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Peres MFP, Serafim A, Oliveira ABD, Mercante JPP. Migraine cure: a patients' perspective. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2021.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective
To conduct a web-based survey concerning patient’s perspective in the migraine cure.
Material and Methods
A total of 1,102 patients fitting the International Classification of Headache Disorders (ICHD-3) migraine criteria, seeking medical care at the Brain Research Institute at Albert Einstein Hospital in Sao Paulo, Brazil, from January to December 2015, participated in the survey. The online-based survey was accessed via the institute’s website and consisted of demographic data, a description of migraine symptoms, diagnosis and treatment, and the patient’s opinion of migraine cure and which treatment they would consider taking.
Results
Migraine intensity was significantly higher in female participants than male participants. Chronic migraine tended to affect female participants more than male participants. There was a significant difference in the rate of migraine cure belief between patients with episodic and chronic migraine.
Conclusion
Some points that were important to migraineurs have been identified in this study. Ultimately, the findings of this study may facilitate the migraine treatment decision process, by providing a better understanding of patients’ perspectives and beliefs, thus creating a more friendly communication between migraineurs and care providers and hopefully, improving the quality of life of patients.
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Silvestro M, Orologio I, Bonavita S, Scotto di Clemente F, Fasano C, Tessitore A, Tedeschi G, Russo A. Effectiveness and Safety of CGRP-mAbs in Menstrual-Related Migraine: A Real-World Experience. Pain Ther 2021; 10:1203-1214. [PMID: 34106431 PMCID: PMC8586402 DOI: 10.1007/s40122-021-00273-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/13/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Migraine shows a significantly higher prevalence in women, especially during reproductive age when menstrual-related hormonal fluctuations represent the most common migraine trigger. Indeed, over 50% of patients report a higher occurrence of migraine attacks during the perimenstrual window. Menstrual migraine attacks are consistently referred to as more disabling, less responsive to symptomatic treatments, longer in duration, and more prone to relapse than non-menstrual migraine attacks. Evidence strongly suggests that estrogen fluctuations are involved in migraine attacks worsening during the perimenstrual window through several mechanisms directly or indirectly involving the CGRP pathway. We aimed to evaluate whether mAbs blocking CGRP-ligand or receptor (CGRP-mAbs) could represent an effective and safe preventive treatment for menstrual migraine attacks in patients with menstrual-related migraine (MRM) with previous treatment failures. METHODS Forty patients with MRM with at least three previous treatment failures received monthly CGRP-mAbs. At the baseline and after six CGRP-mAbs administrations, patients underwent to extensive interviews to assess frequency, duration, intensity, and responsiveness to painkiller intake of migraine attacks occurring during the perimenstrual window. RESULTS After six administrations of CGRP-mAbs we observed a reduction of median menstrual migraine frequency (from 5 to 2 days per month), pain intensity (from 8/10 to 6/10), and attacks duration (from 24 to 8 h) (p < 0.001). Nevertheless, a significant increase in the percentage of responding to migraine painkillers was observed from 42.5% at baseline to 95% at T1 (p < 0.001). CONCLUSIONS CGRP-mAbs could represent a safe and effective preventive therapeutic strategy able to reduce the disabling burden of menstrual migraine attack frequency, duration, intensity, and significantly improve the response to painkillers. These findings could be related to and further indirectly prove the greater influence of CGRP-mediated mechanisms in the pathophysiology of menstrual migraine attacks.
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Affiliation(s)
- Marcello Silvestro
- Department of Advanced Medical and Surgical Sciences (DAMS), Headache Center, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Ilaria Orologio
- Department of Advanced Medical and Surgical Sciences (DAMS), Headache Center, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences (DAMS), Headache Center, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Fabrizio Scotto di Clemente
- Department of Advanced Medical and Surgical Sciences (DAMS), Headache Center, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Carla Fasano
- Department of Advanced Medical and Surgical Sciences (DAMS), Headache Center, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences (DAMS), Headache Center, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences (DAMS), Headache Center, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Antonio Russo
- Department of Advanced Medical and Surgical Sciences (DAMS), Headache Center, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy.
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Warnock JK, Cohen LJ, Blumenthal H, Hammond JE. Hormone-Related Migraine Headaches and Mood Disorders: Treatment with Estrogen Stabilization. Pharmacotherapy 2017; 37:120-128. [PMID: 27888528 DOI: 10.1002/phar.1876] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Because estrogens and the trigeminal system are inherently linked, prescribers who are treating a woman with a hormonally related mood disorder and migraine headaches should consider hormonal options to optimize the patient's treatment. This article discusses the interrelationships of estrogen, serotonin, and the trigeminal system as they relate to menstrual migraine occurrence and hormone-related mood symptoms. In addition, clinical examples are provided to facilitate the prescribers treating women during reproductive transitions in which declining estrogens are related to their suffering.
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Affiliation(s)
- Julia K Warnock
- Department of Psychiatry, School of Community Medicine, University of Oklahoma, Tulsa, OK
| | - Lawrence J Cohen
- Department of Pharmacotherapy, UNT System College of Pharmacy, University of North Texas Health Sciences Center, Fort Worth, Texas
| | - Harvey Blumenthal
- Department of Psychiatry, School of Community Medicine, University of Oklahoma, Tulsa, OK
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Bordini CA, Roesler C, Carvalho DDS, Macedo DDP, Piovesan É, Melhado EM, Dach F, Kowacs F, Silva Júnior HMD, Souza JAD, Maciel Jr JA, Carvalho JJDFD, Speciali JG, Barea LM, Queiroz LP, Ciciarelli MC, Valença MM, Lima MMF, Vincent MB, Jurno ME, Monzillo PH, Moreira Filho PF, Domingues R. Recommendations for the treatment of migraine attacks - a Brazilian consensus. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:262-71. [DOI: 10.1590/0004-282x2015021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/27/2015] [Indexed: 11/22/2022]
Abstract
ABSTRACT In this article, a group of experts in headache management of the Brazilian Headache Society developed through a consensus strategic measurements to treat a migraine attack in both the child and the adult. Particular emphasis was laid on the treatment of migraine in women, including at pregnancy, lactation and perimenstrual period.
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Abstract
This article discusses the role that hormones play in adolescent girls and young women with headaches, which are very common in adolescent girls, in particular, migraine. In many cases, migraine onset may occur shortly around the time of menarche, prevalence of recurrent migraine in this population approaches 15%, and typically the symptoms continue through adulthood. Hormonal changes associated with puberty and the menstrual cycle may significantly influence migraine in young women. This article reviews the following topics: management of menstrually related headaches, changes in ovarian hormones and their relationship to migraine, and oral contraceptives and pregnancy effects on migraine.
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Affiliation(s)
- Ann Pakalnis
- Departments of Pediatrics and Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
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Prophylactic treatment in menstrual migraine: A proof-of-concept study. J Neurol Sci 2015; 354:103-9. [DOI: 10.1016/j.jns.2015.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 05/04/2015] [Accepted: 05/06/2015] [Indexed: 11/20/2022]
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Negro A, Napoletano F, Lionetto L, Marsibilio F, Sani G, Girardi P, Martelletti P. Treatment of menstrual migraine: utility of control of related mood disturbances. Expert Rev Neurother 2014; 14:493-502. [DOI: 10.1586/14737175.2014.906304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Acupuncture as prophylaxis for menstrual-related migraine: study protocol for a multicenter randomized controlled trial. Trials 2013; 14:374. [PMID: 24195839 PMCID: PMC3830503 DOI: 10.1186/1745-6215-14-374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 10/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Menstrual-related migraine is a common form of migraine affecting >50% of female migraineurs. Acupuncture may be a choice for menstrual-related migraine, when pharmacological prophylaxis is not suitable. However, the efficacy of acupuncture has not been confirmed. We design and perform a randomized controlled clinical trial to evaluate the efficacy of acupuncture compared with naproxen in menstrual-related migraine patients. METHODS/DESIGN This is a multicenter, single blind, randomized controlled clinical trial. A total of 184 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 medicine (Naproxen Sustained Release Tablets). All treatments will be given for 3 months (menstrual cycles).The primary outcome measures are the change of migraine days inside the menstrual cycle and the proportion of responders (defined as the proportion of patients with at least a 50% reduction in the number of menstrual migraine days). The secondary outcome measures are the change of migraine days outside the menstrual cycle, duration of migraine attack, the Visual Analogue Scale (VAS), and intake of acute medication. The assessment will be made at baseline (before treatment), 3 months (menstrual cycles), and 4 months (menstrual cycles) after the first acupuncture session. DISCUSSION The results of this trial will be helpful to supply the efficacy of acupuncture for menstrual-related migraine prophylaxis. TRIAL REGISTRATION ISRCTN ISRCTN57133712.
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Brain imaging reveals that engagement of descending inhibitory pain pathways in healthy women in a low endogenous estradiol state varies with testosterone. Pain 2013; 154:515-524. [DOI: 10.1016/j.pain.2012.11.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 09/12/2012] [Accepted: 11/30/2012] [Indexed: 11/23/2022]
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Abstract
Hormonal contraceptives are not only effective methods of birth control but also are effective at treating and/or preventing a variety of gynecologic and general disorders. Hormonal contraceptives can decrease the severity of acne, correct menstrual irregularities, treat endometriosis-associated pain, decrease bleeding associated with uterine myomas, decrease pain associated with menstrual periods, moderate symptoms associated with premenstrual syndrome, reduce menstrual migraine frequency, and increase bone mineral density as well as decrease the risk of specific cancers such as endometrial and ovarian cancer. Women need to receive this information to guide them in their decisions regarding choice of contraception as well as treatment options for gynecologic disorders.
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Affiliation(s)
- Joyce King
- Emory University, Atlanta, GA 30322, USA.
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Dixon PC, Bergstrom L. Menstrual Migraine: Current Strategies for Diagnosis and Management. J Nurse Pract 2011. [DOI: 10.1016/j.nurpra.2010.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Margaret F Moloney
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA 30302-4019, USA.
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Prophylaxis and Treatment of Menstrual Migraine. Pain Manag Nurs 2011. [DOI: 10.1016/j.pmn.2010.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Allais G, Bussone G, D'Andrea G, Moschiano F, d'Onofrio F, Valguarnera F, Manzoni GC, Grazzi L, Allais R, Benedetto C, Acuto G. Almotriptan 12.5 mg in menstrually related migraine: a randomized, double-blind, placebo-controlled study. Cephalalgia 2010; 31:144-51. [PMID: 20660540 PMCID: PMC3057443 DOI: 10.1177/0333102410378048] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Menstrually related migraine (MRM) affects more than half of female migraineurs. Because such migraines are often predictable, they provide a suitable target for treatment in the mild pain phase. The present study was designed to provide prospective data on the efficacy of almotriptan for treatment of MRM. METHODS Premenopausal women with MRM were randomized to almotriptan (N = 74) or placebo (N = 73), taken at onset of the first perimenstrual migraine. Patients crossed over to the other treatment for the first perimenstrual migraine of their second cycle, followed by a two-month open-label almotriptan treatment period. RESULTS Significantly more patients were pain-free at two hours (risk ratio [RR] = 1.81; p = .0008), pain-free from 2-24 hours with no rescue medication (RR = 1.99; p = .0022), and pain-free from 2-24 hours with no rescue medication or adverse events (RR = 1.94; p = .0061) with almotriptan versus placebo. Nausea (p = .0007) and photophobia (p = .0083) at two hours were significantly less frequent with almotriptan. Almotriptan efficacy was consistent between three attacks, with 56.2% of patients pain-free at two hours at least twice. Adverse events were similar with almotriptan and placebo. CONCLUSION Almotriptan was significantly more effective than placebo in women with MRM attacks, with consistent efficacy in longer-term follow-up.
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Affiliation(s)
- Gianni Allais
- Women's Headache Center, Department of Gynecology and Obstetrics, University of Turin, Italy.
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Abstract
Migraine is a complex neurological disorder that in recent years has received more and more attention. Knowledge regarding this primary headache has increased substantially, both with respect to its pathogenesis and how to effectively treat its symptoms. Over the years, the proposed location of the onset of migraine has moved from the periphery of the nervous system toward deeper parts of the brain. Migraine can be viewed as an inherited failure of trigeminal sensory processing with abnormal neuronal excitability in the trigeminal nucleus caudalis, which, in turn, causes central sensitization and amplification of the pain. Increased activation of the trigeminal nerve during a migraine attack causes release of the calcitonin gene-related peptide (CGRP) inside and outside the BBB. Within the CNS, CGRP promotes trigeminal sensory input and facilitates central sensitization. The future introduction of CGRP antagonists in clinical practice could represent significant progress for acute migraine therapy.
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Affiliation(s)
- Carl Dahlöf
- Professor of Neurology, Institute of Neuroscience & Physiology, Sahlgrenska University Hospital, Medical Director & Founder of Gothenburg Migraine Clinic, Gothenburg Migraine Clinic, c/o Läkarhuset, Södra vägen 27, S-411 35 Gothenburg, Sweden
| | - Hans-Christoph Diener
- Professor of Neurology, Department of Neurology, University Duisburg-Essen, Essen, Germany
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