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Conti M, Bovenzi R, Palmieri MG, Placidi F, Stefani A, Mercuri NB, Albanese M. Early effect of onabotulinumtoxinA on EEG-based functional connectivity in patients with chronic migraine: A pilot study. Headache 2024; 64:825-837. [PMID: 38837259 DOI: 10.1111/head.14750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE In this pilot prospective cohort study, we aimed to evaluate, using high-density electroencephalography (HD-EEG), the longitudinal changes in functional connectivity (FC) in patients with chronic migraine (CM) treated with onabotulinumtoxinA (OBTA). BACKGROUND OBTA is a treatment for CM. Several studies have shown the modulatory action of OBTA on the central nervous system; however, research on migraine is limited. METHODS This study was conducted at the Neurology Unit of "Policlinico Tor Vergata," Rome, Italy, and included 12 adult patients with CM treated with OBTA and 15 healthy controls (HC). Patients underwent clinical scales at enrollment (T0) and 3 months (T1) from the start of treatment. HD-EEG was recorded using a 64-channel system in patients with CM at T0 and T1. A source reconstruction method was used to identify brain activity. FC in δ-θ-α-β-low-γ bands was analyzed using the weighted phase-lag index. FC changes between HCs and CM at T0 and T1 were assessed using cross-validation methods to estimate the results' reliability. RESULTS Compared to HCs at T0, patients with CM showed hyperconnected networks in δ (p = 0.046, area under the receiver operating characteristic curve [AUC: 0.76-0.98], Cohen's κ [0.65-0.93]) and β (p = 0.031, AUC [0.68-0.95], Cohen's κ [0.51-0.84]), mainly involving orbitofrontal, occipital, temporal pole and orbitofrontal, superior temporal, occipital, cingulate areas, and hypoconnected networks in α band (p = 0.029, AUC [0.80-0.99], Cohen's κ [0.42-0.77]), predominantly involving cingulate, temporal pole, and precuneus. Patients with CM at T1, compared to T0, showed hypoconnected networks in δ band (p = 0.032, AUC [0.73-0.99], Cohen's κ [0.53-0.90]) and hyperconnected networks in α band (p = 0.048, AUC [0.58-0.93], Cohen's κ [0.37-0.78]), involving the sensorimotor, orbitofrontal, cingulate, and temporal cortex. CONCLUSION These preliminary results showed that patients with CM presented disrupted EEG-FC compared to controls restored by a single session of OBTA treatment, suggesting a primary central modulatory action of OBTA.
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Affiliation(s)
- Matteo Conti
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Roberta Bovenzi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Fabio Placidi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Alessandro Stefani
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Maria Albanese
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Neurology Unit, Regional Referral Headache Center, University of Rome "Tor Vergata", Rome, Italy
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Ilgaz Aydinlar E, Erdogan Soyukibar T, Yalinay Dikmen P. The effectiveness and predictors influencing the outcome of onabotulinumtoxinA treatment in chronic migraine: understanding from diverse patient profiles in a single session. Front Neurol 2024; 15:1417303. [PMID: 38962481 PMCID: PMC11219632 DOI: 10.3389/fneur.2024.1417303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/31/2024] [Indexed: 07/05/2024] Open
Abstract
Objective This real-world study aimed to investigate how onabotulinumtoxinA affects the outcome of migraine, along with accompanying anxiety, depression, and bruxism among a group of patients with chronic migraine (CM) and define predictors of good response. Methods Patients diagnosed with CM who received onabotulinumtoxinA were included in this single-center, real-world retrospective cohort study. Monthly headache days (MHDs), monthly migraine days (MMDs), headache intensity (numeric rating scale-NRS) and headache characteristics were evaluated at baseline and 12 weeks post-treatment. Patient-reported outcome measures (PROMs) included Migraine Disability Assessment Scale (MIDAS), Headache Impact Test-6 (HIT-6) scores, 12-item Allodynia Symptom Checklist (ASC-12), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). Response to onabotulinumtoxinA (% reduction in MHDs) and treatment-related adverse events (TRAEs) were also evaluated. OnabotulinumA was applied to the masseter muscles in patients complaining of bruxism. Results A total of 72 patients (mean ± SD age: 36.3 ± 8.5 years; 91.7% were female) diagnosed with CM were included. OnabotulinumtoxinA revealed significant decrease in median (IQR) MHDs [from 20(15-25) at baseline to 6(4-10), p < 0.001], MMDs [from 9(6-12) to 3(1-6), p < 0.001] and NRS [from 9(8-10) to 7(6-8), p < 0.001], and the MIDAS [from 54(30-81) to 16(7-24), p < 0.001], HIT-6 [from 67(65-69) to 58(54-64), p < 0.001], ASC-12 [from 6(1.5-9) to 2(0-9), p = 0.002], BAI [from 12(6.5-19) to 9(3-17), p < 0.001] and BDI [from 11(6.5-17) to 3(2-7) p < 0.001] scores at 12 weeks post-treatment. Patients complaining of bruxism received onabotulinumtoxinA injections in the first n = 27 (37.5%) and 12. week post-treatment n = 19 (70.4%) periods. Overall, 70.8% of patients responded (≥50% reduction in MHDs), while 29.2% did not (<50% reduction). Both groups showed similar characteristics in demographics, migraine history, baseline PROMs scores, comorbidities, and prior treatments. Conclusion OnabotulinumtoxinA is an effective treatment option that rapidly improves migraine outcomes, disability, and impact while also alleviating comorbid depression and/or anxiety. This study's noteworthy finding is that onabotulinumtoxinA is effective in a majority of CM patients, irrespective of their prior treatment history, migraine characteristics, or concurrent comorbidities. Furthermore, we identified no specific predictors for a favorable response to onabotulinumtoxinA. Applying onabotulinumtoxinA to the masseter muscles can relieve discomfort associated with concurrent bruxism; however, it does not impact migraine outcomes.
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Affiliation(s)
- Elif Ilgaz Aydinlar
- Department of Neurology, Acıbadem University School of Medicine, Istanbul, Türkiye
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Alonge P, Brighina F, Maccora S, Pilati L, Di Marco S, Ventimiglia D, Maggio B, Cutrò I, Camarda C, Torrente A. Beyond Pain: The Effects of OnabotulinumtoxinA Therapy on Sensitization and Interictal Symptoms in Chronic Migraine. Toxins (Basel) 2024; 16:203. [PMID: 38787055 PMCID: PMC11125997 DOI: 10.3390/toxins16050203] [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: 03/13/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Chronic migraine is a disease with a high burden on patients from both a working and quality of life point of view. The pathophysiology of this subtype of migraine is due to several factors, such as medication overuse. Nevertheless, the detrimental recurring of headache attacks with central and peripheral sensitization plays a central role and explains some additional symptoms complained about by these patients even in the interictal phase. OnabotulinumtoxinA is a therapy indicated for chronic migraine since it has proven to reduce peripheral sensitization, showing even efficacy on central symptoms. The aim of this narrative review is to present the current evidence regarding the effect of OnabotulinumtoxinA on sensitization and interictal symptoms.
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Affiliation(s)
- Paolo Alonge
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)
| | - Simona Maccora
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)
- Neurology Unit, ARNAS Civico di Cristina and Benfratelli Hospitals, 90127 Palermo, Italy
| | - Laura Pilati
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)
- Neurology and Stroke Unit, P.O. “S. Antonio Abate”, 91016 Erice, Italy
| | - Salvatore Di Marco
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)
- Neurology and Stroke Unit, P.O. “S. Antonio Abate”, 91016 Erice, Italy
| | - Davide Ventimiglia
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)
| | - Bruna Maggio
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)
| | - Ivana Cutrò
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)
| | - Cecilia Camarda
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)
| | - Angelo Torrente
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)
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De la Torre Canales G, Poluha RL, Bonjardim LR, Ernberg M, Conti PCR. Botulinum toxin-A effects on pain, somatosensory and psychosocial features of patients with refractory masticatory myofascial pain: a randomized double-blind clinical trial. Sci Rep 2024; 14:4201. [PMID: 38378855 PMCID: PMC10879180 DOI: 10.1038/s41598-024-54906-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/18/2024] [Indexed: 02/22/2024] Open
Abstract
The antinociceptive effect of BoNT-A have been well documented in animal studies; however, results of few but well-designed randomized placebo-controlled clinical trials about BoNT-A efficacy in masticatory myofascial pain (MFP) are inconsistent. Therefore, the present randomized, double-blind, placebo-controlled clinical trial evaluated the efficacy of BoNT-A in patients with refractory MFP. Twenty-eight patients with pain reduction of less than 30% despite conservative treatment and with an average pain intensity of > 50 mm on the visual analogue scale (VAS) participated. Patients were randomly assigned to receive a total of 80 U of BoNT-A or saline solution (SS) injected into the masseter and anterior temporalis muscles. Pain intensity (VAS), quantitative sensory testing (QST), conditioned pain modulation (CPM), and psychosocial status were examined. Follow-up was performed at 1 and 6 months. For repeated-measure comparisons between evaluation times, Friedman test with Bonferroni correction was used for pain and somatosensory variables and the Wilcoxon test for the psychosocial variables. The Mann-Whitney test was used for all comparisons between groups. The BoNT-A group had a significant decrease in pain intensity at follow-ups compared with the SS group (p < 0.001). QST assessment revealed higher pressure pain threshold values in the masseter muscle for BoNT-A group compared to SS (p < 0.03) at all follow-ups. No differences were found for mechanical pain threshold and wind-up ratio values (p > 0.05) in the entire study. The BoNT-A group presented the most efficient CPM effect (p < 0.03) only at the 1 month follow-up in the masseter muscle. There was a significant time effect for BoNT-A in all psychosocial variables (p < 0.05) and a drug effect in the Central Sensitization Inventory (p < 0.01), Pittsburgh Sleep Quality Index (p < 0.004), and Healthy Survey 36 (p < 0.05) at 6 months follow-up. The study demonstrates that a single injection-session of BoNT-A has positive effects on the hall pain spectrum of patients with refractory masticatory myofascial pain.
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Affiliation(s)
- Giancarlo De la Torre Canales
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and The Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden.
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, Almada, Portugal.
- Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil.
| | - Rodrigo Lorenzi Poluha
- Department of Dentistry, State University of Maringá, Paraná, Brazil
- Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Leonardo Rigoldi Bonjardim
- Bauru Orofacial Pain Group, Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
- Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Malin Ernberg
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and The Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden
| | - Paulo César Rodrigues Conti
- Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
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Torrente A, Alonge P, Pilati L, Gagliardo A, Vassallo L, Di Stefano V, Lupica A, Quartana I, Viticchi G, Silvestrini M, Bartolini M, Camarda C, Brighina F. Effects of a Single Session of OnabotulinumtoxinA Therapy on Sleep Quality and Psychological Measures: Preliminary Findings in a Population of Chronic Migraineurs. Toxins (Basel) 2023; 15:527. [PMID: 37755953 PMCID: PMC10537449 DOI: 10.3390/toxins15090527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/09/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
Chronic migraine is a burdensome condition, and onabotulinumtoxinA is revealed to be an effective therapy. Migraine shows a bidirectional relationship with sleep, but the effects of preventive therapies on sleep quality are poorly studied. This study aims to evaluate the effects of a single session of onabotulinumtoxinA on patients' sleep quality and correlates the results with measures of comorbid anxiety/depression. Patients completed self-administrable questionnaires about sleep quality (Pittsburgh Sleep Quality Index-PSQI) and psychological symptoms (Beck Depression Inventory, 2nd edition-BDI-II-and Hospital Anxiety and Depression Scale-HADS-subscales "a" and "d" for anxiety and depression, respectively), and reported migraine frequency at baseline and after 12 weeks. The 42 included patients showed a significant reduction in migraine days (from 20.6 ± 6.0 to 13.6 ± 6.2, p < 0.001), while no changes were observed in sleep quality (PSQI score from 11.0 ± 5.0 to 9.8 ± 4.6, p = 0.277) or psychological measures (BDI-II from 16.7 ± 10.2 to 15.7 ± 10.3, p = 0.678; HADS-a from 10.3 ± 4.8 to 9.3 ± 5.5, p = 0.492; and HADS-d from 7.2 ± 3.9 to 7.1 ± 5.0, p = 0.901). On the other hand, a strong correlation among PSQI, BDI-II, HADS-a, and HADS-d scores (p < 0.001, rho > 0.7) was found. Despite its efficacy in migraine prevention, a single session of onabotulinumtoxinA was not able to affect patients' sleep quality or their psychological symptoms.
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Affiliation(s)
- Angelo Torrente
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (A.T.); (P.A.); (L.P.); (A.G.); (L.V.); (V.D.S.); (A.L.); (I.Q.); (C.C.)
| | - Paolo Alonge
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (A.T.); (P.A.); (L.P.); (A.G.); (L.V.); (V.D.S.); (A.L.); (I.Q.); (C.C.)
| | - Laura Pilati
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (A.T.); (P.A.); (L.P.); (A.G.); (L.V.); (V.D.S.); (A.L.); (I.Q.); (C.C.)
| | - Andrea Gagliardo
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (A.T.); (P.A.); (L.P.); (A.G.); (L.V.); (V.D.S.); (A.L.); (I.Q.); (C.C.)
- Clinical Neurophysiology Unit, Sleep Lab, “Clinical Course”, 90143 Palermo, Italy
| | - Lavinia Vassallo
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (A.T.); (P.A.); (L.P.); (A.G.); (L.V.); (V.D.S.); (A.L.); (I.Q.); (C.C.)
| | - Vincenzo Di Stefano
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (A.T.); (P.A.); (L.P.); (A.G.); (L.V.); (V.D.S.); (A.L.); (I.Q.); (C.C.)
| | - Antonino Lupica
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (A.T.); (P.A.); (L.P.); (A.G.); (L.V.); (V.D.S.); (A.L.); (I.Q.); (C.C.)
| | - Irene Quartana
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (A.T.); (P.A.); (L.P.); (A.G.); (L.V.); (V.D.S.); (A.L.); (I.Q.); (C.C.)
| | - Giovanna Viticchi
- Neurological Clinic, Marche Polytechnic University, 60020 Ancona, Italy; (G.V.); (M.S.); (M.B.)
| | - Mauro Silvestrini
- Neurological Clinic, Marche Polytechnic University, 60020 Ancona, Italy; (G.V.); (M.S.); (M.B.)
| | - Marco Bartolini
- Neurological Clinic, Marche Polytechnic University, 60020 Ancona, Italy; (G.V.); (M.S.); (M.B.)
| | - Cecilia Camarda
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (A.T.); (P.A.); (L.P.); (A.G.); (L.V.); (V.D.S.); (A.L.); (I.Q.); (C.C.)
| | - Filippo Brighina
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy; (A.T.); (P.A.); (L.P.); (A.G.); (L.V.); (V.D.S.); (A.L.); (I.Q.); (C.C.)
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Turkel CC, Aurora S, Diener HC, Dodick DW, Lipton RB, Silberstein SD, Brin MF. Treatment of chronic migraine with Botox (onabotulinumtoxinA): Development, insights, and impact. Medicine (Baltimore) 2023; 102:e32600. [PMID: 37499085 PMCID: PMC10374186 DOI: 10.1097/md.0000000000032600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Chronic migraine (CM) is a neurological disease characterized by frequent migraine attacks that prevent affected individuals from performing daily activities of living, significantly diminish quality of life, and increase familial burden. Before onabotulinumtoxinA was approved for CM, there were few treatment options for these seriously disabled patients and none had regulatory approval. The terminology and recognition of CM evolved in parallel with the onabotulinumtoxinA clinical development program. Because there were no globally accepted classification criteria for CM when onabotulinumtoxinA was in development, the patient populations for the trials conducted by Allergan were determined by the Allergan migraine team in collaboration with headache scientists and clinicians. These trials and collaborations ultimately led to improvements in CM classifications. In 2010, onabotulinumtoxinA became the first medication and first biologic approved specifically to prevent headaches in patients with CM. Approval was based on 2 similarly designed phase 3, double-blind, randomized, placebo-controlled, multicenter clinical studies. Both studies showed significantly greater improvements in mean change from baseline in headache-day frequency in patients with CM receiving onabotulinumtoxinA compared with those receiving placebo. The safety and effectiveness of onabotulinumtoxinA have been established globally in >5000 patients with CM with or without medication overuse treated in clinical and observational studies. Benefits also include improvements in quality of life, fewer psychiatric comorbidities, and reduced healthcare resource utilization. Across studies, onabotulinumtoxinA was well tolerated; adverse events tended to be mild or moderate in severity and to decline over subsequent treatment cycles.
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Affiliation(s)
| | | | - Hans-Christoph Diener
- Faculty of Medicine, Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | | | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Mitchell F Brin
- Allergan/AbbVie, Irvine, CA, USA
- University of California, Irvine, CA, USA
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Chen SP. Migraine and treatment-resistant depression. PROGRESS IN BRAIN RESEARCH 2023; 281:149-173. [PMID: 37806714 DOI: 10.1016/bs.pbr.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Migraine and major depressive disorders (MDD) or treatment resistant depression (TRD) represent a significant global burden and are often comorbid, further complicating diagnosis and treatment. Epidemiological studies have demonstrated a bidirectional relationship between migraine and MDD/TRD, with patients suffering from one disorder exhibiting a heightened risk of developing the other. This association is believed to result from shared genetic factors, neurotransmitter dysregulation, inflammation, hormonal alteration, and other conditions comorbid with both disorders. Emerging evidence suggests that therapeutics targeting common pathways in both disorders may be beneficial for comorbid patients. Novel therapeutics for migraine or MDD/TRD, such as calcitonin gene-related peptide (CGRP)-targeting therapy, onabotulinumtoxinA, ketamine/esketamine, vagus nerve stimulation or transcranial magnetic stimulation, may be helpful in selected patients with comorbid migraine-MDD/TRD. Nevertheless, continued efforts are needed to improve early detection and intervention, to better understand the complex interplay between genetic, environmental, and psychosocial factors contributing to this comorbidity, to identify novel therapeutic targets, and ultimately, to alleviate the disease burden caused by this comorbidity.
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Affiliation(s)
- Shih-Pin Chen
- Department of Medical Research & Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan; Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Westergaard ML, Jensen RH, Carlsson J. Headache comorbidity in refugees and migrants with post-traumatic stress disorder. Cephalalgia 2023; 43:3331024221147502. [PMID: 36786299 DOI: 10.1177/03331024221147502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Headache is often comorbid with post-traumatic stress disorder yet overlooked in health assessments of refugees. OBJECTIVES To describe prevalence of severe headache among refugees with post-traumatic stress disorder and compare severity of post-traumatic stress disorder symptoms and treatment outcomes among those with and without severe headache. METHODS This follow-up study used data from the Danish Database on Refugees with Trauma. Participants were recruited from 2009 to 2015 at a specialized psychiatric clinic. Prevalence of severe headache was computed by age, sex, and history of head injury or torture. Severe headache was defined as maximum headache scores on the Hopkins Symptom Checklist, Symptom Checklist-90 or the Visual Analogue Scale. Groups with and without severe headache were described according to validated questionnaires before and after 12-18 months of multidisciplinary treatment for post-traumatic stress disorder. Regression analyses were used to analyze associations between headache at start of treatment and symptom burden post-treatment, controlled for pre-treatment scores and possible confounders. RESULTS Among 403 female and 489 male participants, nearly all (97.5%) complained of headaches. Severe headache prevalence was 31.4% to 50.0% (depending on which questionnaire was used) and was significantly more common among females and those aged 30-49 years. There was no clear relationship between headache and head injury or torture. Participants with severe headache had heavier symptom burdens compared to those without severe headache. Post-treatment, headache prevalence by age and sex did not change significantly. Those without severe headache showed a tendency toward improvement in outcome measures; this was not seen among those with severe headache. Pre-treatment headache scores were correlated with all outcome measures. Regression analyses controlled for pre-treatment scores of the outcome variables showed associations between pre-treatment headache scores (Hopkins Symptom Checklist or Symptom Checklist-90) and post-treatment scores for intrusion, numbing, hyperarousal, anxiety, disability, and quality of life (all p < 0.02). CONCLUSION Headache is a prevalent comorbid condition among refugees with post-traumatic stress disorder. Measures of pre-treatment headache severity appear to predict post-traumatic stress disorder treatment outcomes. Severe headache adversely affects post-traumatic stress disorder prognosis. Assessment and treatment options should be studied further.
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Affiliation(s)
| | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Jessica Carlsson
- Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup.,Mental Health Services in the Capital Region of Denmark, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Baraldi C, Lo Castro F, Ornello R, Sacco S, Pani L, Guerzoni S. OnabotulinumtoxinA: Still the Present for Chronic Migraine. Toxins (Basel) 2023; 15:59. [PMID: 36668879 PMCID: PMC9865956 DOI: 10.3390/toxins15010059] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
OnabotulinumtoxinA (BT-A) is one of the few drugs approved for the preventive treatment of chronic migraine (CM). Despite this, some aspects of its mechanism of action are still a matter of debate, and the precise magnitude of BT-A effects needs to be completely elucidated. BT-A acts primarily upon trigeminal and cervical nerve endings, by inhibiting the release of inflammatory mediators such as calcitonin gene-related peptide, as well as reducing the insertion of ionotropic and metabotropic receptors into the neuronal membrane. These actions increase the depolarization threshold of trigeminal and cervical nerve fibers, thus reducing their activation. The central actions of BT-A are still a matter of debate: a retrograde axonal transport has been postulated, but not clearly assessed in humans. Clinically, the efficacy of BT-A in CM has been assessed by large, randomized placebo-controlled trials, such as the Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials. Those results were also confirmed in a wide range of open-label studies, even for long-term periods. Recently, novel findings have led to a better understanding of its pharmacological actions and clinical usefulness in migraine prevention. This narrative review summarizes, updates and critically revises the available data on BT-A and its possible implementation in chronic migraine. Moreover, the current role of BT-A in CM treatment has been discussed.
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Affiliation(s)
- Carlo Baraldi
- Department of Biomedical, Metabolic and Neural Sciences, PhD School in Neurosciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Flavia Lo Castro
- Department of Biomedical, Metabolic and Neural Sciences, Post Graduate School of Pharmacology and Clinical Toxicology, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Raffaele Ornello
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Simona Sacco
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Luca Pani
- Department of Biomedical, Metabolic and Neural Sciences, Pharmacology Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL 33136, USA
- VeraSci, Durham, NC 27707, USA
- Department of Specialist Medicines, Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse, Laboratory of Clinical Pharmacology and Pharmacogenomics, AOU Policlinico Di Modena, 41124 Modena, Italy
| | - Simona Guerzoni
- Department of Specialist Medicines, Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse, Laboratory of Clinical Pharmacology and Pharmacogenomics, AOU Policlinico Di Modena, 41124 Modena, Italy
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10
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Efficacy of Onabotulinum Toxin A on Obsessive–Compulsive Traits in a Population of Chronic Migraine Patients. Brain Sci 2022; 12:brainsci12111563. [DOI: 10.3390/brainsci12111563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/06/2022] [Accepted: 11/13/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Drug addiction may play an important role in chronic migraine (CM) with medication-overuse headache (MOH). Psychiatric diseases are associated with CM, but data regarding obsessive–compulsive disorder (OCD) are lacking. We aimed to establish the prevalence of OCD traits in CM patients with MOH and the impact on onabotulinum toxin A (OBT-A) treatment. Methods: A total of 75 patients with CM and MOH undergoing treatment with OBT-A in our Headache Centre were evaluated. At baseline and after four injection sessions, we assessed the migraine burden and the presence of OCD traits with the Obsessive–Compulsive Inventory—Revised (OCI-R) test. Results: At baseline, 28% of patients had OCI-R scores compatible with borderline OCD aspects, while 22.7% were pathological. An improvement in headache was significantly associated with an increase in the number of subjects with a normal OCI-R score at T0 and T1, whereas patients with a pathological OCI-R score at T0 showed a significantly higher prevalence of CM at T1. Conclusions: Our data showed a significant rate of OCD traits at baseline, which could strengthen the hypothesis of an addictive disorder underlying CM with MOH. OCD traits seem to influence the OBT-A response. An OCD assessment could be useful in improving patients’ selections before starting treatments.
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11
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Viticchi G, Falsetti L, Salvemini S, Silvestrini M, Riva A, Buratti L, Bartolini M. Gender differences in obsessive–compulsive disorder traits among chronic migraine patients. Neurol Sci 2022; 43:5735-5737. [DOI: 10.1007/s10072-022-06266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
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12
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Cutaneous allodynia and thermal thresholds in chronic migraine: The effect of onabotulinumtoxinA. Clin Neurol Neurosurg 2022; 220:107357. [DOI: 10.1016/j.clineuro.2022.107357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/08/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022]
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13
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Wollmer MA, Magid M, Kruger THC, Finzi E. Treatment of Depression with Botulinum Toxin. Toxins (Basel) 2022; 14:toxins14060383. [PMID: 35737044 PMCID: PMC9231293 DOI: 10.3390/toxins14060383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 02/01/2023] Open
Abstract
Injection of botulinum toxin (BoNT) into the glabellar region of the face is a novel therapeutic approach in the treatment of depression. This treatment method has several advantages, including few side effects and a long-lasting, depot-like effect. Here we review the clinical and experimental evidence for the antidepressant effect of BoNT injections as well as the theoretical background and possible mechanisms of action. Moreover, we provide practical instructions for the safe and effective application of BoNT in the treatment of depression. Finally, we describe the current status of the clinical development of BoNT as an antidepressant and give an outlook on its potential future role in the management of mental disorders.
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Affiliation(s)
- Marc Axel Wollmer
- Asklepios Clinic North-Ochsenzoll, Asklepios Campus Hamburg, Medical Faculty, Semmelweis University, 22419 Hamburg, Germany
- Correspondence: ; Tel.: +49-40-181887-2372
| | - Michelle Magid
- Dell Medical School, University of Texas at Austin, Austin, TX 78712, USA;
| | - Tillmann H. C. Kruger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, 30625 Hannover, Germany;
- Center for Systems Neuroscience, 30559 Hannover, Germany
| | - Eric Finzi
- Department of Psychiatry & Behavioral Sciences, George Washington School of Medicine, Washington, DC 20037, USA;
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14
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Blumenfeld A, McVige J, Knievel K. Post-traumatic headache: Pathophysiology and management - A review. JOURNAL OF CONCUSSION 2022. [DOI: 10.1177/20597002221093478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Post-traumatic headache (PTH) is a common secondary headache due to traumatic brain injury. In the past, significant research has been conducted to understand the pathophysiology and treatment options for PTH. However, PTH still lacks evidence-based treatment, and most of the management depends on the primary phenotype observed in the patient. Objective The main objective of this review is to provide a single reference that covers the current understanding of the pathophysiology and the treatment options available for PTH. Methods A detailed literature search on PubMed was performed, and a narrative review was prepared. Results The pathophysiology of PTH is multifactorial. Acute PTH may be attributed to increased peripheral pain sensitization with impaired pain inhibiting pathways. Chronic or persistent PTH may be due to a chronic inflammatory response and peripheral as well as central sensitization. The mechanism responsible for the transition of acute to persistent PTH is unknown. The migraine-like phenotype is reported to be the most prevalent headache type seen in PTH. New targets for preventive treatment have been identified in recent years, such as neuropeptides like calcitonin-gene-related peptide (CGRP), nitric oxide, and glutamate. The preventive pharmacological and non-pharmacological strategies employed for migraine (e.g. anti-CGRP monoclonal antibodies, onabotulinumtoxinA, physical therapy, cognitive and behavioral treatment, and neurostimulation techniques) have shown in preliminary studies that they are potentially efficacious, but large, randomized, double blind, placebo controlled trials are needed to further establish these as treatment options for PTH. Conclusions The lack of evidence-based treatment for PTH has created a need for future large trials to confirm the safety and efficacy of the currently employed treatments.
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Affiliation(s)
- Andrew Blumenfeld
- The Los Angeles Headache Center and The San Diego Headache Center, Los Angeles, CA, USA
| | | | - Kerry Knievel
- Barrow Neurological Institute, Phoenix, Arizona, USA
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15
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Saçmacı H, Tanik N, İnan LE. Current Perspectives on the Impact of Chronic Migraine on Sleep Quality: A Literature Review. Nat Sci Sleep 2022; 14:1783-1800. [PMID: 36225323 PMCID: PMC9549806 DOI: 10.2147/nss.s335949] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Recent studies have shown that sleep problems occur in migraineurs and poor sleep causes chronification, but the mechanisms by which chronic migraine affects sleep quality are still unknown. This review aims to analyze commonly reported sleep disturbances in chronic migraine (CM) and determine the effect of CM on sleep quality. MATERIALS AND METHODS We conducted a comprehensive review of all published articles on CM and sleep quality from inception to March 2022 in the literature. Clinical trials, observational studies, and case series (≥20 cases) were included. Two reviewers and a supervisor reviewed the titles and abstracts of all search results with predefined inclusion and exclusion criteria. PubMed search for randomized controlled trials and open studies on CM and sleep quality reported in English between 1983 and 2022 was conducted using the keywords including chronic migraine, sleep, insomnia, sleep quality, polysomnography, and Pittsburgh Sleep Quality Index. RESULTS A total of 535 potentially relevant articles were found. A total of 455 articles and reviews, meta-analyses published in any language other than English, with other exclusion criteria, were excluded from the review. In the remaining articles, 36 clinical studies, reviewing sleep quality and its association with migraine, were identified and reviewed. Evidence from this review shows that poor sleep and migraine chronicity are intertwined with other accompanying comorbidities and dysregulation of circadian rhythm that innovative treatments promise to bring relief to both poor sleep as well as migraine. CONCLUSION Sleep disorders are common in CM and the association between migraine chronification and sleep quality is bidirectional. Comorbid conditions with accompanying frequent attacks in migraine may impair sleep quality. While the maladaptive pain process worsens sleep, poor sleep quality also negatively affects migraine pain. Sleep disturbance, which is affected by worsening migraine attacks, causes deterioration in the quality of life, loss of workforce, and economic burden.
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Affiliation(s)
- Hikmet Saçmacı
- Department of Neurology, Yozgat Bozok University, School of Medicine, Yozgat, 66100, Turkey
| | - Nermin Tanik
- Department of Neurology, Yozgat Bozok University, School of Medicine, Yozgat, 66100, Turkey
| | - Levent Ertuğrul İnan
- Department of Neurology, Ministry of Health Ankara Research and Training Hospital, Ankara, 06230, Turkey
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16
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Gottschalk C, Basu A, Blumenfeld A, Torphy B, Marmura MJ, Pavlovic JM, Dumas PK, Lalvani N, Buse DC. The importance of an early onset of migraine preventive disease control: A roundtable discussion. CEPHALALGIA REPORTS 2022. [DOI: 10.1177/25158163221134593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Newly approved migraine preventive therapies have allowed for rapid control of migraine activity, offering potential to minimize the burden of migraine. This report summarizes a roundtable discussion convened to analyze evidence for early onset of prevention, ascertain its clinical relevance, and provide guidance for healthcare professionals in crafting goals and treatment expectations for patients with migraine initiating preventive therapy. Methods: A virtual roundtable meeting of migraine clinicians, researchers, and patient advocates convened in October 2020. Participants reviewed and discussed data summarizing patient and healthcare professional perceptions of migraine prevention and evidence from the peer-reviewed and gray literature to develop corresponding recommendations. Summary: Evidence from clinical studies of anti-calcitonin gene-related peptide monoclonal antibodies (erenumab, fremanezumab, galcanezumab, and eptinezumab) and the chemodenervation agent onabotulinumtoxinA indicate that patients may experience reduction of migraine activity within 7 days of drug administration and early attainment of disease control is associated with improvements in clinically important outcomes. The roundtable of experts proposes that early onset be defined as demonstration of preventive benefits within 1 week of treatment initiation. We recommend focusing discussion with patients around “disease control” and potential benefits of early onset of prevention, so patients can set realistic preventive therapy goals and expectations.
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Affiliation(s)
| | - Anirban Basu
- The CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Andrew Blumenfeld
- Headache Center of Southern California, The Neurology Center, Carlsbad, CA, USA
| | - Bradley Torphy
- Chicago Headache Center and Research Institute, Chicago, IL, USA
| | - Michael J Marmura
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jelena M Pavlovic
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Nim Lalvani
- American Migraine Foundation, Mount Royal, NJ, USA
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Postmarketing safety surveillance data reveals protective effects of botulinum toxin injections against incident anxiety. Sci Rep 2021; 11:24173. [PMID: 34934096 PMCID: PMC8692576 DOI: 10.1038/s41598-021-03713-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/29/2021] [Indexed: 01/30/2023] Open
Abstract
Randomized controlled trials (RCTs) have shown an antidepressant effect of glabellar botulinum toxin (BoNT) injections. In the FDA Adverse Event Reporting System (FAERS) database, BoNT injection is associated with reduced incidence rates of depression across various non-psychiatric indications, which confirms the previous findings independently of specific expectations to an antidepressant effect of BoNT. The rationale of using BoNT to treat depression is to interrupt proprioceptive body feedback that may reinforce negative emotions. Negative emotions also occur in other mental disorders, suggesting a transdiagnostic therapeutic potential of BoNT in psychiatry. Here we report an analysis of the FAERS database, in which we found that, compared to alternative treatments, BoNT injections were associated with lower incidence of anxiety symptoms and related disorders. Among seven indications/injection sites, we found this protective effect of BoNT in cosmetic use/facial muscles, migraine/facial and head muscles, spasms and spasticity/upper and lower limbs, torticollis and neck pain/neck muscles, and sialorrhea/parotid and submandibular glands (reporting odds ratios 0.79-0.27). These findings are encouraging for possible future RCTs on the use of BoNT as a treatment for anxiety and related disorders.
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18
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Liu Y, Yang T, Li J, Xu H, Li S, Xiong L. Breakthroughs on the clinical management of headache and questions that need to be solved. IBRAIN 2021; 7:298-308. [PMID: 37786564 PMCID: PMC10529177 DOI: 10.1002/ibra.12003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 10/04/2023]
Abstract
Headache is a common refractory disorder among adults, especially in females, which can lower the quality of life in patients and increase medical costs. Nearly 90% of people have been affected by headache disorders during their lifetime. The severe situation of headaches has drawn the attention of researchers in recent years. Although the mechanism of headache has not been fully understood by us, there are many effective preventive drugs and treatments available. This review is aimed to sum up the progress in clinical trials of headaches in the past 5 years.
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Affiliation(s)
- Yu‐Cong Liu
- School of AnesthesiologyZunyi Medical UniversityZunyiGuizhouChina
| | - Ting‐Ting Yang
- School of AnesthesiologyZunyi Medical UniversityZunyiGuizhouChina
| | - Jing Li
- School of AnesthesiologyZunyi Medical UniversityZunyiGuizhouChina
| | - Hui‐Chan Xu
- School of AnesthesiologyZunyi Medical UniversityZunyiGuizhouChina
| | - Shun‐Lian Li
- School of AnesthesiologyZunyi Medical UniversityZunyiGuizhouChina
| | - Liu‐Lin Xiong
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
- Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
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D’Amico D, Grazzi L, Guastafierro E, Sansone E, Leonardi M, Raggi A. Withdrawal failure in patients with chronic migraine and medication overuse headache. Acta Neurol Scand 2021; 144:408-417. [PMID: 34036572 PMCID: PMC8453823 DOI: 10.1111/ane.13475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/23/2021] [Accepted: 05/06/2021] [Indexed: 12/28/2022]
Abstract
Objectives The management of chronic migraine (CM) with Medication Overuse Headache (MOH) consists of withdrawal therapy, education on medications’ use and prescription of prophylaxis. Little attention has been given to patients who fail in achieving a successful short‐term outcome after withdrawal: we aim to describe predictors of failure. Methods Patients with CM and MOH were enrolled at the Neurological Institute C. Besta of Milano, and included if they completed the three months follow‐up. Withdrawal failure was defined as the situation in which patients either did not revert from chronic to episodic migraine (EM), were still overusing acute medications, or both did not revert to EM and kept overusing acute medications. Predictors of failure were addressed with a logistic regression, and for all variables, the longitudinal course in the two groups was described. Results In 39, out of 137 patients, withdrawal was unsuccessful: the predictors included day‐hospital‐based withdrawal (OR: 2.37; 95% CI: 1.06–5.29), emergency room (ER) access before withdrawal (OR: 2.81; 95% CI: 1.13–6.94) and baseline headache frequency >69 days/three months (OR: 2.97; 95% CI: 1.32–6.65). Patients who failed withdrawal did not improve on medications intake, use of prophylactic and non‐pharmacological treatments, symptoms of anxiety and depression. Conclusions Patients who were treated in day‐hospital, those who recently attended ER for headache, and those with more than 69 headache/3 months, as well as to those with relevant symptoms of anxiety and depression who did not improve should be closely monitored to reduce likelihood of non‐improvement after structured withdrawal.
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Affiliation(s)
- Domenico D’Amico
- Fondazione IRRCS Istituto Neurologico C. Besta Dipartimento Neuroalgologia Centro Cefalee Milano Italy
| | - Licia Grazzi
- Fondazione IRRCS Istituto Neurologico C. Besta Dipartimento Neuroalgologia Centro Cefalee Milano Italy
| | - Erika Guastafierro
- Fondazione IRRCS Istituto Neurologico C. Besta UO Neurologia Salute Pubblica e Disabilità Milano Italy
| | - Emanuela Sansone
- Fondazione IRRCS Istituto Neurologico C. Besta UO Neurologia Salute Pubblica e Disabilità Milano Italy
| | - Matilde Leonardi
- Fondazione IRRCS Istituto Neurologico C. Besta UO Neurologia Salute Pubblica e Disabilità Milano Italy
| | - Alberto Raggi
- Fondazione IRRCS Istituto Neurologico C. Besta UO Neurologia Salute Pubblica e Disabilità Milano Italy
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OnabotulinumtoxinA in Migraine: A Review of the Literature and Factors Associated with Efficacy. J Clin Med 2021; 10:jcm10132898. [PMID: 34209849 PMCID: PMC8269087 DOI: 10.3390/jcm10132898] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/12/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
The efficacy of onabotulinumtoxinA (OnaB-A) as a preventative treatment for chronic migraine, emerging fortuitously from clinical observation is now supported by class one evidence and over two decades of real-world clinical data. There is still limited ability to predict a clinically meaningful response to OnaB-A for individual patients, however. This review summarises briefly the proposed mechanism of OnaB-A in chronic migraine, the literature of predictors of clinical response, and recent developments in the field.
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21
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Galvez-Sánchez CM, Montoro CI, Moreno-Padilla M, Reyes del Paso GA, de la Coba P. Effectiveness of Acceptance and Commitment Therapy in Central Pain Sensitization Syndromes: A Systematic Review. J Clin Med 2021; 10:2706. [PMID: 34205244 PMCID: PMC8235706 DOI: 10.3390/jcm10122706] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Acceptance and commitment therapy (ACT) is considered by the American Psychological Association as an evidence-based treatment for a variety of disorders, including chronic pain. The main objective of the present systematic review was to determine the effectiveness of ACT in patients with central pain sensitization syndromes (CPSS). METHODS This systematic review was conducted according to the guidelines of the Cochrane Collaboration and PRISMA statements. The protocol was registered in advance in the Prospective Register of Systematic Reviews (PROSPERO) international database. The selected articles were evaluated using the Cochrane risk of bias (ROB) assessment tool. The PubMed, Scopus, and Web of Science databases were searched. RESULTS The literature search identified 21 studies (including investigations of fibromyalgia syndrome, irritable bowel syndrome, and migraine) eligible for the systematic review. There were no studies regarding the effectiveness of ACT for chronic tension-type headache (CTTH), interstitial cystitis (IC), or temporomandibular disorder (TMD). The evaluation of ROB showed that 12 of the selected studies were of low quality, 5 were of moderate quality, and 4 were high quality. ACT reduces some clinical symptoms, such as anxiety, depression, and pain. This positive effect of ACT might be mediated by pain acceptance, psychological flexibility, optimism, self-efficacy, or adherence to values. ACT showed better results in comparison to non-intervention (e.g., "waiting list") conditions, as well as pharmacological and psychoeducational interventions. It is not entirely clear whether extended ACT treatments are more advantageous than briefer interventions. CONCLUSIONS There are few studies about the effectiveness of ACT on CPSS. However, ACT seems to reduce subjective CPSS symptoms and improve the health-related quality of life of these patients. The absence of studies on the effectiveness of ACT in CTTH, IC, and TMD, indicate the pressing need for further ACT studies in these CPSS.
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Affiliation(s)
- Carmen M. Galvez-Sánchez
- Department of Psychology, University of Jaén, 23071 Jaén, Spain; (C.I.M.); (M.M.-P.); (G.A.R.d.P.); (P.d.l.C.)
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Clinical and Neurophysiological Effects of Botulinum Neurotoxin Type A in Chronic Migraine. Toxins (Basel) 2021; 13:toxins13060392. [PMID: 34072379 PMCID: PMC8229748 DOI: 10.3390/toxins13060392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic pain syndromes present a subversion of both functional and structural nociceptive networks. We used transcranial magnetic stimulation (TMS) to evaluate changes in cortical excitability and plasticity in patients with chronic migraine (CM) treated with botulinum neurotoxin type A (BoNT/A). We enrolled 11 patients with episodic migraine (EM) and 11 affected by CM. Baseline characteristics for both groups were recorded using single- and paired-pulse TMS protocols. The same TMS protocol was repeated in CM patients after four cycles of BoNT/A completed in one year. At baseline, compared with EM patients, patients with CM had a lower threshold in both hemispheres (right hemisphere: 46% ± 7.8 vs. 52% ± 4.28, p = 0.03; left hemisphere: 52% ± 4.28 vs. 53.54% ± 6.58, p = 0.02). In EM, paired-pulse stimulation elicited a physiologically shaped response, whereas in CM, physiological intracortical inhibition (ICI) between 1 and 3 ms intervals was absent at baseline. On the contrary, increasing intracortical facilitation (ICF) was observed for all interstimulus intervals (ISIs). In CM, cortical excitability was partially reduced after BoNT/A treatment, along with a significant decrease observed in MIDAS score (from 20.7 to 9.8; p = 0.008). The lower motor threshold in CM reflects a higher cortical hyperexcitability. The lack of physiological ICI in CM could indicate sensitisation of the trigeminovascular system. Although reduced, this type of response is still observable after treatment, despite a marked clinical improvement. Our study suggests a long-term alteration of cortical plasticity due to chronic pain.
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23
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Lu J, Zhang Q, Guo X, Liu W, Xu C, Hu X, Ni J, Lu H, Zhao H. Calcitonin Gene-Related Peptide Monoclonal Antibody Versus Botulinum Toxin for the Preventive Treatment of Chronic Migraine: Evidence From Indirect Treatment Comparison. Front Pharmacol 2021; 12:631204. [PMID: 34012392 PMCID: PMC8126691 DOI: 10.3389/fphar.2021.631204] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/15/2021] [Indexed: 12/25/2022] Open
Abstract
Background: The previously approved botulinum toxin and nowadays promising calcitonin gene-related peptide (CGRP) monoclonal antibody have shown efficacy for preventing chronic migraine (CM). However, there is no direct evidence for their relative effectiveness and safety. In this study, we conducted an indirect treatment comparison to compare the efficacy and safety of CGRP monoclonal antibody with botulinum toxin for the preventive treatment of chronic migraine. Methods: Up to August 31, 2020, we systematically searched PubMed, Embase, and Cochrane Library Central Register of Controlled Trials (Central). Weighted mean difference (WMD) and relative risk (RR) were used to evaluate clinical outcomes. Indirect treatment comparison (ITC) software was used to conduct indirect treatment comparison. Results: Ten studies were pooled with 6,325 patients in our meta-analysis. Both botulinum toxin and CGRP monoclonal antibody demonstrated favorable efficacy in the change of migraine days, headache days, HIT-6 score, and 50% migraine responder rate compared with placebo. In indirect treatment comparison, CGRP monoclonal antibody was superior to botulinum toxin in the frequency of acute analgesics intake (WMD = −1.31, 95% CI: −3.394 to 0.774, p = 0.02113), the rate of treatment-related adverse events (AEs) (RR = 0.664, 95% CI: 0.469 to 0.939, p = 0.04047), and the rate of treatment-related serious adverse events (RR = 0.505, 95% CI: 0.005 to 46.98, p < 0.001). Conclusion: For chronic migraine patients, CGRP monoclonal antibody was slightly better than botulinum toxin in terms of efficacy and safety. In the future, head-to-head trials would be better to evaluate the efficacy and safety between different medications in the prevention of chronic migraine.
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Affiliation(s)
- Jiajie Lu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Quanquan Zhang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoning Guo
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Liu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunyang Xu
- Department of Neurology, Traditional Chinese Medicine Hospital of Kunshan, Kunshan, China
| | - Xiaowei Hu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianqiang Ni
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haifeng Lu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongru Zhao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Lipton RB, Cohen JM, Galic M, Seminerio MJ, Yeung PP, Aycardi E, Bigal ME, Bibeau K, Buse DC. Effects of fremanezumab in patients with chronic migraine and comorbid depression: Subgroup analysis of the randomized HALO CM study. Headache 2021; 61:662-672. [PMID: 33891348 PMCID: PMC8251795 DOI: 10.1111/head.14097] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/22/2021] [Accepted: 02/08/2021] [Indexed: 01/03/2023]
Abstract
Objective To evaluate the efficacy of fremanezumab in patients with chronic migraine (CM) and moderate to severe depression. Background Fremanezumab, a fully humanized monoclonal antibody that selectively targets calcitonin gene–related peptide, has been approved for the preventive treatment of migraine in adults. CM and depression are highly comorbid. Methods The 12‐week, Phase 3 HALO trial randomized patients with CM to fremanezumab quarterly (675 mg/placebo/placebo), fremanezumab monthly (675/225/225 mg), or placebo. Post hoc analyses evaluated the effects of fremanezumab in patients with moderate to severe depression (baseline 9‐item Patient Health Questionnaire sum score ≥10) on monthly number of headache days of at least moderate severity; monthly migraine days; Patient Global Impression of Change (PGIC); 6‐item Headache Impact Test (HIT‐6) scores; and depression. Results For the 219/1121 (19.5%) patients with moderate to severe depression at baseline, fremanezumab was associated with a significant reduction in monthly number of headache days of at least moderate severity for active treatment versus placebo (least‐squares mean change ± standard error for quarterly dosing: −5.3 ± 0.77; for monthly dosing: −5.5 ± 0.72; and for placebo: −2.2 ± 0.81; both p < 0.001). More patients achieved a ≥50% reduction in headache days of at least moderate severity with fremanezumab (quarterly: 31/78 [39.7%]; monthly: 39/96 [40.6%]) than placebo (9/67 [13.4%]; both p < 0.001). Compared with placebo, fremanezumab improved PGIC and HIT‐6 scores. Conclusions Fremanezumab demonstrated efficacy in the preventive treatment of CM and reduced headache impact in patients with comorbid depression.
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Affiliation(s)
- Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joshua M Cohen
- Global Medical Affairs, Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Maja Galic
- Global Medical Affairs, Teva Pharmaceuticals Europe B.V., Amsterdam, The Netherlands
| | - Michael J Seminerio
- North America Medical Affairs, Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Paul P Yeung
- Global Medical Affairs, Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Ernesto Aycardi
- Global Medical Affairs, Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Marcelo E Bigal
- Research and Development, Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Kristen Bibeau
- Global Medical Affairs, Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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25
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Affatato O, Moulin TC, Pisanu C, Babasieva VS, Russo M, Aydinlar EI, Torelli P, Chubarev VN, Tarasov VV, Schiöth HB, Mwinyi J. High efficacy of onabotulinumtoxinA treatment in patients with comorbid migraine and depression: a meta-analysis. J Transl Med 2021; 19:133. [PMID: 33789668 PMCID: PMC8011097 DOI: 10.1186/s12967-021-02801-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/19/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Migraine and depression are highly prevalent and partly overlapping disorders that cause strong limitations in daily life. Patients tend to respond poorly to the therapies available for these diseases. OnabotulinumtoxinA has been proven to be an effective treatment for both migraine and depression. While many studies have addressed the effect of onabotulinumtoxinA in migraine or depression separately, a growing body of evidence suggests beneficial effects also for patients comorbid with migraine and depression. The current meta-analysis systematically investigates to what extent onabotulinumtoxinA is efficient in migraineurs with depression. METHODS A systematic literature search was performed based on PubMed, Scopus and Web of Science from the earliest date till October [Formula: see text], 2020. Mean, standard deviation (SD) and sample size have been used to evaluate improvement in depressive symptoms and migraine using random-effects empirical Bayes model. RESULTS Our search retrieved 259 studies, eight of which met the inclusion criteria. OnabotulinumtoxinA injections administered to patients with both chronic migraine and major depressive disorder led to mean reduction of [Formula: see text] points (CI [[Formula: see text]], [Formula: see text]) in the BDI scale, of [Formula: see text] points (CI [[Formula: see text]], [Formula: see text]) in the BDI-II scale and of [Formula: see text] points (CI [[Formula: see text]], [Formula: see text]) in the PHQ-9 scale, when evaluating depressive symptoms. In the case of the migraine-related symptoms, we found mean reductions of [Formula: see text] (CI [[Formula: see text]], [Formula: see text]) points in the HIT6 scale, [Formula: see text] (CI [[Formula: see text]], [Formula: see text]) in the MIDAS scale, [Formula: see text] (CI [[Formula: see text]], [Formula: see text]) points in the VAS scale and of [Formula: see text] (CI [[Formula: see text]], [Formula: see text]) migraine episodes per month. Comorbid patients showed slightly better improvements in BDI, HIT6 scores and migraine frequency compared to monomorbid patients. The latter group manifested better results in MIDAS and VAS scores. CONCLUSION Treatment with onabotulinumtoxinA leads to a significant reduction of disease severity of both chronic migraine and major depressive disorder in patients comorbid with both diseases. Comparative analyses suggest an equivalent strong effect in monomorbid and comorbid patients, with beneficial effects specifically seen for certain migraine features.
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Affiliation(s)
- Oreste Affatato
- Department of Neuroscience, University of Uppsala, Uppsala, Sweden.
| | - Thiago C Moulin
- Department of Neuroscience, University of Uppsala, Uppsala, Sweden
| | - Claudia Pisanu
- Department of Neuroscience, University of Uppsala, Uppsala, Sweden.,Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Victoria S Babasieva
- Department of Neuroscience, University of Uppsala, Uppsala, Sweden.,Department of Pharmacology, Institute of Pharmacy, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Marco Russo
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Elif I Aydinlar
- Department of Neurology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Paola Torelli
- Headache Centre, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Vladimir N Chubarev
- Department of Pharmacology, Institute of Pharmacy, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vadim V Tarasov
- Department of Pharmacology, Institute of Pharmacy, I. M. Sechenov First Moscow State Medical University, Moscow, Russia.,Institute for Translational Medicine and Biothechnology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Helgi B Schiöth
- Department of Neuroscience, University of Uppsala, Uppsala, Sweden.,Institute for Translational Medicine and Biothechnology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Jessica Mwinyi
- Department of Neuroscience, University of Uppsala, Uppsala, Sweden
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26
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Al-Hashel JY, Kh Ashkanani H, Almutairi O, Bokubar FA, Mubarak S, Alwazzan S, Alroughani R, Youssry D, Farouk Ahmed S. Onabotulinumtoxin A Improves Psychological Aspects in Chronic Migraine Patients. Front Neurol 2021; 11:633355. [PMID: 33584525 PMCID: PMC7873558 DOI: 10.3389/fneur.2020.633355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Chronic migraine (CM) affects 5.4% of the Kuwaiti population. It is associated with significant headache-related disability, psychiatric comorbidity and reduced quality of life. The aim of this study is to assess the efficacy of Onabotulinumtoxin A on psychological aspects of chronic migraine patients. Methods: This prospective study over 36 months included chronic migraine patients in a tertiary headache center. Eligible patients met International Classification of Headache Disorders disorders-third edition, beta version (ICHD-III) revision criteria for chronic migraine. Patients with history of psychiatric or medical problems other than migraine disorders were excluded. Patients who received less than 4 injections cycles of Onabotulinumtoxin A were excluded. Identified patients received 155 units of Onabotulinumtoxin A quarterly according to the Phase III Research Evaluating Migraine Prophylaxis Therapy Trail (PREEMPT) protocol. Quality of life, the seven-item Generalized Anxiety Disorder (GAD-7) scores, the nine-item Patient Health Questionnaire (PHQ9), and the Pittsburgh Sleep Quality Index (PSQI) were collected before injection and at the end of the study. Mean comparison tests were performed using the independent sample t-test to assess the effects of Onabotulinumtoxin A on quality of life and comorbid symptoms of anxiety, depression, and quality of sleep. Results: The study identified 131 chronic migraine patients with a mean age of 44.92 years, mean disease duration of 12.20 years and a mean treatment sessions of 7.58. In their last visit, most of our sample showed improvement in quality of life (81%), GAD-7 (81%), PHQ9 (79%), and PSQ1 (76%). The mean score of patient satisfaction was 7.21. Onabotulinumtoxin A treatment for CM improved quality of life significantly (72.92 vs. 103.62; P < 0.0001). It was also associated with significant reduction in anxiety [GAD-7 (12.00 vs. 6.61; P < 0.0001)] and depression [PHQ-9 (17.91 vs. 12.52; P < 0.0001)] scores, as well as reduced difficulty in sleeping [PSQI (12.60 vs. 6.66; P < 0.0001)] at the last visit. Conclusion: Prophylactic Onabotulinumtoxin A treatment for CM was associated with significant improvement of quality of life, reduction in symptoms of anxiety and depression, as well as improved symptoms of poor sleep.
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Affiliation(s)
- Jasem Youssef Al-Hashel
- Neurology Department, Ibn Sina Hospital, Kuwait, Kuwait
- Faculty of Medicine, Kuwait University, Kuwait, Kuwait
| | | | | | | | | | | | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait, Kuwait
| | - Doaa Youssry
- Neurology Department, Ibn Sina Hospital, Kuwait, Kuwait
- Department of Neurology, Cairo University, Cairo, Egypt
| | - Samar Farouk Ahmed
- Neurology Department, Ibn Sina Hospital, Kuwait, Kuwait
- Neuropsychiatry Department, Faculty of Medicine, Minia University, Minia, Egypt
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27
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Sastre Real M, Díaz de Terán J. OnabotulinumtoxinA Is an Effective Treatment for Chronic Migraine in Patients With Comorbid Fibromyalgia. Front Neurol 2020; 11:575130. [PMID: 33178117 PMCID: PMC7593548 DOI: 10.3389/fneur.2020.575130] [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: 06/22/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: Fibromyalgia (FM) is a frequent comorbidity in patients with chronic migraine (CM). PREEMPT trials, which demonstrated the efficacy of OnabotulinumtoxinA (OnabotA) on CM, excluded patients with FM. Our aim was to evaluate the effectiveness of OnabotA in a series of patients with CM and FM. Methods: We analyzed patients with a previous diagnosis of CM and FM who had received sessions of OnabotA quarterly between January 2014 and January 2020 in a specialized Headache Clinic. Primary endpoint was the reduction in moderate to severe headache days at 3, 6, 9, and 12 months. Results: Data were collected from 31 patients with CM and FM that received OnabotA (100% females). Mean age at first procedure was 50.2 ± 11.3 years. Depression (93.5%), other central sensitization syndromes (irritable bowel syndrome, interstitial cystitis, multiple chemical sensitivity, endometriosis, and chronic fatigue syndrome) (48.4%), and medication overuse headache (90.3%) were frequent comorbidities. 48.4% of patients had failed ≥3 preventives previously. The percentage of patients who achieved ≥30 and ≥50% moderate-severe headache reduction on the third month was 65.4 and 48.2%, respectively. Twenty-three patients completed four cycles of treatment, with 13.4 fewer headache days per month than at baseline (p < 0.001). By 1 year, 69.5% had ≥50% reduction of headache frequency and 39.1% had a ≥75% reduction. In 4 cases (21%), OnabotA was interrupted due to a lack of response. Only mild adverse effects were recorded. Conclusion: OnabotA is an effective treatment for CM in patients with FM.
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Affiliation(s)
- María Sastre Real
- Department of Neurology, La Paz University Hospital, Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Javier Díaz de Terán
- Department of Neurology, La Paz University Hospital, Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,CranioSPain Research Group, La Salle Higher Center for University Studies, Physiotherapy Department, Autonomous University of Madrid, Madrid, Spain
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28
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Impulse control disorders in chronic migraine with medication overuse after onabotulinumtoxinA: A single-center prospective cohort study. J Clin Neurosci 2020; 80:152-155. [PMID: 33099338 DOI: 10.1016/j.jocn.2020.07.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/16/2020] [Accepted: 07/31/2020] [Indexed: 01/17/2023]
Abstract
Chronic migraine (CM) with medication overuse headache (MOH) is one of the most common and disabling chronic headache disorders associated with both frequencies of use of medication and behavioral alterations, including psychopathology and psychological drug dependence. Several previous studies on large patient samples have demonstrated the efficacy of Onabotulinum toxin A (OnabotA) on physical symptomatology treatment of headache, but effects on behavioral alterations remain still debate. Our study investigated the effects of OnabotA on psychiatric comorbidities and on quality of life of patients with CM and MOH that failed on traditional therapies. OnabotA was injected, according to the PREEMPT paradigm, 40 patients with CM and MOH and data on headache-related impairment, before and after the OnabotA injections were collected from the patient's headache diaries. Data on depressive, anxiety symptomatology and impulse control disorders also were collected by means of self-report scales and a semi-structured interview. After six months, patients with CM and MOH showed a significant decrease in monthly headache attacks (from 19.3 ± 5.9 to 11.8 ± 8.5, p = 0.003), monthly headache days (from 23 ± 8.9 to 11.1 ± 6.2, p = 0.001), numbers of analgesics used per month (from 18.2 ± 6.3 to 8.5 ± 4.7, p < 0.0001). The anxiety symptomatology (p ≤ 0.003) and impulse control disorders (from 30% to 10%), but not depressive symptomatology (p = 0.81), were significantly reduced from throughout the study. The treatment with OnabotA proved beneficial effects on anxiety symptomatology and on impulse control disorders in our clinical practice with CM and MOH and further studies should shed light in larger patient samples on long-term behavioural effects.
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29
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Chu P, Ju YES, Hinze AM, Kim AH. Measures of Sleep in Rheumatologic Diseases: Sleep Quality Patient-Reported Outcomes in Rheumatologic Diseases. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:410-430. [PMID: 33091275 PMCID: PMC7586459 DOI: 10.1002/acr.24238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Philip Chu
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Yo-El S. Ju
- Sleep Medicine Center, Department of Neurology, Washington University School of Medicine, Saint Louis, MO
| | - Alicia M. Hinze
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Alfred H.J. Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO
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30
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Schim J. Moving the Needle, the Clinical Perspective. Headache 2020; 60:2042-2048. [DOI: 10.1111/head.13904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Jack Schim
- The Headache Center Neurology Center of Southern California Carlsbad CA USA
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31
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Blumenfeld AM, Patel AT, Turner IM, Mullin KB, Manack Adams A, Rothrock JF. Patient-Reported Outcomes from a 1-Year, Real-World, Head-to-Head Comparison of OnabotulinumtoxinA and Topiramate for Headache Prevention in Adults With Chronic Migraine. J Prim Care Community Health 2020; 11:2150132720959936. [PMID: 32985341 PMCID: PMC7536482 DOI: 10.1177/2150132720959936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction/Objective: Chronic migraine (CM) is associated with impaired health-related quality of
life and substantial socioeconomic burden, but many people with CM are
underdiagnosed and do not receive appropriate preventive treatment.
OnabotulinumtoxinA and topiramate have demonstrated
efficacy (treatment benefit under ideal conditions) for
the prevention of headaches in people with CM in clinical trials, but
real-world studies suggest markedly different clinical
effectiveness (treatment benefit based on a blend of
efficacy and tolerability). This study sought to evaluate patient-reported
outcomes (PROs) of onabotulinumtoxinA versus topiramate immediate release
for people with CM. Methods: FORWARD was a prospective, multicenter, randomized, parallel-group,
open-label, phase 4 study comparing onabotulinumtoxinA 155 U every 12 weeks
with topiramate 50 to 100 mg/day for ≤36 weeks in people with CM. PROs
measured included the Headache Impact Test (HIT-6), 9-item Patient Health
Questionnaire Quick Depression Assessment (PHQ-9), Work Productivity and
Activity Impairment Questionnaire: Specific Health Problem (WPAI:SHP), and
Functional Impact of Migraine Questionnaire (FIMQ). Results: A total of 282 patients were randomized and treated with onabotulinumtoxinA
(n = 140) or topiramate (n = 142). From baseline to week 30, mean HIT-6 test
scores improved significantly in patients taking onabotulinumtoxinA compared
with topiramate (P < .001). Improvements in depression
over time were observed via larger changes in PHQ-9 scores with
onabotulinumtoxinA than topiramate (P < .001). Work
productivity assessed via WPAI:SHP scores revealed significant improvements
with onabotulinumtoxinA versus topiramate in Work Productivity Loss
(P = .024) and Activity Impairment
(P < .001) domains. Results from the FIMQ also revealed
a larger reduction from baseline with onabotulinumtoxinA vs topiramate
(P < .0001). Conclusion: OnabotulinumtoxinA treatment had more favorable real-world effectiveness than
topiramate on depression, headache impact, functioning and daily living,
activity, and work productivity. The overall study results suggest that the
beneficial effects on a range of PROs are the result of improved
effectiveness when onabotulinumtoxinA is used as preventive treatment for
CM. Trial Registration: ClinicalTrials.gov: NCT02191579; https://clinicaltrials.gov/ct2/show/NCT02191579
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Affiliation(s)
- Andrew M Blumenfeld
- Headache Center of Southern California, The Neurology Center, Carlsbad, CA, USA
| | - Atul T Patel
- Kansas City Bone and Joint Clinic, Overland Park, KS, USA
| | - Ira M Turner
- The Center for Headache Care and Research, Island Neurological Associates, Plainview, NY, USA
| | | | | | - John F Rothrock
- George Washington University School of Medicine, Washington, DC, USA
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Donisi V, Mazzi MA, Gandolfi M, Deledda G, Marchioretto F, Battista S, Poli S, Giansante M, Geccherle E, Perlini C, Smania N, Del Piccolo L. Exploring Emotional Distress, Psychological Traits and Attitudes in Patients with Chronic Migraine Undergoing OnabotulinumtoxinA Prophylaxis versus Withdrawal Treatment. Toxins (Basel) 2020; 12:E577. [PMID: 32911799 PMCID: PMC7551686 DOI: 10.3390/toxins12090577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 12/20/2022] Open
Abstract
This explorative cross-sectional study aims at exploring emotional distress, psychological profiles, and the attitude towards receiving psychological support in eighty-seven patients with chronic migraine (CM) undergoing OnabotulinumtoxinA prophylactic treatment (OBT-A, n = 40) or withdrawal treatment (WT, n = 47). The outcomes were explored through a specific battery of questionnaires. 25% of patients undergoing OBT-A and almost half of the patients undergoing WT reported psychological distress of at least moderate-severe level, respectively. Coping strategies, self-efficacy, and perceived social support were similar in the two groups. Patients undergoing OBT-A presented lower psychological inflexibility than patients undergoing WT. Predictors of higher psychological distress were low perceived social support by friends, low self-efficacy, and higher avoidance strategies. In both groups, most of the patients evaluated receiving psychological support to be useful (79%). The potential beneficial effects of OBT-A on the severity of symptoms and psychological distress might further support its role in the multidisciplinary management of patients with CM. Identifying patients with psychological vulnerabilities who may benefit from psychological support is relevant in patients with CM.
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Affiliation(s)
- Valeria Donisi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (V.D.); (M.A.M.); (C.P.); (L.D.P.)
| | - Maria Angela Mazzi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (V.D.); (M.A.M.); (C.P.); (L.D.P.)
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, UOC Neurorehabilitation, AOUI Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy;
| | - Giuseppe Deledda
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy; (G.D.); (S.P.); (M.G.); (E.G.)
| | - Fabio Marchioretto
- Neurological Unit, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy;
| | - Simone Battista
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Via Magliotto, 2, 17100 Savona, Italy;
| | - Sara Poli
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy; (G.D.); (S.P.); (M.G.); (E.G.)
| | - Matteo Giansante
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy; (G.D.); (S.P.); (M.G.); (E.G.)
| | - Eleonora Geccherle
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy; (G.D.); (S.P.); (M.G.); (E.G.)
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (V.D.); (M.A.M.); (C.P.); (L.D.P.)
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, UOC Neurorehabilitation, AOUI Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy;
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (V.D.); (M.A.M.); (C.P.); (L.D.P.)
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Makunts T, Wollmer MA, Abagyan R. Postmarketing safety surveillance data reveals antidepressant effects of botulinum toxin across various indications and injection sites. Sci Rep 2020; 10:12851. [PMID: 32732918 PMCID: PMC7393507 DOI: 10.1038/s41598-020-69773-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/20/2020] [Indexed: 02/07/2023] Open
Abstract
The World Health Organization estimates the number of people suffering from depression to be over 264 million. Current monoamine transmission modulating therapeutics, even with proper adherence and acceptable tolerability, are not effective for nearly one third of the patients, leading clinicians to explore other therapeutic options such as electroconvulsive therapy, transcranial magnetic stimulation, ketamine infusions, and, more recently, glabellar botulinum toxin, BoNT, injections. The scale and mechanism of antidepressant action of BoNT is unclear and maybe hypothetically attributed to the disruption of proprioceptive facial feedback reinforcing negative emotions. Here we verify the antidepressant effect of botulinum toxin by analysis of over 40 thousand BoNT treatment reports out of thirteen million postmarketing safety reports in the FDA Adverse Event Reporting System, FAERS. The results of the analysis indicate that patients who received BoNT injections to treat hyperhidrosis, facial wrinkles, migraine prophylaxis, spasticity, and spasms, had a significantly lower number of depression reports when compared to patients undergoing different treatments for the same conditions. These findings suggest that the antidepressant effect of BoNT is significant, and, surprisingly, is observed for a broad range of injection sites.
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Affiliation(s)
- Tigran Makunts
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA.,Oak Ridge Institute of Science and Education Fellowship at Office of Clinical Pharmacology, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Marc Axel Wollmer
- Asklepios Clinic North-Ochsenzoll, Asklepios Campus Hamburg, Medical Faculty, Semmelweis University, Hamburg, Germany
| | - Ruben Abagyan
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA.
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Wang YF. OnabotulinumtoxinA injection in the treatment of chronic migraine. PROGRESS IN BRAIN RESEARCH 2020; 255:171-206. [PMID: 33008506 DOI: 10.1016/bs.pbr.2020.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/19/2022]
Abstract
The earliest descriptions of botulism were in the early 19th century, and was reported by the German physician Justinus Kerner. The term "botulism" was derived from the Latin word botulus, indicating its original association with sausages. It took another 150 years or so to come into clinical use. The first clinical application was strabismus, and was developed by the American ophthalmologist Alan B. Scott, whose effort led to the pharmaceutical product known as onabotulinumtoxinA today. The therapeutic benefit in migraine was an incidental finding in a report by the American plastic surgeon William J. Binder, which inspired a series of clinical studies in headache disorders. The doses and injection techniques in the earlier reports were variable, so were the results. It was until the Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) 1 and 2 studies when its efficacy and safety, as well as the indication, i.e., chronic migraine (CM), were ascertained. Even though there were criticisms regarding the heterogeneities in the results between the PREEMPT 1 and 2 studies, the data on efficacy endpoints and safety were generally consistent, which were subsequently confirmed by the open-label extension of the PREEMPT 1 and 2 studies, and three open-label studies, namely the Chronic Migraine OnabotulinuMtoxinA Prolonged Efficacy open Label (COMPEL), the REal-life use of botulinum toxin for the symptomatic treatment of adults with chronic migraine, measuring healthcare resource utilization, and Patient-reported OutcomeS observed in practice (REPOSE) studies, and the CM Post-Authorization Safety Study (CM PASS) studies. On the other hand, the results were challenged by the Chronification and Reversibility of Migraine (CHARM) study, which involved CM patients with medication overuse. It was concluded that the clinical improvement was attributed to early withdrawal of the overused acute medications, rather than onabotulinumtoxinA injections. However, fundamental differences in the patient profile and methodology between the CHARM and PREEMPT studies existed, and cautious should be exercised when interpreting and comparing the results. According to the practical guidelines and reimbursement regulations in many countries, its use is limited to CM patients, and is reserved for those who fail at least 2-3 preventive medications, due to either lack of efficacy or intolerability. Cessation of treatment is recommended in patients who do not respond to 2-3 injection cycles, or in patients whose headache frequency has dropped to <10-15 days a month. Even in the era of calcitonin-gene-related peptide monoclonal antibodies, onabotulinumtoxinA injection remains a treatment option of reasonable cost-effectiveness in carefully selected patients.
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Affiliation(s)
- Yen-Feng Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
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Alpuente A, Gallardo VJ, Torres-Ferrús M, Álvarez-Sabin J, Pozo-Rosich P. Short and Mid-Term Predictors of Response to OnabotulinumtoxinA: Real-Life Experience Observational Study. Headache 2020; 60:677-685. [PMID: 32086801 DOI: 10.1111/head.13765] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify clinical predictors of excellent response to OnabotulinumtoxinA in patients with chronic migraine (CM) at 6 and 12 months of follow-up. BACKGROUND Clinical predictors of response to OnabotulinumtoxinA are scarce and have not been clearly reproduced and analyzed in detail. So far, predictors of response to OnabotulinumtoxinA assess response in general or good response, but not an excellent response. METHODS Cohort study of patients attended in a specialized Headache Clinic in treatment with OnabotulinumtoxinA were classified according to their improvement in frequency: no-response (<25%) and excellent response (≥75%). A comparative analysis was carried out at 6 and 12 months identifying clinical predictors of excellent response to OnabotulinumtoxinA at each timepoint. RESULTS Data were collected from 221 patients. After 6 and also 12 months, we observed a statistically significant mean reduction in frequency and analgesic intake. At month 6, independent variables associated with excellent response (OR[95%CI]) were daily headache frequency (0.32[0.14-0.74]; P = .005), medication overuse (MO) (2.28[1.19-4.37]; P = .013), and a higher ratio of migraine days/month (MDM) (1.20[1.10-1.45]; P = .018) at baseline. At month 12, independent predictors of excellent response were patients with less than 30 years of migraine evolution (0.43[0.23-0.82]; P = .011), presence of anxiety (0.44[0.23-0.85]; P = .018), and aura (0.48[0.25-0.92]; P = .037). Excellent responders showed a higher improvement rate in pain intensity at 6 and 12 months. CONCLUSIONS Patients with daily frequency and MO show a clinical improvement in short-term. Patients with comorbidities who start treatment earlier in the course of the disease need a longer duration of treatment. The profile of response to treatment with OnabotulinumtoxinA determines its minimum treatment duration and the timepoint of a meaningful response.
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Affiliation(s)
- Alicia Alpuente
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Víctor José Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrús
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Álvarez-Sabin
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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Ho S, Darby D, Bear N. Cognitive effects of onabotulinumtoxinA in chronic migraine. BMJ Neurol Open 2020; 2:e000014. [PMID: 33681771 PMCID: PMC7871717 DOI: 10.1136/bmjno-2019-000014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/18/2019] [Accepted: 12/17/2019] [Indexed: 01/03/2023] Open
Abstract
Background Chronic migraine is a disabling condition, often associated with comorbidities including cognitive dysfunction, anxiety and depression. It is unclear whether cognitive complaints are associated with the underlying migraine pathophysiological process or related to drugs or comorbidities of depression and anxiety. Objective To evaluate cognitive changes in chronic migraine and assess reversibility of cognitive dysfunction following effective migraine treatment using onabotulinumtoxinA. Methods This was a prospective real-world study of 60 patients with chronic migraine treated with onabotulinumtoxinA. Headache diaries recorded total headache days at baseline and duration of 12 weeks post-treatment. Computerised cognitive tests of reaction time and working memory (WM) speed and accuracy using a purpose-specific website was implemented at baseline, 6 weeks and 12 weeks. The Patient Health Questionnaire (PHQ-9) and Penn State Worry Questionnaire-Past Week (PSWQ-PW) were administered for depression and anxiety levels. Associations between clinical response, cognitive parameters, PHQ-9 and PSWQ-PW were analysed. Results At 6 weeks post-treatment, 88% patients achieved good response (≥50% reduction in headache frequency) with improvement of PHQ-9, PSWQ-PW, cognitive speed tests and WM accuracy compared with baseline (all p<0.05). There was no overall correlation between good headache response and improved cognitive measures and no association between good headache response and improved PHQ-9 and PSWQ-PW scores. Improved WM accuracy correlated with reduced PSWQ-PW (p=0.047). There was no correlation between improved WM accuracy and reduced PHQ-9. Conclusions OnabotulinumtoxinA treatment for chronic migraine improved anxiety, depression and cognitive performances but these improvements did not correlate with reduction in headache and migraine frequency. Improved WM accuracy was significantly associated with reduced anxiety level.
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Affiliation(s)
- Susan Ho
- Neurology, St John of God Mt Lawley Hospital, Mount Lawley, Western Australia, Australia
| | - David Darby
- Neurology Department, Florey Institute of Neuroscience and Mental Health-Austin Campus, Heidelberg, Victoria, Australia
| | - Natasha Bear
- Department of Statistics, Bear Statistics, Perth, Western Australia, Australia
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Abstract
OnabotulinumtoxinA (Botox®; a formulation of botulinum toxin type A (BoNT/A)] is indicated for the prevention of headaches in adults with chronic migraine (CM) in numerous countries, including those of Europe. In clinical trials, intramuscular administration of BoNT/A (155-195 units at 12-week intervals) to patients with CM was generally well tolerated and associated with sustained and clinically meaningful improvements in multiple assessments of headache symptoms, headache-related impact and/or disability and migraine-specific health-related quality of life over a period of 1 year (in the pivotal PREEMPT 1 and 2 studies) and 2 years (in the phase IV COMPEL study). The efficacy and safety of BoNT/A therapy have been confirmed in a number of large, prospective, real-world studies conducted in Europe, including the 2-year REPOSE study. Intramuscular BoNT/A has also demonstrated greater clinical utility than the oral prophylactic medication topiramate in a clinical practice setting (FORWARD study).
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Affiliation(s)
- James E Frampton
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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Yuan H, Silberstein SD. The Use of Botulinum Toxin in the Management of Headache Disorders. Handb Exp Pharmacol 2020; 263:227-249. [PMID: 32562057 DOI: 10.1007/164_2020_365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Tremendous progress has been made in the past decades for the treatment of headache disorders. Chronic migraine is the most disabling type of headache and requires the use of acute and preventive medications, many of which are associated with adverse events that limit patient adherence. Botulinum toxin (BoNT) serotype A, a neurotoxin derived from certain strains of Clostridium, disrupts neuropeptide secretion and receptor translocation related to trigeminal nociception, thereby preventing pain sensitization through peripheral and possibly central mechanisms. Ever since the first randomized controlled trial on onabotulinumtoxinA (onabotA) for migraine was published two decades ago, onabotA has been the only BoNT formulation approved for use in the prevention of chronic migraine. Superior tolerability and efficacy have been demonstrated on multiple migraine endpoints in many controlled trials and real-life studies. OnabotA is a safe and efficacious treatment for chronic migraine and possibly high-frequency episodic migraine. Further research is still needed to understand its mechanism of action to fully develop its therapeutic potential.
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Affiliation(s)
- Hsiangkuo Yuan
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
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Rothrock JF, Adams AM, Lipton RB, Silberstein SD, Jo E, Zhao X, Blumenfeld AM. FORWARD Study: Evaluating the Comparative Effectiveness of OnabotulinumtoxinA and Topiramate for Headache Prevention in Adults With Chronic Migraine. Headache 2019; 59:1700-1713. [PMID: 31559634 PMCID: PMC6899480 DOI: 10.1111/head.13653] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2019] [Indexed: 01/03/2023]
Abstract
Objective To compare effectiveness of onabotulinumtoxinA and topiramate for chronic migraine (CM) prevention. Background The efficacy* of onabotulinumtoxinA and topiramate has been established in placebo‐controlled randomized clinical trials (*defined as the benefit of treatment under ideal conditions). The effectiveness* of the 2 preventive treatments, however, has not been established (*the benefit of treatment under real‐world conditions, representing a blend of efficacy and tolerability). Methods In this multicenter, randomized, parallel‐group, post‐authorization, open‐label prospective study (FORWARD; http://ClinicalTrials.gov, NCT02191579), we randomized adults with CM (1:1) to onabotulinumtoxinA 155 U every 12 weeks for 3 cycles or topiramate “immediate release” 50‐100 mg/day to week 36. Primary outcome measure was proportion of patients achieving ≥50% reduction in headache days (weeks 29‐32). Missing values were imputed using baseline observation carried forward (BOCF) methodology. After 12 weeks, patients initially randomized to topiramate could cross over to onabotulinumtoxinA treatment. We monitored and recorded all adverse events (AEs). Results We enrolled 282 patients (onabotulinumtoxinA, n = 140; topiramate, n = 142) and 148 patients completed randomized treatment (onabotulinumtoxinA, n = 120 [86%]; topiramate, n = 28 [20%]). Primary reasons for withdrawal were ineffective treatment (onabotulinumtoxinA, n = 7 [5%]; topiramate, n = 27 [19%]) and AEs (onabotulinumtoxinA, n = 5 [4%]; topiramate, n = 72 [51%]). Eighty topiramate patients crossed over to onabotulinumtoxinA. In the BOCF analysis, a significantly higher proportion of patients randomized to onabotulinumtoxinA experienced ≥50% reduction in headache frequency compared with those randomized to topiramate (40% [56/140] vs 12% [17/142], respectively; adjusted OR, 4.9 [95% CI, 2.7‐9.1]; P < .001). OnabotulinumtoxinA was superior to topiramate in meeting secondary endpoints. In a post hoc analysis using observed data, the 50% responder rates at week 12 were 45.6% for onabotulinumtoxinA (n = 125) and 29.4% for topiramate (n = 109) (P = .015). AEs were reported by 48% (105/220) of onabotulinumtoxinA and 79% (112/142) of topiramate patients. Results were similar in those who crossed over to onabotulinumtoxinA. Conclusions While using imputation methods of accounting for differences in discontinuation rates, we found onabotulinumtoxinA to have greater clinical utility than topiramate, largely because of tolerability issues associated with the latter and a relatively higher number of onabotulinumtoxinA patients remaining on treatment.
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Affiliation(s)
- John F Rothrock
- Department of Neurology, George Washington University School of Medicine, Washington, DC, USA
| | | | - Richard B Lipton
- Department of Neurology, Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Esther Jo
- Global Medical Affairs, Allergan plc, Irvine, CA, USA
| | - Xiang Zhao
- Department of Statistics, Pharmaceutical Product Development, Austin, TX, USA
| | - Andrew M Blumenfeld
- Department of Neurology, Headache Center of Southern California, The Neurology Center, Carlsbad, CA, USA
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Coles NA, Larsen JT, Kuribayashi J, Kuelz A. Does Blocking Facial Feedback Via Botulinum Toxin Injections Decrease Depression? A Critical Review and Meta-Analysis. EMOTION REVIEW 2019. [DOI: 10.1177/1754073919868762] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Researchers have proposed that blocking facial feedback via glabellar-region botulinum toxin injections (GBTX) can reduce depression. Random-effects meta-analyses of studies that administered GBTX to individuals with depression indicate that, 6 weeks postintervention, GBTX groups were significantly less depressed compared to placebo groups ( d = 0.83) and pretreatment levels ( d = 1.57). However, we noted the following concerns: (a) effect sizes were extraordinarily large, (b) authors failed to provide information to compute 51% of relevant effect sizes, (c) 96% of effect sizes came from studies conducted by investigators with conflicts of interest, (d) there is some evidence of publication bias, and (e) studies used ineffective blinding procedures. These considerations suggest that confidence in GBTX as a treatment for depression is premature.
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Affiliation(s)
| | | | | | - Ashley Kuelz
- Department of Psychology, University of Tennessee, USA
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Gandolfi M, Donisi V, Marchioretto F, Battista S, Smania N, Del Piccolo L. A Prospective Observational Cohort Study on Pharmacological Habitus, Headache-Related Disability and Psychological Profile in Patients with Chronic Migraine Undergoing OnabotulinumtoxinA Prophylactic Treatment. Toxins (Basel) 2019; 11:toxins11090504. [PMID: 31470654 PMCID: PMC6783872 DOI: 10.3390/toxins11090504] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 12/16/2022] Open
Abstract
Chronic Migraine (CM) is a disabling neurologic condition with a severe impact on functioning and quality of life. Successful therapeutic management of patients with CM is complex, and differences in therapeutic response could be attributable to genetically determined factors, sensitivity to pharmacological treatment, psychosocial and relational factors affecting the patient’s compliance and approach on the therapeutic treatment. The aim of this prospective observational study was to explore self-efficacy, coping strategies, psychological distress and headache-related disability in a cohort of 40 patients with CM (mean age: 46.73; standard deviation 13.75) treated with OnabotulinumtoxinA and the relationship between these clinical and psychological aspects and acute medication consumption during OnabotulinumtoxinA prophylactic treatment. Patients presented an overall significant reduction in the Headache Index (HI) (p < 0.001), HI with severe intensity (p = 0.009), and total analgesic consumption (p = 0.003) after the prophylactic treatment. These results are in line with the literature. Despite this, higher nonsteroidal anti-inflammatory drugs consumption was associated with higher psychological distress, higher HI with severe and moderate intensity, and worse quality of life. Conversely, triptans consumption was correlated with HI of mild intensity, and problem-focused coping strategies. To conclude, the psychological profile, and in particular, the psychological distress and specific coping strategies might influence the self-management of acute medication.
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy.
- UOC Neurorehabilitation, AOUI Verona, 37134 Verona, Italy.
| | - Valeria Donisi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Fabio Marchioretto
- Unit of Neurology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy
| | - Simone Battista
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
- UOC Neurorehabilitation, AOUI Verona, 37134 Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
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Schiano di Cola F, Caratozzolo S, Liberini P, Rao R, Padovani A. Response Predictors in Chronic Migraine: Medication Overuse and Depressive Symptoms Negatively Impact Onabotulinumtoxin-A Treatment. Front Neurol 2019; 10:678. [PMID: 31354606 PMCID: PMC6635602 DOI: 10.3389/fneur.2019.00678] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/10/2019] [Indexed: 01/03/2023] Open
Abstract
Background: Despite numerous studies that have investigated clinical, radiological, and biochemical response predictors, the clinical profile of those patients who might benefit from OnabotulinumtoxinA is still missing. The aim of the present study was to identify potential OnabotulinumtoxinA response predictors among several clinical characteristics and confirm OnabotulinumtoxinA efficacy and safety in chronic migraine (CM) prevention. Methods: The study was conducted at the Headache Center—Neurology Clinic—Spedali Civili Hospital of Brescia. Eighty-four consecutive CM patients were enrolled, with a mean age of 48 years (SD 9.7) and a mean disease duration of 10.1 years (SD 6.6). The mean reported headache-days frequency was 22.5 (SD 5.9) per month, while the mean number of severe headache-days was 15.2 (SD 8.9) with a mean monthly medication intake of 33.2 (SD 5.6). The clinical characteristics analyzed as potential response predictors were: gender, disease duration, migraine characteristics (location, side constancy, unilateral autonomic and neurovegetative symptoms), previous prophylactic treatments, add-on therapies, withdrawal therapies, psychiatric (anxiety and depression symptoms) comorbidities and medication overuse. Results: A significant reduction from baseline to 3, 6, 9, and 12 month treatment cycles in total headache days, high intensity headache days and triptans consumption per month was found. Depressive symptoms and medication overuse negatively predicted OnabotulinumtoxinA outcome. Conclusions: Our results confirm the efficacy and safety of OnabotulinumtoxinA in CM. Depressive comorbidity and medication overuse, among all clinical variables, were the only significant response predictors. Such findings provide interesting insights regarding patients selection for OnabotulinumtoxinA treatment as, with the introduction of anti calcitonin gene-related (CGRP) monoclonal antibodies, clinicians will have to thoroughly judge and tailor among the many available therapeutic options now available. Future research might be needed to confirm our findings, in particular for its therapeutic implications.
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Affiliation(s)
- Francesca Schiano di Cola
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | - Renata Rao
- Neurology Unit, Spedali Civili Hospital, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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