof and how such knowledge may impact surgical treatment. Methods: Eight fresh frozen cadavers were dissected focusing on the LON in relation to 3 clinically relevant compression zones. The x axis was a line drawn through the occipital protuberance (OP) and the y axis, the posterior midline (PM). In addition, a prospectively collected cohort of 36 patients who underwent decompression of the LON is presented with their clinical results, including migraine headache index scores. Results: The LON was found in compression zone 1, with a mean of 7.8 cm caudal to the OP and 6.3 cm lateral to the PM. The LON was found at the midpoint of compression zone 2, with an average of 5.5 cm caudal to the OP and 6.2 cm lateral to the PM. At compression zone 3, the medial-most LON branch was located approximately 1 cm caudal to the OP and 5.35 cm lateral to the PM, whereas the lateral-most branch was identified 1 cm caudal to the OP and 6.5 cm lateral to the PM. Of the 36 decompression patients analyzed, only 5 (14%) required neurectomy as the remainder achieved statistically significant improvements in migraine headache index scores postoperatively. Conclusion: The knowledge of LON anatomy can aid in nerve dissection and preservation, thereby leading to successful outcomes without requiring neurectomy.
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