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Rothrock JF. Headache due to Vascular Disorders. Neurol Clin 2024; 42:375-388. [PMID: 38575257 DOI: 10.1016/j.ncl.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Headache and cerebrovascular disease (CVD) are inextricably linked. Although in some cases headache complicating CVD may be little more than a symptomatic afterthought, in other cases, early recognition of headache's role in the CVD process is critical to effective management. In other words, headaches secondary to CVD span a spectrum, and in this article, we will review that spectrum.
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Affiliation(s)
- John F Rothrock
- Inova Health/University of Virginia School of Medicine, Migraineur.
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2
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Pellesi L, Do TP, Hougaard A. Pharmacological management of migraine: current strategies and future directions. Expert Opin Pharmacother 2024; 25:673-683. [PMID: 38720629 DOI: 10.1080/14656566.2024.2349791] [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: 02/22/2024] [Accepted: 04/26/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Migraine is a complex neurological disorder that affects a significant portion of the global population. As traditional pharmacological approaches often fall short in alleviating symptoms, the development of innovative therapies has garnered significant interest. This text aims to summarize the current pharmacological options for managing migraine and to explore the potential impact of novel therapies. AREAS COVERED We focused on conventional treatments, emerging therapies, and novel compounds in clinical development, including therapies targeting the trigeminovascular system, cannabis-based therapies, hormonal and metabolic therapies, and other options. English peer-reviewed articles were searched in PubMed, Scopus, and ClinicalTrials.gov electronic databases. EXPERT OPINION Several novel treatment options for migraine have become available in recent years. Emerging pharmacological therapies targeting the trigeminovascular system, cannabis-based therapies, hormonal and metabolic interventions, and other emerging treatment modalities, may prove to be valuable for the treatment of migraine. Further research, clinical trials, and substantiated evidence are necessary to validate the efficacy, safety, and long-term outcomes of these therapeutic options.
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Affiliation(s)
- Lanfranco Pellesi
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Thien Phu Do
- Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Neurology, Danish Knowledge Center on Headache Disorders, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Anders Hougaard
- Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
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Charles AC, Digre KB, Goadsby PJ, Robbins MS, Hershey A. Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine: An American Headache Society position statement update. Headache 2024; 64:333-341. [PMID: 38466028 DOI: 10.1111/head.14692] [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: 02/06/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To provide a position statement update from The American Headache Society specifically regarding therapies targeting calcitonin gene-related peptide (CGRP) for the prevention of migraine. BACKGROUND All migraine preventive therapies previously considered to be first-line treatments were developed for other indications and adopted later for migraine. Adherence to these therapies is often poor due to issues with efficacy and tolerability. Multiple new migraine-specific therapies have been developed based on a broad foundation of pre-clinical and clinical evidence showing that CGRP plays a key role in the pathogenesis of migraine. These CGRP-targeting therapies have had a transformational impact on the management of migraine but are still not widely considered to be first-line approaches. METHODS Evidence regarding migraine preventive therapies including primary and secondary endpoints from randomized placebo-controlled clinical trials, post hoc analyses and open-label extensions of these trials, and prospective and retrospective observational studies were collected from a variety of sources including PubMed, Google Scholar, and ClinicalTrials.gov. The results and conclusions based upon these results were reviewed and discussed by the Board of Directors of The American Headache Society to confirm consistency with clinical experience and to achieve consensus. RESULTS The evidence for the efficacy, tolerability, and safety of CGRP-targeting migraine preventive therapies (the monoclonal antibodies: erenumab, fremanezumab, galcanezumab, and eptinezumab, and the gepants: rimegepant and atogepant) is substantial, and vastly exceeds that for any other preventive treatment approach. The evidence remains consistent across different individual CGRP-targeting treatments and is corroborated by extensive "real-world" clinical experience. The data indicates that the efficacy and tolerability of CGRP-targeting therapies are equal to or greater than those of previous first-line therapies and that serious adverse events associated with CGRP-targeting therapies are rare. CONCLUSION The CGRP-targeting therapies should be considered as a first-line approach for migraine prevention along with previous first-line treatments without a requirement for prior failure of other classes of migraine preventive treatment.
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Affiliation(s)
- Andrew C Charles
- Department of Neurology, UCLA Goldberg Migraine Program, Los Angeles, California, USA
| | - Kathleen B Digre
- Departments of Neurology and Ophthalmology, University of Utah, Salt Lake City, Utah, USA
| | - Peter J Goadsby
- Department of Neurology, UCLA Goldberg Migraine Program, Los Angeles, California, USA
- King's College London, London, UK
| | - Matthew S Robbins
- Department of Neurology, Weill Cornell Medical College, New York, New York, USA
| | - Andrew Hershey
- Department of Pediatrics and Neurology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Mainland RL, Skinner CR, Saary J. Aeromedical Risk of Migraine. Aerosp Med Hum Perform 2024; 95:101-112. [PMID: 38263111 DOI: 10.3357/amhp.6291.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
INTRODUCTION: Migraine is a common condition that can carry considerable risk to aeromedical duties. Because randomized controlled trials are not an appropriate method to evaluate flight safety risk for medical conditions that may cause subtle or sudden incapacitation, the determination of fitness-to-fly must be based on risk assessments informed by extrapolated evidence. Therefore, we conducted a review of current literature to provide background information to inform the aeromedical risk assessment of migraine using a risk matrix approach.METHODS: We identified studies on topics pertinent to conducting an aeromedical risk assessment of migraine. We generated an overview of the literature synthesizing the findings of articles retrieved from searches of Scopus, Ovid, PubMed, and the Cochrane Library published in English from all years, in both general and aircrew populations. International headache and neurology guidelines, as well as headache policies from the U.S. Air Force, were also reviewed.RESULTS: This review includes information on the following topics relevant to conducting an evidence-based risk assessment of migraine: diagnosis, prevalence, incidence, natural course, clinical presentation, triggers, comorbidities, neuroimaging, implications of family history, and efficacy of pharmacological and nonpharmacological therapies.DISCUSSION: This review summarizes current literature on migraine for use in a risk matrix approach to the aeromedical assessment of migraine in prospective and current aircrew. Awareness of the most current epidemiological data related to a variety of migraine parameters facilitates an evidence-based risk assessment of migraine in aircrew and requires iterative updates as new information becomes available.Mainland RL, Skinner CR, Saary J. Aeromedical risk of migraine. Aerosp Med Hum Perform. 2024; 95(2):101-112.
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Tseng PT, Zeng BY, Chen JJ, Kuo CH, Zeng BS, Kuo JS, Cheng YS, Sun CK, Wu YC, Tu YK, Stubbs B, Carvalho AF, Liang CS, Chen TY, Hsu CW, Suen MW, Yang CP, Hsu SP, Chen YW, Shiue YL, Hung CM, Su KP, Lin PY. High Dosage Omega-3 Fatty Acids Outperform Existing Pharmacological Options for Migraine Prophylaxis: A Network Meta-Analysis. Adv Nutr 2024; 15:100163. [PMID: 38110000 PMCID: PMC10808921 DOI: 10.1016/j.advnut.2023.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/08/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023] Open
Abstract
Migraine is a highly prevalent neurologic disorder with prevalence rates ranging from 9% to 18% worldwide. Current pharmacologic prophylactic strategies for migraine have limited efficacy and acceptability, with relatively low response rates of 40% to 50% and limited safety profiles. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are considered promising therapeutic agents for migraine prophylaxis. The aim of this network meta-analysis (NMA) was to compare the efficacy and acceptability of various dosages of EPA/DHA and other current Food and Drug Administration-approved or guideline-recommended prophylactic pharmacologic interventions for migraine. Randomized controlled trials (RCTs) were eligible for inclusion if they enrolled participants with a diagnosis of either episodic or chronic migraine. All NMA procedures were conducted under the frequentist model. The primary outcomes assessed were 1) changes in migraine frequency and 2) acceptability (i.e., dropout for any reason). Secondary outcomes included response rates, changes in migraine severity, changes in the frequency of using rescue medications, and frequency of any adverse events. Forty RCTs were included (N = 6616; mean age = 35.0 y; 78.9% women). Our analysis showed that supplementation with high dosage EPA/DHA yields the highest decrease in migraine frequency [standardized mean difference (SMD): -1.36; 95% confidence interval (CI): -2.32, -0.39 compared with placebo] and the largest decrease in migraine severity (SMD: -2.23; 95% CI: -3.17, -1.30 compared with placebo) in all studied interventions. Furthermore, supplementation with high dosage EPA/DHA showed the most favorable acceptability rates (odds ratio: 1.00; 95% CI: 0.06, 17.41 compared with placebo) of all examined prophylactic treatments. This study provides compelling evidence that high dosage EPA/DHA supplementation can be considered a first-choice treatment of migraine prophylaxis because this treatment displayed the highest efficacy and highest acceptability of all studied treatments. This study was registered in PROSPERO as CRD42022319577.
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Affiliation(s)
- Ping-Tao Tseng
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Psychology, Collage of Medical and Health Science, Taichung, Asia University, Taiwan; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan; Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Bing-Yan Zeng
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Jiann-Jy Chen
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan; Department of Otorhinolaryngology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chun-Hsien Kuo
- Department of Psychology, Collage of Medical and Health Science, Taichung, Asia University, Taiwan
| | - Bing-Syuan Zeng
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - John S Kuo
- Neuroscience and Brain Disease Center and Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Yu-Shian Cheng
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine for International Students, College of Medicine, I-Shou University Kaohsiung, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Positive Ageing Research Institute (PARI), Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Andre F Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mein-Woei Suen
- Department of Psychology, Collage of Medical and Health Science, Taichung, Asia University, Taiwan; Gender Equality Education and Research Center, Asia University, Taichung, Taiwan; Department of Medical Research, Asia University Hospital, Asia University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Pai Yang
- Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan; Department of Nutrition, Hungkuang University, Taichung, Taiwan
| | - Shih-Pin Hsu
- Department of Neurology, E-Da hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan.
| | - Chao-Ming Hung
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Division of General Surgery, Department of Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.
| | - Kuan-Pin Su
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Mind-Body Interface Research Center (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan.
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital.
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Patniyot I, Banerjee A, Nobleza K, Nguyen D, Duggan D, Holick M, Dudley-Harrell H. A retrospective analysis of the use of candesartan for migraine prevention in adolescents. Headache 2024; 64:96-97. [PMID: 38235835 DOI: 10.1111/head.14666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Irene Patniyot
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital Pediatric Headache Center, Baylor College of Medicine, Houston, Texas, USA
| | - Ankona Banerjee
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital Pediatric Headache Center, Baylor College of Medicine, Houston, Texas, USA
| | - Kenneth Nobleza
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital Pediatric Headache Center, Baylor College of Medicine, Houston, Texas, USA
| | - Duc Nguyen
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital Pediatric Headache Center, Baylor College of Medicine, Houston, Texas, USA
| | - Deanna Duggan
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital Pediatric Headache Center, Baylor College of Medicine, Houston, Texas, USA
| | - Michelle Holick
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital Pediatric Headache Center, Baylor College of Medicine, Houston, Texas, USA
| | - Holly Dudley-Harrell
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital Pediatric Headache Center, Baylor College of Medicine, Houston, Texas, USA
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Qaiser H, Uzair M, Arshad M, Zafar A, Bashir S. Evaluating the Potential of Green Light Exposure on Nociception-A Mini Review. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:675-679. [PMID: 37221686 DOI: 10.2174/1871527322666230522105931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/13/2023] [Accepted: 04/20/2023] [Indexed: 05/25/2023]
Abstract
The capacity of animals to react to unpleasant stimuli that might endanger their integrity is known as nociception. Pharmacological treatments do not show satisfactory results in response to nociception. In the recent era, light therapy emerged as a potential non-pharmacological approach for treating various diseases, including seasonal affective disorders, migraine, pain, and others. Evaluating the potential of green light exposure on nociception involves studying its effects on different types of pain and pain-related conditions and determining the optimal exposure methods. This review provides the beneficial effects of green light on the reduction in the frequency of pain. The green light exposure on nociception changes the activity of pain-related genes and proteins in cells. This review could provide insights into the underlying mechanisms by which green light modulates pain. Overall, evaluating the potential of green light exposure on nociception requires a multidisciplinary approach and should consider the safety, efficacy, optimal dose, and duration of green light exposure and the type of pain. However, few studies have been reported so far; therefore, light therapy for treating migraines require more studies on animal models to provide precise results of light effects on nociception.
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Affiliation(s)
- Hammad Qaiser
- Department of Biological Sciences, Faculty of Basic & Applied Sciences, International Islamic University, Islamabad, Pakistan
| | - Mohammad Uzair
- Department of Biological Sciences, Faculty of Basic & Applied Sciences, International Islamic University, Islamabad, Pakistan
| | - Muhammad Arshad
- Department of Biological Sciences, Faculty of Basic & Applied Sciences, International Islamic University, Islamabad, Pakistan
| | - Anessa Zafar
- CMH Kharian Medical College, Kharian Cantonment, Kharian Cantt Kharian, Gujrat, Pakistan
| | - Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Bjørk MH, Borkenhagen S, Oteiza F, Dueland AN, Sørgaard FE, Saether EM, Bugge C. Comparative retention and effectiveness of migraine preventive treatments: A nationwide registry-based cohort study. Eur J Neurol 2024; 31:e16062. [PMID: 37754544 DOI: 10.1111/ene.16062] [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: 12/08/2022] [Revised: 07/28/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND AND PURPOSE Little is known about the comparative effects of migraine preventive drugs. We aimed to estimate treatment retention and effectiveness of migraine preventive drugs in a nationwide registry-based cohort study in Norway between 2010 and 2020. METHODS We assessed retention, defined as the number of uninterrupted treatment days, and effectiveness, defined as the reduction in filled triptan prescriptions during four 90-day periods after the first preventive prescription, compared to a 90-day baseline period. We compared retention and efficacy for different drugs against beta blockers. Comparative retention was estimated with hazard ratios (HRs), adjusted for covariates, using Cox regression, and effectiveness as odds ratios (ORs) using logistic regression, with propensity-weighted adjustment for covariates. RESULTS We identified 104,072 migraine patients, 81,890 of whom were female (78.69%) and whose mean (standard deviation) age was 44.60 (15.61) years. Compared to beta blockers, botulinum toxin (HR 0.43, 95% confidence interval [CI] 0.42-0.44) and calcitonin gene-related peptide pathway antibodies (CGRPabs; HR 0.63, 95% CI 0.59-0.66) were the least likely to be discontinued, while clonidine (HR 2.95, 95% CI 2.88-3.02) and topiramate (HR 1.34, 95% CI 1.31-1.37) were the most likely to be discontinued. Patients on simvastatin, CGRPabs, and amitriptyline were more likely to achieve a clinically significant reduction in triptan use during the first 90 days of treatment, with propensity score-adjusted ORs of 1.28 (95% CI 1.19-1.38), 1.23 (95% CI 0.79-1.90), and 1.13 (95% CI 1.08-1.17), respectively. CONCLUSIONS We found a favorable effect of CGRPabs, amitriptyline, and simvastatin compared with beta blockers, while topiramate and clonidine were associated with poorer outcomes.
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Affiliation(s)
- Marte H Bjørk
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- NorHEAD, Norwegian Headache Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Aud N Dueland
- Sandvika Nevrosenter, Sandvika, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | | | - Christoffer Bugge
- Oslo Economics, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Villapol S, Janatpour ZC, Affram KO, Symes AJ. The Renin Angiotensin System as a Therapeutic Target in Traumatic Brain Injury. Neurotherapeutics 2023; 20:1565-1591. [PMID: 37759139 PMCID: PMC10684482 DOI: 10.1007/s13311-023-01435-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Traumatic brain injury (TBI) is a major public health problem, with limited pharmacological options available beyond symptomatic relief. The renin angiotensin system (RAS) is primarily known as a systemic endocrine regulatory system, with major roles controlling blood pressure and fluid homeostasis. Drugs that target the RAS are used to treat hypertension, heart failure and kidney disorders. They have now been used chronically by millions of people and have a favorable safety profile. In addition to the systemic RAS, it is now appreciated that many different organ systems, including the brain, have their own local RAS. The major ligand of the classic RAS, Angiotensin II (Ang II) acts predominantly through the Ang II Type 1 receptor (AT1R), leading to vasoconstriction, inflammation, and heightened oxidative stress. These processes can exacerbate brain injuries. Ang II receptor blockers (ARBs) are AT1R antagonists. They have been shown in several preclinical studies to enhance recovery from TBI in rodents through improvements in molecular, cellular and behavioral correlates of injury. ARBs are now under consideration for clinical trials in TBI. Several different RAS peptides that signal through receptors distinct from the AT1R, are also potential therapeutic targets for TBI. The counter regulatory RAS pathway has actions that oppose those stimulated by AT1R signaling. This alternative pathway has many beneficial effects on cells in the central nervous system, bringing about vasodilation, and having anti-inflammatory and anti-oxidative stress actions. Stimulation of this pathway also has potential therapeutic value for the treatment of TBI. This comprehensive review will provide an overview of the various components of the RAS, with a focus on their direct relevance to TBI pathology. It will explore different therapeutic agents that modulate this system and assess their potential efficacy in treating TBI patients.
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Affiliation(s)
- Sonia Villapol
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX, USA
| | - Zachary C Janatpour
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Kwame O Affram
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Aviva J Symes
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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10
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Zhao YJ, Idu Jion YB, Ho KH, Wong PS, Lo YL, Chan YC, Ang LL, Yeo SN, Soh SB, Wu TS, Yuan Ong JJ. Approach to headache disorders and the management of migraine: consensus guidelines from the Headache Society of Singapore, first edition (2023). Singapore Med J 2023:386395. [PMID: 37870040 DOI: 10.4103/singaporemedj.smj-2022-195] [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: 10/24/2023]
Abstract
Headache disorders, particularly migraine, are one of the most common and disabling neurological disorders. There is a need for high-quality, accessible care for patients with headache disorders across all levels of the healthcare system in Singapore. The role of the Headache Society of Singapore is to increase awareness and advance the understanding of these disorders and to advocate for the needs of affected patients. In this first edition of local consensus guidelines, we focus on treatment approaches for headaches and provide consensus recommendations for the management of migraine in adults. The recommendations in these guidelines can be used as a practical tool in routine clinical practice by primary care physicians, neurologists and other healthcare professionals who have a common interest in headache disorders.
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Affiliation(s)
- Yi Jing Zhao
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - King Hee Ho
- Ho Neurology Pte Ltd, Gleneagles Medical Centre, Singapore
| | - Pei Shieen Wong
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - Yew Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Yee Cheun Chan
- Division of Neurology, Department of Medicine, National University Hospital; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lai Lai Ang
- Yong Loo Lin School of Medicine, National University of Singapore; National University Polyclinics, National University Health System, Singapore
| | - Sow Nam Yeo
- The Pain Specialist, Mount Elizabeth Hospital and Mount Elizabeth Novena Hospital, Singapore
| | - Soon Beng Soh
- Primary Care Network, National University Health System, Singapore
| | - Tuck Seng Wu
- Department of Pharmacy, National University Hospital, Singapore
| | - Jonathan Jia Yuan Ong
- Division of Neurology, Department of Medicine, National University Hospital; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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George A, Minen MT. Episodic Migraine and Psychiatric Comorbidity: A Narrative Review of the Literature. Curr Pain Headache Rep 2023; 27:461-469. [PMID: 37382869 DOI: 10.1007/s11916-023-01123-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE OF REVIEW We evaluate the evolving evidence of psychiatric comorbidities associated with episodic migraine. Utilizing recent research publications, we aim to assess traditional treatment option considerations and discuss recent and evolving non-pharmacologic treatment progress for episodic migraine and related psychiatric conditions. RECENT FINDINGS Recent findings indicate that episodic migraine is strongly linked to comorbid depression, anxiety, posttraumatic stress disorder, and sleep disorders. Not only do patients with episodic migraine have higher rates of psychiatric comorbidity, but a higher number of headache days reported is also strongly linked to an increased risk of developing a psychiatric disorder, indicating there may be a link between frequency and psychiatric comorbidity and that patients with high-frequency episodic migraine should be assessed for psychiatric comorbidity. Few migraine preventive medications have examined the effect of the medication on both migraine and psychiatric comorbidity though we discuss what has been reported in the literature. Non-pharmacologic-based treatments including behavioral therapies and mind-body interventions previously developed for psychiatric conditions, e.g., mindfulness-based CBT (MBCT), acceptance and commitment therapy (ACT), and mindfulness-based stress reduction (MBSR) therapy, have promising results for patients diagnosed with episodic migraine and may therefore be useful in treating migraine and comorbid psychiatric conditions. Psychiatric comorbidity may affect the efficacy of the treatment of episodic migraine. Thus, we must assess for psychiatric comorbidities to inform better treatment plans for patients. Providing patients with episodic migraine with alternate modalities of treatment may help to improve patient-centered care and increase patients' sense of self-efficacy.
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Affiliation(s)
- Alexis George
- Department of Neurology, NYU Langone Health, 222 East 41st Street, New York, NY, 10017, USA
| | - Mia T Minen
- Department of Neurology, NYU Langone Health, 222 East 41st Street, New York, NY, 10017, USA.
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Kalkman DN, Couturier EGM, El Bouziani A, Dahdal J, Neefs J, Woudstra J, Vogel B, Trabattoni D, MaassenVanDenBrink A, Mehran R, de Winter RJ, Appelman Y. Migraine and cardiovascular disease: what cardiologists should know. Eur Heart J 2023; 44:2815-2828. [PMID: 37345664 DOI: 10.1093/eurheartj/ehad363] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/06/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023] Open
Abstract
Migraine is a chronic neurovascular disease with a complex, not fully understood pathophysiology with multiple causes. People with migraine suffer from recurrent moderate to severe headache attacks varying from 4 to 72 h. The prevalence of migraine is two to three times higher in women compared with men. Importantly, it is the most disabling disease in women <50 years of age due to a high number of years lived with disability, resulting in a very high global socioeconomic burden. Robust evidence exists on the association between migraine with aura and increased incidence of cardiovascular disease (CVD), in particular ischaemic stroke. People with migraine with aura have an increased risk of atrial fibrillation, myocardial infarction, and cardiovascular death compared with those without migraine. Ongoing studies investigate the relation between migraine and angina with non-obstructive coronary arteries and migraine patients with patent foramen ovale. Medication for the treatment of migraine can be preventative medication, such as beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, antiepileptics, antidepressants, some of the long-acting calcitonin gene-related peptide receptor antagonists, or monoclonal antibodies against calcitonin gene-related peptide or its receptor, or acute medication, such as triptans and calcitonin gene-related peptide receptor antagonists. However, these medications might raise concerns when migraine patients also have CVD due to possible (coronary) side effects. Specifically, knowledge gaps remain for the contraindication to newer treatments for migraine. All cardiologists will encounter patients with CVD and migraine. This state-of-the-art review will outline the basic pathophysiology of migraine and the associations between migraine and CVD, discuss current therapies, and propose future directions for research.
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Affiliation(s)
- Deborah N Kalkman
- Department of Clinical and Experimental Cardiology, Heart Center; Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
| | - Emile G M Couturier
- Department of Neurology, Boerhaave Medisch Centrum, Amsterdam, The Netherlands
| | - Abdelhak El Bouziani
- Department of Clinical and Experimental Cardiology, Heart Center; Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
| | - Jorge Dahdal
- Department of Cardiology, Heart Center, Amsterdam UMC-Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jolien Neefs
- Department of Clinical and Experimental Cardiology, Heart Center; Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
| | - Janneke Woudstra
- Department of Cardiology, Heart Center, Amsterdam UMC-Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robbert J de Winter
- Department of Clinical and Experimental Cardiology, Heart Center; Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Heart Center, Amsterdam UMC-Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Bager JE, Manhem K, Andersson T, Hjerpe P, Bengtsson-Boström K, Ljungman C, Mourtzinis G. Hypertension: sex-related differences in drug treatment, prevalence and blood pressure control in primary care. J Hum Hypertens 2023; 37:662-670. [PMID: 36658330 PMCID: PMC10403353 DOI: 10.1038/s41371-023-00801-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/15/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023]
Abstract
Antihypertensive treatment is equally beneficial for reducing cardiovascular risk in both men and women. Despite this, the drug treatment, prevalence and control of hypertension differ between men and women. Men and women respond differently, particularly with respect to the risk of adverse events, to many antihypertensive drugs. Certain antihypertensive drugs may also be especially beneficial in the setting of certain comorbidities - of both cardiovascular and extracardiac nature - which also differ between men and women. Furthermore, hypertension in pregnancy can pose a considerable therapeutic challenge for women and their physicians in primary care. In addition, data from population-based studies and from real-world data are inconsistent regarding whether men or women attain hypertension-related goals to a higher degree. In population-based studies, women with hypertension have higher rates of treatment and controlled blood pressure than men, whereas real-world, primary-care data instead show better blood pressure control in men. Men and women are also treated with different antihypertensive drugs: women use more thiazide diuretics and men use more angiotensin-enzyme inhibitors and calcium-channel blockers. This narrative review explores these sex-related differences with guidance from current literature. It also features original data from a large, Swedish primary-care register, which showed that blood pressure control was better in women than men until they reached their late sixties, after which the situation was reversed. This age-related decrease in blood pressure control in women was not, however, accompanied by a proportional increase in use of antihypertensive drugs and female sex was a significant predictor of less intensive antihypertensive treatment.
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Affiliation(s)
- Johan-Emil Bager
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Emergency Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Karin Manhem
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Emergency Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tobias Andersson
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden
| | - Per Hjerpe
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden
| | - Kristina Bengtsson-Boström
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden
| | - Charlotta Ljungman
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Georgios Mourtzinis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine and Emergency Mölndal, Sahlgrenska University Hospital, Gothenburg, Sweden
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Carcel C, Haghdoost F, Shen J, Nanda P, Bai Y, Atkins E, Torii-Yoshimura T, Clough AJ, Davies L, Cordato D, Griffiths LR, Balicki G, Wang X, Vidyasagar K, Malavera A, Anderson CS, Zagami AS, Delcourt C, Rodgers A. The effect of blood pressure lowering medications on the prevention of episodic migraine: A systematic review and meta-analysis. Cephalalgia 2023; 43:3331024231183166. [PMID: 37350141 DOI: 10.1177/03331024231183166] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Currently, only a few specific blood pressure-lowering medications are recommended for migraine prevention. Whether benefits extend to other classes or drugs is uncertain. METHODS Embase, MEDLINE, and the Cochrane Central Registry of Controlled Trials were searched for randomized control trials on the effect of blood pressure-lowering medications compared with placebo in participants with episodic migraine. Data were collected on four outcomes - monthly headache or migraine days, and monthly headache or migraine attacks, with a standardised mean difference calculated for overall. Random effect meta-analysis was performed. RESULTS In total, 50 trials (70% of which were crossover) were included, comprising 60 comparisons. Overall mean age was 39 years, and 79% were female. Monthly headache days were fewer in all classes compared to placebo, and this was statistically significant for all but one class: alpha-blockers -0.7 (95% CI: -1.2, -0.1), angiotensin-converting enzyme inhibitors -1.3 (95% CI: -2.9, 0.2), angiotensin II receptor blockers -0.9 (-1.6, -0.1), beta-blocker -0.4 (-0.8, -0.0) and calcium channel blockers -1.8 (-3.4, -0.2). Standardised mean difference was significantly reduced for all drug classes and was separately significant for numerous specific drugs: clonidine, candesartan, atenolol, bisoprolol, metoprolol, propranolol, timolol, nicardipine and verapamil. CONCLUSION Among people with episodic migraine, a broader number of blood pressure-lowering medication classes and drugs reduce headache frequency than those currently included in treatment guidelines.Trial Registration: The study was registered at PROSPERO (CRD42017079176).
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Affiliation(s)
- Cheryl Carcel
- The George Institute for Global Health, , University of New South Wales, Sydney, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Faraidoon Haghdoost
- The George Institute for Global Health, , University of New South Wales, Sydney, Australia
| | - Joanne Shen
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Puneet Nanda
- The George Institute for Global Health, , University of New South Wales, Sydney, Australia
| | - Yu Bai
- Peking Union Medical College, Beijing, China
| | - Emily Atkins
- The George Institute for Global Health, , University of New South Wales, Sydney, Australia
| | - Takako Torii-Yoshimura
- The George Institute for Global Health, , University of New South Wales, Sydney, Australia
| | | | - Leo Davies
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Dennis Cordato
- Department of Neurology, Liverpool Hospital, Liverpool, Australia
| | - Lyn R Griffiths
- Centre for Genomics and Personalised Health, Queensland University of Technology, Queensland, Australia
| | - Grace Balicki
- The George Institute for Global Health, , University of New South Wales, Sydney, Australia
| | - Xia Wang
- The George Institute for Global Health, , University of New South Wales, Sydney, Australia
| | | | - Alejandra Malavera
- The George Institute for Global Health, , University of New South Wales, Sydney, Australia
| | - Craig S Anderson
- The George Institute for Global Health, , University of New South Wales, Sydney, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
- The George Institute China at Peking University Health Science Centre, Beijing, China
| | - Alessandro S Zagami
- Department of Neurology, Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Candice Delcourt
- The George Institute for Global Health, , University of New South Wales, Sydney, Australia
- Macquarie University, Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Sydney, Australia
| | - Anthony Rodgers
- The George Institute for Global Health, , University of New South Wales, Sydney, Australia
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15
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Zhang J, Mao Y, Li Y, Zhao K, Xie Q, Wang K, Shi J. Association between migraine or severe headache and hypertension among US adults: A cross-sectional study. Nutr Metab Cardiovasc Dis 2023; 33:350-358. [PMID: 36604265 DOI: 10.1016/j.numecd.2022.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Epidemiological evidence of the association between migraines, severe headaches, and hypertension is contradictory. Hypertension is a critical risk factor for cardiovascular diseases. Migraine is a common neurological disease and a major cause of disability worldwide. Therefore, we aimed to investigate the relationship between migraine, severe headaches, and hypertension among US adults. METHODS AND RESULTS Cross-sectional data from 5716 subjects were obtained from the National Health and Nutrition Examination Survey between 1999 and 2004. Weighted logistic regression models investigated the association between migraines, severe headaches, and hypertension. In total, 5716 subjects were enrolled in the present study, of whom 1134 (19.8%) had migraine or severe headaches. Participants with migraine were predominantly younger females and had a higher body mass index (BMI), lower educational level, lower dietary intake of potassium and calcium, lower serum levels of total cholesterol (TC), creatinine, and hemoglobin, as well as a higher estimated glomerular filtration rate (eGFR) (all P < 0.05). After fully adjusting for potential confounders, migraine or severe headaches were positively associated with hypertension (OR 1.25, 95% CI: 1.03-1.53). CONCLUSION Our study found a positive association between migraine, severe headaches, and hypertension. Further studies are needed to verify the causality of this association and elucidate the underlying mechanisms.
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Affiliation(s)
- Jing Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Yukang Mao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China; Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, 215000, China
| | - Yansong Li
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Kun Zhao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Qiyang Xie
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Kai Wang
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
| | - Jing Shi
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
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Ali MD, Gayasuddin Qur F, Alam MS, M Alotaibi N, Mujtaba MA. Global Epidemiology, Clinical Features, Diagnosis and Current Therapeutic Novelties in Migraine Therapy and their Prevention: A Narrative Review. Curr Pharm Des 2023; 29:3295-3311. [PMID: 38270151 DOI: 10.2174/0113816128266227231205114320] [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: 06/29/2023] [Accepted: 09/21/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION The current article reviews the latest information on epidemiology, clinical features, diagnosis, recent advancements in clinical management, current therapeutic novelties, and the prevention of migraines. In a narrative review, all studies as per developed MeSH terms published until February 2023, excluding those irrelevant, were identified through a PubMed literature search. METHODS Overall, migraine affects more than a billion people annually and is one of the most common neurological illnesses. A wide range of comorbidities is associated with migraines, including stress and sleep disturbances. To lower the worldwide burden of migraine, comprehensive efforts are required to develop and enhance migraine treatment, which is supported by informed healthcare policy. Numerous migraine therapies have been successful, but not all patients benefit from them. RESULTS CGRP pathway-targeted therapy demonstrates the importance of translating mechanistic understanding into effective treatment. In this review, we discuss clinical features, diagnosis, and recently approved drugs, as well as a number of potential therapeutic targets, including pituitary adenylate cyclase-activating polypeptide (PACAP), adenosine, opioid receptors, potassium channels, transient receptor potential ion channels (TRP), and acid-sensing ion channels (ASIC). CONCLUSION In addition to providing more treatment options for improved clinical care, a better understanding of these mechanisms facilitates the discovery of novel therapeutic targets.
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Affiliation(s)
- Mohammad Daud Ali
- Department of Pharmacy, Mohammed Al-Mana College for Medical Sciences, Abdulrazaq Bin Hammam Street, Al Safa, Dammam 34222, Saudi Arabia
| | - Fehmida Gayasuddin Qur
- Department of Obstetrics and Gynecology, Princess Royal Maternity Hospital, Glasgow, Scotland
| | - Md Sarfaraz Alam
- Department of Pharmaceutics, HIMT College of Pharmacy, Rajpura 8, Institutional Area, Knowledge Park I, Greater Noida, Uttar Pradesh 201301, India
| | - Nawaf M Alotaibi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Northern Border University, Rafha Campus, Arar, Saudi Arabia
| | - Md Ali Mujtaba
- Department of Pharmaceutics, Faculty of Pharmacy, Northern Border University, Rafha Campus, Arar, Saudi Arabia
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Loh NR, Whitehouse WP, Howells R. What is new in migraine management in children and young people? Arch Dis Child 2022; 107:1067-1072. [PMID: 35190383 DOI: 10.1136/archdischild-2021-322373] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/29/2022] [Indexed: 12/14/2022]
Abstract
For this narrative review, we found recent publications on the use and effectiveness of old therapies including nutraceuticals, such as riboflavin, vitamin D, magnesium, melatonin and talking therapies. Recent large trials of established conventional pharmaceuticals such as propranolol, pizotifen, topiramate and amitriptyline for childhood migraine have failed, but the use of a quasi-placebo in future trials could help. We reviewed the evidence for angiotensin antagonists including candesartan in adults, but found a lack of evidence for their use in children. There have been new developments in pharmaceuticals recently, including a more selective 5-HT1F agonist, lasmiditan, an effective acute treatment with no vasoconstrictor activity in adults, currently being tested in children. Also, a number of new calcitonin gene-related peptide (CGRP) antibodies and antagonists, with proven efficacy in acute treatment and/or prevention of migraine in adults, are undergoing trials in children. Peripheral nerve blocks and botulinum toxin are gaining popularity in adult practice, but we really need more good quality evidence for their effectiveness in children. Finally, electroceuticals, that is, therapeutic electric devices, are now marketed for acute and or preventative treatment, including an external trigeminal nerve stimulator (e-TNS), a non-invasive vagal nerve stimulator (nVNS), a single-pulse transcranial magnetic stimulator (sTMS) and a remote electrical neuromodulation device (REN). At the moment, evidence for their effectiveness in children is still lacking. So, there has been much progress, but mostly for adults. We are in urgent need of more migraine trials in children.
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Affiliation(s)
- Ne Ron Loh
- Paediatrics, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,Paediatrics, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | | | - Rachel Howells
- Royal Devon and Exeter NHS Trust, Children & Young People, Exeter, UK
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18
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Kung D, Rodriguez G, Evans R. Chronic Migraine. Neurol Clin 2022; 41:141-159. [DOI: 10.1016/j.ncl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Santos PSF, Melhado EM, Kaup AO, Costa ATNMD, Roesler CADP, Piovesan ÉJ, Sarmento EM, Theotonio GOM, Campos HCD, Fortini I, Souza JAD, Júnior JAM, Segundo JBA, Carvalho JJFD, Speziali JG, Calia LC, Barea LM, Queiroz LP, Souza MNP, Figueiredo MRCF, Costa MENDM, Peres MFP, Jurno ME, Peixoto PM, Kowacs PA, Rocha-Filho PAS, Filho PFM, Silva-Neto RP, Fragoso YD. Consensus of the Brazilian Headache Society (SBCe) for prophylactic treatment of episodic migraine: part II. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:953-969. [PMID: 36257618 PMCID: PMC10658446 DOI: 10.1055/s-0042-1755320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/09/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Migraine affects 1 billion people worldwide and > 30 million Brazilians; besides, it is an underdiagnosed and undertreated disorder. OBJECTIVE The need to disseminate knowledge about the prophylactic treatment of migraine is known, so the Brazilian Headache Society (SBCe, in the Portuguese acronym) appointed a committee of authors with the objective of establishing a consensus with recommendations on the prophylactic treatment of episodic migraine based on articles from the world literature as well as from personal experience. METHODS Meetings were held entirely online, with the participation of 12 groups that reviewed and wrote about the pharmacological categories of drugs and, at the end, met to read and finish the document. The drug classes studied in part II of this Consensus were: antihypertensives, selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, calcium channel blockers, other drugs, and rational polytherapy. RESULTS From this list of drugs, only candesartan has been established as effective in controlling episodic migraine. Flunarizine, venlafaxine, duloxetine, and pizotifen were defined as likely to be effective, while lisinopril, enalapril, escitalopram, fluvoxamine, quetiapine, atorvastatin, simvastatin, cyproheptadine, and melatonin were possibly effective in prophylaxis of the disease. CONCLUSIONS Despite an effort by the scientific community to find really effective drugs in the treatment of migraine, given the large number of drugs tested for this purpose, we still have few therapeutic options.
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Affiliation(s)
- Paulo Sergio Faro Santos
- Instituto de Neurologia de Curitiba, Departamento de Neurologia, Setor de
Cefaleia e Dor Orofacial, Curitiba PR, Brazil.
| | - Eliana Meire Melhado
- Centro Universitário Padre Albino, Faculdade de Medicina, Departamento de
Neurologia, Catanduva SP, Brazil.
| | - Alexandre Ottoni Kaup
- Houston Headache Clinic, Houston TX, USA.
- Universidade Federal de São Paulo, São Paulo SP, Brazil.
- Universidade de Santo Amaro, São Paulo SP, Brazil.
| | | | | | - Élcio Juliato Piovesan
- Universidade Federal do Paraná, Departamento de Clínica Médica, Disciplina de
Neurologia, Curitiba PR, Brazil.
| | | | | | | | - Ida Fortini
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia,
São Paulo SP, Brazil.
| | - Jano Alves de Souza
- Universidade Federal Fluminense, Departamento de Medicina Clínica, Disciplina
de Neurologia, Niterói RJ, Brazil.
| | - Jayme Antunes Maciel Júnior
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento
de Neurologia, Campinas SP, Brazil.
| | | | - João José Freitas de Carvalho
- Unichristus, Curso de Medicina, Disciplina de Neurologia, Fortaleza CE,
Brazil.
- Hospital Geral de Fortaleza, Serviço de Neurologia, Núcleo de Cefaleias,
Fortaleza CE, Brazil.
| | - José Geraldo Speziali
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto,
Departamento de Neurologia, Ribeirão Preto SP, Brazil.
| | - Leandro Cortoni Calia
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo SP,
Brazil.
| | - Liselotte Menke Barea
- Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Disciplina
de Neurologia, Porto Alegre RS, Brazil.
| | - Luiz Paulo Queiroz
- Universidade Federal de Santa Catarina, Hospital Universitário, Serviço de
Neurologia, Florianópolis SC, Brazil.
| | | | | | | | | | - Mauro Eduardo Jurno
- Fundação José Bonifácio Lafayette de Andrada, Faculdade de Medicina de
Barbacena, Barbacena MG, Brazil.
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Regional de Barbacena
Dr. José Américo, Barbacena MG, Brazil.
| | | | - Pedro André Kowacs
- Instituto de Neurologia de Curitiba, Serviço de Neurologia, Curitiba PR,
Brazil.
- Universidade Federal do Paraná, Complexo Hospital de Clínicas, Serviço de
Neurologia, Curitiba PR, Brazil.
| | - Pedro Augusto Sampaio Rocha-Filho
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Área de
Neuropsquiatria, Recife PE, Brazil.
- Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Ambulatório de
Cefaleias, Recife PR, Brazil.
| | - Pedro Ferreira Moreira Filho
- Universidade Federal Fluminense, Hospital Universitário Antônio Pedro,
Departamento de Medicina Clínica, Niterói RJ, Brazil.
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Smyth D, Britton Z, Murdin L, Arshad Q, Kaski D. Vestibular migraine treatment: a comprehensive practical review. Brain 2022; 145:3741-3754. [PMID: 35859353 DOI: 10.1093/brain/awac264] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/18/2022] [Accepted: 07/01/2022] [Indexed: 11/12/2022] Open
Abstract
Vestibular migraine is an underdiagnosed but increasingly recognised neurological condition that causes episodic vertigo associated with other features of migraine. It is now thought to be the most common cause of spontaneous (non-positional) episodic vertigo, affecting up to 1% of the population. A meta-analysis of preventative treatments for vestibular migraine was published in 2021 but the authors were unable to establish a preferred treatment strategy due to low quality of evidence and heterogeneity of study design and outcome reporting. There remains therefore a clinical need for pragmatic management guidelines specific to vestibular migraine using the available evidence. Here we provide a practical review utilising a systematic qualitative assessment of the evidence for abortive and preventative interventions in adults. The overall evidence base for vestibular migraine treatment is of low quality. Nevertheless, we provide practical treatment recommendations based on the available evidence and our experience to help guide clinicians treating patients with vestibular migraine. We also discuss how future clinical trials could be designed to improve the quality of evidence in this condition.
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Affiliation(s)
- Duncan Smyth
- Department of Neuro-Otology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Zelie Britton
- Department of Neuro-Otology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Louisa Murdin
- Guy's and St Thomas' NHS Foundation Trust, London, UK; and Ear Institute, Faculty of Brain Sciences, University College London, London, UK
| | - Qadeer Arshad
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Diego Kaski
- Department of Neuro-Otology, National Hospital for Neurology and Neurosurgery, London, UK
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Khalil M, Ajona-Moreno D, Villar-Martínez MD, Greenwood F, Hoffmann J, Goadsby PJ. Erenumab in chronic migraine: experience from a UK tertiary centre and comparison with other real-world evidence. Eur J Neurol 2022; 29:2473-2480. [PMID: 35445471 PMCID: PMC9545124 DOI: 10.1111/ene.15364] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/16/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
Background and purpose Chronic migraine is a highly disabling primary headache disorder that is the most common diagnosis of patients seen at tertiary headache centres. Typical oral preventive therapies are associated with many limitations that impact their therapeutic utility. Erenumab was the first available calcitonin gene‐related peptide monoclonal antibody in the UK. It had proven efficacy in migraine prevention in clinical trials and limited real‐world data in tertiary settings. Methods We audited our first 92 patients (n = 73 females) with severely disabling chronic migraine who were given monthly erenumab 70 mg sc for 6 months between December 2018 and December 2019. Results At 3 months, monthly migraine days were significantly reduced by a median of 4 days, and all other variables also showed significant improvement. The improvement was not affected by baseline analgesic use status. More than half of our patients experienced a clinically meaningful improvement in migraine days. No serious adverse events were reported. Conclusions Our real‐world data with erenumab demonstrate it is effective and well tolerated in managing patients with chronic migraine in a tertiary care setting.
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Affiliation(s)
- Modar Khalil
- ¹NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London
| | - David Ajona-Moreno
- ¹NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London
| | | | - Fiona Greenwood
- ¹NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London
| | - Jan Hoffmann
- ¹NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London.,Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Peter J Goadsby
- ¹NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London.,Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,Department of Neurology, University of California, Los Angeles, CA, USA
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22
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Sico JJ, Macedo F, Lewis J, Spevak C, Vogsland R, Ford A, Skop K, Sall J. The Primary Care Management of Headache: Synopsis of the 2020 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Mil Med 2022; 187:e1091-e1102. [PMID: 35022782 DOI: 10.1093/milmed/usab490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/20/2021] [Accepted: 01/09/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In June of 2020, the U.S. DVA and DoD approved a new joint clinical practice guideline for assessing and managing patients with headache. This guideline provides a framework to evaluate, treat, and longitudinally manage the individual needs and preferences of patients with headache. METHODS In October of 2018, the DVA/DoD Evidence-Based Practice Work Group convened a guideline development panel that included clinical stakeholders and conformed to the National Academy of Medicine's tenets for trustworthy clinical practice guidelines. RESULTS The guideline panel developed key questions, systematically searched and evaluated the literature, created a 1-page algorithm, and advanced 42 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system. CONCLUSION This synopsis summarizes the key features of the guideline in three areas: prevention, assessing and treating medication overuse headache, and nonpharmacologic and pharmacologic management of headache.
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Affiliation(s)
- Jason J Sico
- Headache Centers of Excellence (HCoE) Program, National Programs Center, Orange, CT 06477, USA.,HCoE Research and Evaluation Center, Veterans Health Administration.,Department of Neurology (Headache Medicine and Vascular Neurology) and Internal Medicine (General Medicine), Yale School of Medicine, New Haven, CT 06520, USA.,VA Connecticut Healthcare System Department of Neurology, National Programs Center, Orange, CT 06477, USA
| | - Franz Macedo
- Minneapolis VA Health Care System, Minneapolis, MN 55417, USA
| | - Jeffrey Lewis
- Wright-Patterson Air Force Base Mental Health Clinic, Wright-Patterson AFB, OH 45433, USA
| | - Christopher Spevak
- Physical Medicine and Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Minneapolis VA Health Care System, Minneapolis, MN 55417, USA
| | | | - Aven Ford
- USAFSAM/FECN, Wright-Patterson AFB, OH 45433, USA
| | - Karen Skop
- Physical Medicine and Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL 33612, USA
| | - James Sall
- Quality and Patient Safety, Office of Evidence Based Practice, U.S. Department of Veterans Affairs, New Braunfels, TX 78132, USA.,Department of Clinical Anesthesia, Georgetown University School of Medicine.,Program Director Pain Fellowship, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
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23
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Azimova Y, Amelin A, Alferova V, Artemenko A, Akhmadeeva L, Golovacheva V, Danilov A, Ekusheva E, Isagulian E, Koreshkina M, Kurushina O, Latysheva N, Lebedeva E, Naprienko M, Osipova V, Pavlov N, Parfenov V, Rachin A, Sergeev A, Skorobogatykh K, Tabeeva G, Filatova E. Clinical guidelines "Migraine". Zh Nevrol Psikhiatr Im S S Korsakova 2022. [DOI: 10.17116/jnevro20221220134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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24
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Migraine and Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00043-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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25
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Vandervorst F, Van Deun L, Van Dycke A, Paemeleire K, Reuter U, Schoenen J, Versijpt J. CGRP monoclonal antibodies in migraine: an efficacy and tolerability comparison with standard prophylactic drugs. J Headache Pain 2021; 22:128. [PMID: 34696711 PMCID: PMC8547103 DOI: 10.1186/s10194-021-01335-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several drugs are available for the preventive treatment of both episodic and chronic migraine. The choice of which therapy to initiate first, second, or third is not straightforward and is based on multiple factors, including general efficacy, tolerability, potential for serious adverse events, comorbid conditions, and costs. Recently, a new class of migraine preventive drugs was introduced, i.e. monoclonal antibodies against calcitonin gene-related peptide (CGRP) or its receptor. METHODS The present article summarizes the evidence gathered with this new migraine preventive drug class from randomized placebo-controlled clinical trials. It further puts this into perspective next to the evidence gained by the most widely used agents for the prevention of episodic and chronic migraine with an emphasis on efficacy and the robustness with which this efficacy signal was obtained. RESULTS Although being a relatively new class of migraine preventive drugs, monoclonal antibodies blocking the CGRP pathway have an efficacy which is at least comparable if not higher than those of the currently used preventive drugs. Moreover, the robustness of this efficacy signal is substantiated by several randomized clinical trials each including large numbers of patients. In addition, because of their excellent tolerability and with long-term safety data emerging, they seem to have an unprecedented efficacy over adverse effect profile, clearly resulting in an added value for migraine prevention. CONCLUSIONS Balancing the data presented in the current manuscript with additional data concerning long term safety on the one hand and cost issues on the other hand, can be of particular use to health policy makers to implement this new drug class in the prevention of migraine.
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Affiliation(s)
- Fenne Vandervorst
- Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Laura Van Deun
- Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Annelies Van Dycke
- Department of Neurology, General Hospital Sint-Jan Bruges, Bruges, Belgium
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jean Schoenen
- Headache Research Unit, Dept of Neurology-Citadelle Hospital, University of Liège, Liège, Belgium
| | - Jan Versijpt
- Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
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26
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Eigenbrodt AK, Ashina H, Khan S, Diener HC, Mitsikostas DD, Sinclair AJ, Pozo-Rosich P, Martelletti P, Ducros A, Lantéri-Minet M, Braschinsky M, Del Rio MS, Daniel O, Özge A, Mammadbayli A, Arons M, Skorobogatykh K, Romanenko V, Terwindt GM, Paemeleire K, Sacco S, Reuter U, Lampl C, Schytz HW, Katsarava Z, Steiner TJ, Ashina M. Diagnosis and management of migraine in ten steps. Nat Rev Neurol 2021; 17:501-514. [PMID: 34145431 PMCID: PMC8321897 DOI: 10.1038/s41582-021-00509-5] [Citation(s) in RCA: 174] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 02/05/2023]
Abstract
Migraine is a disabling primary headache disorder that directly affects more than one billion people worldwide. Despite its widespread prevalence, migraine remains under-diagnosed and under-treated. To support clinical decision-making, we convened a European panel of experts to develop a ten-step approach to the diagnosis and management of migraine. Each step was established by expert consensus and supported by a review of current literature, and the Consensus Statement is endorsed by the European Headache Federation and the European Academy of Neurology. In this Consensus Statement, we introduce typical clinical features, diagnostic criteria and differential diagnoses of migraine. We then emphasize the value of patient centricity and patient education to ensure treatment adherence and satisfaction with care provision. Further, we outline best practices for acute and preventive treatment of migraine in various patient populations, including adults, children and adolescents, pregnant and breastfeeding women, and older people. In addition, we provide recommendations for evaluating treatment response and managing treatment failure. Lastly, we discuss the management of complications and comorbidities as well as the importance of planning long-term follow-up.
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Affiliation(s)
- Anna K Eigenbrodt
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Håkan Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sabrina Khan
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hans-Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Dimos D Mitsikostas
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra J Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - 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
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
- Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Anne Ducros
- Neurology Department, Montpellier University Hospital, Montpellier, France
| | - Michel Lantéri-Minet
- Departement d'Evaluation et Traitement de la Douleur, Centre Hospitalo-Universitaire de Nice, Nice, France
| | | | | | - Oved Daniel
- Headache & Facial Pain Clinic, Laniado Medical Center, Netanya, Israel
| | - Aynur Özge
- Department of Neurology, Mersin University Medical Faculty, Mersin, Turkey
| | - Ayten Mammadbayli
- Department of Neurology, Azerbaijan State Medical University, Baku, Azerbaijan
| | - Mihails Arons
- Department of Anesthesiology and Intensive Care, P. Stradins University, Riga, Latvia
| | | | | | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Lampl
- Headache Medical Center, Seilerstaette Linz, Linz, Austria
- Department of Geriatric Medicine, Ordensklinikum Linz, Linz, Austria
| | - Henrik W Schytz
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Zaza Katsarava
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany
- EVEX Medical Corporation, Tbilisi, Georgia
- Department of Nervous Diseases of the Institute of Professional Education, IM Sechenov First Moscow State Medical University, Moscow, Russia
| | - Timothy J Steiner
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Division of Brain Sciences, Imperial College London, London, UK
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Nervous Diseases of the Institute of Professional Education, IM Sechenov First Moscow State Medical University, Moscow, Russia.
- Danish Knowledge Center on Headache Disorders, Glostrup, Denmark.
- Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan.
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Ducros A, de Gaalon S, Roos C, Donnet A, Giraud P, Guégan-Massardier E, Lantéri-Minet M, Lucas C, Mawet J, Moisset X, Valade D, Demarquay G. Revised guidelines of the French headache society for the diagnosis and management of migraine in adults. Part 2: Pharmacological treatment. Rev Neurol (Paris) 2021; 177:734-752. [PMID: 34340810 DOI: 10.1016/j.neurol.2021.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/21/2022]
Abstract
The French Headache Society proposes updated French guidelines for the management of migraine. This article presents the second part of the guidelines, which is focused on the pharmacological treatment of migraine, including both the acute treatment of attacks and the prophylaxis of episodic migraine as well as chronic migraine with and without medication overuse. The specific situations that can be encountered in women with migraine are also discussed, including pregnancy, menstrual migraine, contraception and hormonal replacement therapy.
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Affiliation(s)
- A Ducros
- Department of neurology, Gui-de-Chauliac hospital, CHU Montpellier, university of Montpellier, 34000 Montpellier, France
| | - S de Gaalon
- Department of neurology, Laënnec hospital, CHU de Nantes, Nantes, France
| | - C Roos
- Emergency headache center (centre d'urgences céphalées), department of neurology, Lariboisière hospital, Assistance publique-Hôpitaux de Paris, Paris, France
| | - A Donnet
- Centre d'évaluation et de traitement de la douleur, FHU INOVPAIN, hôpital de La Timone, Marseille, France
| | - P Giraud
- Department of neurology, Annecy Genevois hospital, Annecy, France
| | | | - M Lantéri-Minet
- Pain department, FHU InovPain, CHU Nice Côte Azur université, Nice, France
| | - C Lucas
- Centre d'évaluation et de traitement de la douleur, service de neurochirurgie, hôpital Salengro, CHRU de Lille, Lille, France
| | - J Mawet
- Emergency headache center (centre d'urgences céphalées), department of neurology, Lariboisière hospital, Assistance publique-Hôpitaux de Paris, Paris, France
| | - X Moisset
- Neuro-Dol, université Clermont Auvergne, CHU de Clermont-Ferrand, INSERM, Clermont-Ferrand, France
| | - D Valade
- Department of neurosurgery, hôpital Pitié-Sapêtrière, Paris, France
| | - G Demarquay
- Neurological hospital, Lyon, neuroscience research center (CRNL), INSERM U1028, CNRS UMR5292, Lyon, France.
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Hypertension and Migraine: Time to Revisit the Evidence. Curr Pain Headache Rep 2021; 25:58. [PMID: 34269909 DOI: 10.1007/s11916-021-00976-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW It was reported that migraine was associated with increased vascular risks, and the association between high blood pressure (BP) and migraine was believed by some to be the missing link. The current review focused on the associations between migraine and hypertension and BP per se, and evidence on the directionality of the associations was also reviewed. RECENT FINDINGS In cross-sectional studies, the findings regarding whether migraine was associated with hypertension were inconsistent, and positive, neutral, or even inverse associations were reported. When individual BP parameters were examined separately, migraine was associated with higher diastolic BPs, and perhaps lower pulse pressures, although the associations with systolic BPs were incongruent. When studies mainly recruiting elderly patients are excluded, it appeared that studies reporting a positive association between migraine and high BPs, particularly high diastolic BPs, outnumbered those with an inverse or neutral association. In longitudinal studies, there was evidence that migraine patients were at increased risks of developing hypertension at follow-up. However, studies examining whether high BP could predict new-onset migraine yielded conflicting results. The association between migraine and hypertension is still a controversial issue, and a firm conclusion is precluded by the heterogeneities in methodologies and study populations. Migraine patients are at increased risk of developing hypertension. However, whether hypertension predicts migraine remains inconclusive. Further studies are needed to clarify the complicated association between BP and migraine.
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Ailani J, Burch RC, Robbins MS. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache 2021; 61:1021-1039. [PMID: 34160823 DOI: 10.1111/head.14153] [Citation(s) in RCA: 276] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/04/2021] [Accepted: 05/09/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To incorporate recent research findings, expert consensus, and patient perspectives into updated guidance on the use of new acute and preventive treatments for migraine in adults. BACKGROUND The American Headache Society previously published a Consensus Statement on the use of newly introduced treatments for adults with migraine. This update, which is based on the expanded evidence base and emerging expert consensus concerning postapproval usage, provides practical recommendations in the absence of a formal guideline. METHODS This update involved four steps: (1) review of data about the efficacy, safety, and clinical use of migraine treatments introduced since the previous Statement was published; (2) incorporation of these data into a proposed update; (3) review and commentary by the Board of Directors of the American Headache Society and patients and advocates associated with the American Migraine Foundation; (4) consideration of these collective insights and integration into an updated Consensus Statement. RESULTS Since the last Consensus Statement, no evidence has emerged to alter the established principles of either acute or preventive treatment. Newly introduced acute treatments include two small-molecule calcitonin gene-related peptide (CGRP) receptor antagonists (ubrogepant, rimegepant); a serotonin (5-HT1F ) agonist (lasmiditan); a nonsteroidal anti-inflammatory drug (celecoxib oral solution); and a neuromodulatory device (remote electrical neuromodulation). New preventive treatments include an intravenous anti-CGRP ligand monoclonal antibody (eptinezumab). Several modalities, including neuromodulation (electrical trigeminal nerve stimulation, noninvasive vagus nerve stimulation, single-pulse transcranial magnetic stimulation) and biobehavioral therapy (cognitive behavioral therapy, biofeedback, relaxation therapies, mindfulness-based therapies, acceptance and commitment therapy) may be appropriate for either acute and/or preventive treatment; a neuromodulation device may be appropriate for acute migraine treatment only (remote electrical neuromodulation). CONCLUSIONS The integration of new treatments into clinical practice should be informed by the potential for benefit relative to established therapies, as well as by the characteristics and preferences of individual patients.
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Affiliation(s)
- Jessica Ailani
- Department of Neurology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Rebecca C Burch
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
Background Chronic migraine is an under-recognized and under-treated disorder. A greater understanding of the pathophysiology of migraine and transformation to chronic migraine has led to the first targeted treatments for chronic migraine. In this review, we review current approaches to the diagnosis and management of chronic migraine and discuss recent and emerging novel therapies. Objective The aim of this study was to provide an update on the diagnosis and management of chronic migraine. Methods and Material The PubMed database was searched for relevant articles published on or before October 2020. Results and Conclusions Chronic migraine is an under-recognized and under-treated disorder. Prompt diagnosis and appropriate management can lead to a significant improvement in the quality of life with subsequent socioeconomic benefits.
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Affiliation(s)
- Catriona L Gribbin
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Krishna A Dani
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Alok Tyagi
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
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Abstract
IMPORTANCE Approximately 90% of people in the US experience headache during their lifetime. Migraine is the second leading cause of years lived with disability worldwide. OBSERVATIONS Primary headache disorders are defined as headaches that are unrelated to an underlying medical condition and are categorized into 4 groups: migraine, tension-type headache, trigeminal autonomic cephalalgias, and other primary headache disorders. Studies evaluating prevalence in more than 100 000 people reported that tension-type headache affected 38% of the population, while migraine affected 12% and was the most disabling. Secondary headache disorders are defined as headaches due to an underlying medical condition and are classified according to whether they are due to vascular, neoplastic, infectious, or intracranial pressure/volume causes. Patients presenting with headache should be evaluated to determine whether their headache is most likely a primary or a secondary headache disorder. They should be evaluated for symptoms or signs that suggest an urgent medical problem such as an abrupt onset, neurologic signs, age 50 years and older, presence of cancer or immunosuppression, and provocation by physical activities or postural changes. Acute migraine treatment includes acetaminophen, nonsteroidal anti-inflammatory drugs, and combination products that include caffeine. Patients not responsive to these treatments may require migraine-specific treatments including triptans (5-HT1B/D agonists), which eliminate pain in 20% to 30% of patients by 2 hours, but are accompanied by adverse effects such as transient flushing, tightness, or tingling in the upper body in 25% of patients. Patients with or at high risk for cardiovascular disease should avoid triptans because of vasoconstrictive properties. Acute treatments with gepants, antagonists to receptors for the inflammatory neuropeptide calcitonin gene-related peptide, such as rimegepant or ubrogepant, can eliminate headache symptoms for 2 hours in 20% of patients but have adverse effects of nausea and dry mouth in 1% to 4% of patients. A 5-HT1F agonist, lasmiditan, is also available for acute migraine treatment and appears safe in patients with cardiovascular risk factors. Preventive treatments include antihypertensives, antiepileptics, antidepressants, calcitonin gene-related peptide monoclonal antibodies, and onabotulinumtoxinA, which reduce migraine by 1 to 3 days per month relative to placebo. CONCLUSIONS AND RELEVANCE Headache disorders affect approximately 90% of people during their lifetime. Among primary headache disorders, migraine is most debilitating and can be treated acutely with analgesics, nonsteroidal anti-inflammatory drugs, triptans, gepants, and lasmiditan.
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Affiliation(s)
- Matthew S Robbins
- Department of Neurology, Weill Cornell Medical College, New York, New York
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Efficacy and safety of propranolol for treatment of temporomandibular disorder pain: a randomized, placebo-controlled clinical trial. Pain 2021; 161:1755-1767. [PMID: 32701836 DOI: 10.1097/j.pain.0000000000001882] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Propranolol is a nonselective beta-adrenergic receptor antagonist. A multicenter, randomized, double-blind, placebo-controlled, parallel-group, phase 2b trial enrolled participants aged 18 to 65 years with temporomandibular disorder myalgia to evaluate efficacy and safety of propranolol compared with placebo in reducing facial pain. Participants were randomized 1:1 to either extended-release propranolol hydrochloride (60 mg, BID) or placebo. The primary endpoint was change in facial pain index (FPI = facial pain intensity multiplied by facial pain duration, divided by 100). Efficacy was analyzed as a mean change in FPI from randomization to week 9 and as the proportion of participants with ≥30% or ≥50% reductions in FPI at week 9. Regression models tested for treatment-group differences adjusting for study site, sex, race, and FPI at randomization. Of 299 participants screened, 200 were randomized; 199 had at least one postrandomization FPI measurement and were included in intention-to-treat analysis. At week 9, model-adjusted reductions in mean FPI did not differ significantly between treatment groups (-1.8, 95% CL: -6.2, 2.6; P = 0.41). However, the proportion with a ≥30% reduction in FPI was significantly greater for propranolol (69.0%) than placebo (52.6%), and the associated number-needed-to-treat was 6.1 (P = 0.03). Propranolol was likewise efficacious for a ≥50% reduction in FPI (number-needed-to-treat = 6.1, P = 0.03). Adverse event rates were similar between treatment groups, except for more frequent fatigue, dizziness, and sleep disorder in the propranolol group. Propranolol was not different from placebo in reducing mean FPI but was efficacious in achieving ≥30% and ≥50% FPI reductions after 9 weeks of treatment among temporomandibular disorder participants.
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Ashina M, Buse DC, Ashina H, Pozo-Rosich P, Peres MFP, Lee MJ, Terwindt GM, Halker Singh R, Tassorelli C, Do TP, Mitsikostas DD, Dodick DW. Migraine: integrated approaches to clinical management and emerging treatments. Lancet 2021; 397:1505-1518. [PMID: 33773612 DOI: 10.1016/s0140-6736(20)32342-4] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022]
Abstract
Migraine is a highly disabling neurological disorder that directly affects more than 1 billion individuals worldwide. Available treatment options differ between countries and include acute, preventive, and non-pharmacological therapies. Because of major progress in the understanding of migraine pathogenesis, novel mechanism-based medications have emerged and expanded the armamentarium of treatments. We provide a comprehensive overview of the current standard of care that will enable informed clinical management. First, we discuss the efficacy, tolerability, and safety profile of various pharmacological therapies for acute and preventive treatment of migraine. Second, we review the current knowledge on non-pharmacological therapies, such as neuromodulation and biobehavioural approaches, which can be used for a multidisciplinary approach to clinical management. Third, we emphasise that any effective treatment strategy starts with building a therapeutic plan tailored to individual clinical characteristics, preferences, and needs. Finally, we explore the outlook of emerging mechanism-based treatments that could address unmet challenges in clinical management of migraine.
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Affiliation(s)
- Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Danish Knowledge Center on Headache Disorders, Glostrup, Denmark; Department of Nervous Diseases of the Institute of Professional Education, IM Sechenov First Moscow State Medical University, Moscow, Russia; Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan.
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Håkan Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Headache Research Group, Vall d'Hebron Institute of Research, Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Mario F P Peres
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil
| | - Mi Ji Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Headache Science Centre, Institute for Research, Hospitalization and Healthcare, Mondino Foundation, Pavia, Italy
| | - Thien Phu Do
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dimos D Mitsikostas
- First Neurology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
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Schytz HW, Amin FM, Jensen RH, Carlsen L, Maarbjerg S, Lund N, Aegidius K, Thomsen LL, Bach FW, Beier D, Johansen H, Hansen JM, Kasch H, Munksgaard SB, Poulsen L, Sørensen PS, Schmidt-Hansen PT, Cvetkovic VV, Ashina M, Bendtsen L. Reference programme: diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 3rd edition, 2020. J Headache Pain 2021; 22:22. [PMID: 33832438 PMCID: PMC8034101 DOI: 10.1186/s10194-021-01228-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/12/2021] [Indexed: 12/19/2022] Open
Abstract
Headache and facial pain are among the most common, disabling and costly diseases in Europe, which demands for high quality health care on all levels within the health system. The role of the Danish Headache Society is to educate and advocate for the needs of patients with headache and facial pain. Therefore, the Danish Headache Society has launched a third version of the guideline for the diagnosis, organization and treatment of the most common types of headaches and facial pain in Denmark. The second edition was published in Danish in 2010 and has been a great success, but as new knowledge and treatments have emerged it was timely to revise the guideline. The recommendations for the primary headaches and facial pain are largely in accordance with the European guidelines produced by the European Academy of Neurology. The guideline should be used a practical tool for use in daily clinical practice for primary care physicians, neurologists with a common interest in headache, as well as other health-care professionals treating headache patients. The guideline first describes how to examine and diagnose the headache patient and how headache treatment is organized in Denmark. This description is followed by sections on the characteristics, diagnosis and treatment of each of the most common primary and secondary headache disorders and trigeminal neuralgia. The guideline includes many tables to facilitate a quick overview. Finally, the particular challenges regarding migraine and female hormones as well as headache in children are addressed.
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Affiliation(s)
- Henrik W Schytz
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, 2600, Glostrup, Denmark.
| | - Faisal M Amin
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, 2600, Glostrup, Denmark
| | - Rigmor H Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, 2600, Glostrup, Denmark
| | - Louise Carlsen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, 2600, Glostrup, Denmark
| | - Stine Maarbjerg
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, 2600, Glostrup, Denmark
| | - Nunu Lund
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, 2600, Glostrup, Denmark
| | - Karen Aegidius
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Lise L Thomsen
- Specialized Pediatric Clinic, Jægersborgvej 66B, 2. Sal, 2800, Kgs. Lyngby, Denmark
| | - Flemming W Bach
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Dagmar Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Hanne Johansen
- The Migraine and Headache Association (https://www.hovedpineforeningen.dk), Toftehøj 90, 6470 Sydals, Denmark
| | - Jakob M Hansen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, 2600, Glostrup, Denmark.,National Headache Knowledge Center, Danish Headache Center, Rigshospitalet-Glostrup, Valdemar Hansen Vej 5, Glostrup, 2600, Denmark
| | - Helge Kasch
- Department of Neurology, Spinal Cord Injury Centre of Western Denmark, Viborg Hospital, Viborg, Denmark
| | - Signe B Munksgaard
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, 2600, Glostrup, Denmark
| | - Lars Poulsen
- General Practice, Clinic Laegehuset Nr. Broby, Saksenballe 5, 5672, Broby, Denmark
| | | | | | - Vlasta V Cvetkovic
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, 2600, Glostrup, Denmark
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, 2600, Glostrup, Denmark
| | - Lars Bendtsen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, 2600, Glostrup, Denmark
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Abstract
OBJECTIVES To discuss headache secondary to cerebrovascular disease. BACKGROUND Headache is an important symptom in cerebrovascular diseases. In some conditions, headache is the leading symptom. Migraine is associated with an increased risk of stroke. METHODS The authors undertook a literature search for the terms "headache" and "cerebrovascular diseases". RESULTS We report studies on headache in subarachnoidal hemorrhage, intracerebral hemorrhage, ischemic stroke, TIA, basilar artery thrombosis, cervical artery dissection, cerebellar stroke, arteritis and cerebral sinus venous thrombosis. In addition, we discuss migraine and stroke and thunderclap headache. CONCLUSIONS Headache is a leading symptom in many cerebrovascular diseases. Headache in combination with focal neurological deficits requires immediate diagnosis and treatment.
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Affiliation(s)
- John F Rothrock
- Department of Neurology, George Washington University School of Medicine, MFA Building, Department of Neurology, Washington, DC, USA
| | - Hans-Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty of the University Duisburg-Essen, Essen, Germany
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Real world effectiveness and tolerability of candesartan in the treatment of migraine: a retrospective cohort study. Sci Rep 2021; 11:3846. [PMID: 33589682 PMCID: PMC7884682 DOI: 10.1038/s41598-021-83508-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/03/2021] [Indexed: 12/29/2022] Open
Abstract
To date, two randomized, controlled studies support the use of candesartan for migraine prophylaxis but with limited external validity. We aim to evaluate the effectiveness and tolerability of candesartan in clinical practice and to explore predictors of patient response. Retrospective cohort study including all patients with migraine who received candesartan between April 2008-February 2019. The primary endpoint was the number of monthly headache days during weeks 8-12 of treatment compared to baseline. Additionally, we evaluated the frequency during weeks 20-24. We analysed the percentage of patients with 50% and 75% response rates and the retention rates after three and 6 months of treatment. 120/4121 patients were eligible, aged 45.9 [11.5]; 100 (83.3%) female. Eighty-four patients (70%) had chronic migraine and 53 (42.7%) had medication-overuse headache. The median number of prior prophylactics was 3 (Inter-quartile range 2-5). At baseline, patients had 20.5 ± 8.5 headache days per month, decreasing 4.3 ± 8.4 days by 3 months (weeks 12-16) and by 4.7 ± 8.7 days by 6 months (paired Student's t-test, p < 0.001). The percentage of patients with a 50% response was 32.5% at 3 months and 31.7% at 6 months, while the retention rate was 85.0% and 58.3%. The number of prior treatments (Odds ratio 0.79, 95% CI 0.64-0.97) and the presence of daily headache (Odds ratio 0.39, 95% CI 0.16-0.97) were associated with a lower probability of response. Candesartan showed beneficial effects in the preventive treatment of migraine in clinical practice, including patients with chronic migraine, medication-overuse headache and resistance to prior prophylactics.
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Barzenje AD, Gjesdal K, Winsvold BS, Småstuen MC, Stovner LJ, Gravdahl GB, Nilsen KB. Clinical and vascular responses to propranolol and candesartan in migraine patients: A randomized controlled clinical trial. CEPHALALGIA REPORTS 2020. [DOI: 10.1177/2515816320946491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Both propranolol and candesartan are prophylactic drugs for migraine, but with unknown mechanisms of action. The objectives of the present study were to investigate these drugs’ effects on arterial wall dynamics and the potential relation between their vascular and clinical effect. Methods: The study was based on data from a previously published randomized, placebo-controlled, triple-blinded, double crossover clinical trial comparing the prophylactic effects of candesartan and propranolol in 72 patients. Finapres noninvasive blood pressure curves were analyzed. On the descending limb of the pulse curve, a notch is produced by pulse wave reflection, and its relative height compared to the top of the curve (the notch ratio) was used as a marker of arterial wall stiffness. Results: Candesartan decreased the notch ratio from baseline ( p = 0.005), reflecting more compliant arteries and vasodilation, whereas propranolol increased the notch ratio ( p = 0.005), reflecting less compliant arteries and vasoconstriction. There was no difference in baseline notch ratio between clinical responders and nonresponders. Conclusion: The drugs are both efficient prophylactic medications, yet they have opposite effects on arterial wall dynamics. This suggests that drug effects other than those on arterial compliance must be responsible for their prophylactic effect in migraine.
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Affiliation(s)
| | - Knut Gjesdal
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Bendik Slagsvold Winsvold
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | | | - Lars Jacob Stovner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- National Advisory Unit on Headaches, St. Olavs Hospital, Trondheim, Norway
| | | | - Kristian Bernhard Nilsen
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Section for Clinical Neurophysiology, Department of Neurology, Division of Cinical Neuroscience, Oslo University Hospital, Norway
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38
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Martin LF, Patwardhan AM, Jain SV, Salloum MM, Freeman J, Khanna R, Gannala P, Goel V, Jones-MacFarland FN, Killgore WD, Porreca F, Ibrahim MM. Evaluation of green light exposure on headache frequency and quality of life in migraine patients: A preliminary one-way cross-over clinical trial. Cephalalgia 2020; 41:135-147. [PMID: 32903062 DOI: 10.1177/0333102420956711] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pharmacological management of migraine can be ineffective for some patients. We previously demonstrated that exposure to green light resulted in antinociception and reversal of thermal and mechanical hypersensitivity in rodent pain models. Given the safety of green light emitting diodes, we evaluated green light as a potential therapy in patients with episodic or chronic migraine. MATERIAL AND METHODS We recruited (29 total) patients, of whom seven had episodic migraine and 22 had chronic migraine. We used a one-way cross-over design consisting of exposure for 1-2 hours daily to white light emitting diodes for 10 weeks, followed by a 2-week washout period followed by exposure for 1-2 hours daily to green light emitting diodes for 10 weeks. Patients were allowed to continue current therapies and to initiate new treatments as directed by their physicians. Outcomes consisted of patient-reported surveys. The primary outcome measure was the number of headache days per month. Secondary outcome measures included patient-reported changes in the intensity and frequency of the headaches over a two-week period and other quality of life measures including ability to fall and stay asleep, and ability to perform work. Changes in pain medications were obtained to assess potential reduction. RESULTS When seven episodic migraine and 22 chronic migraine patients were analyzed as separate cohorts, white light emitting diodes produced no significant change in headache days in either episodic migraine or chronic migraine patients. Combining data from the episodic migraine and chronic migraine groups showed that white light emitting diodes produced a small, but statistically significant reduction in headache days from (days ± SEM) 18.2 ± 1.8 to 16.5 ± 2.01 days. Green light emitting diodes resulted in a significant decrease in headache days from 7.9 ± 1.6 to 2.4 ± 1.1 and from 22.3 ± 1.2 to 9.4 ± 1.6 in episodic migraine and chronic migraine patients, respectively. While some improvement in secondary outcomes was observed with white light emitting diodes, more secondary outcomes with significantly greater magnitude including assessments of quality of life, Short-Form McGill Pain Questionnaire, Headache Impact Test-6, and Five-level version of the EuroQol five-dimensional survey without reported side effects were observed with green light emitting diodes. Conclusions regarding pain medications reduction with green light emitting diode exposure were not possible. No side effects of light therapy were reported. None of the patients in the study reported initiation of new therapies. DISCUSSION Green light emitting diodes significantly reduced the number of headache days in people with episodic migraine or chronic migraine. Additionally, green light emitting diodes significantly improved multiple secondary outcome measures including quality of life and intensity and duration of the headache attacks. As no adverse events were reported, green light emitting diodes may provide a treatment option for those patients who prefer non-pharmacological therapies or may be considered in complementing other treatment strategies. Limitations of this study are the small number of patients evaluated. The positive data obtained support implementation of larger clinical trials to determine possible effects of green light emitting diode therapy.This study is registered with clinicaltrials.gov under NCT03677206.
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Affiliation(s)
- Laurent F Martin
- Department of Anesthesiology, College of Medicine, University of Arizona, Tucson, AZ, USA.,Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Amol M Patwardhan
- Department of Anesthesiology, College of Medicine, University of Arizona, Tucson, AZ, USA.,Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA.,Department of Neurosurgery, College of Medicine, University of Arizona, Tucson, AZ, USA.,Comprehensive Pain and Addiction Center, University of Arizona, Tucson, AZ, USA
| | - Sejal V Jain
- Department of Neurology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Michelle M Salloum
- Department of Anesthesiology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Julia Freeman
- Department of Anesthesiology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Rajesh Khanna
- Department of Anesthesiology, College of Medicine, University of Arizona, Tucson, AZ, USA.,Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA.,Comprehensive Pain and Addiction Center, University of Arizona, Tucson, AZ, USA
| | - Pooja Gannala
- Department of Anesthesiology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Vasudha Goel
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA
| | | | - William Ds Killgore
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Frank Porreca
- Department of Anesthesiology, College of Medicine, University of Arizona, Tucson, AZ, USA.,Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Mohab M Ibrahim
- Department of Anesthesiology, College of Medicine, University of Arizona, Tucson, AZ, USA.,Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA.,Department of Neurosurgery, College of Medicine, University of Arizona, Tucson, AZ, USA.,Comprehensive Pain and Addiction Center, University of Arizona, Tucson, AZ, USA
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39
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Tseng PT, Yang CP, Su KP, Chen TY, Wu YC, Tu YK, Lin PY, Stubbs B, Carvalho AF, Matsuoka YJ, Li DJ, Liang CS, Hsu CW, Chen YW, Shiue YL. The association between melatonin and episodic migraine: A pilot network meta-analysis of randomized controlled trials to compare the prophylactic effects with exogenous melatonin supplementation and pharmacotherapy. J Pineal Res 2020; 69:e12663. [PMID: 32347977 DOI: 10.1111/jpi.12663] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/07/2020] [Accepted: 04/21/2020] [Indexed: 01/03/2023]
Abstract
Although exogenous melatonin supplementation has been suggested to be effective for episodic migraine prophylaxis, there is no conclusive evidence comparing the efficacy of exogenous melatonin supplementation to the other FDA-approved pharmacotherapy for episodic migraine prophylaxis. The aim of the current network meta-analysis (NMA) was to compare the efficacy of exogenous melatonin supplementation in patients with episodic migraine. The randomized placebo-controlled trials or randomized controlled trials (RCTs) incorporating a placebo in the study designs were included in our analyses. All of the NMA procedures were conducted under the frequentist model. The primary outcome was changes in frequency of migraine days and response rate after migraine prophylaxis with melatonin supplementation or pharmacological interventions. We included 25 RCTs in total with 4499 patients (mean age = 36.0 years, mean female proportion = 78.9%). The NMA demonstrated that migraine prophylaxis with oral melatonin 3 mg/d (immediate-release) at bedtime was associated with the greatest improvement in migraine frequency [mean difference = -1.71 days, 95% confidence interval (CI): -3.27 to -0.14 days compared to placebo] and the second highest response rate (odds ratio = 4.19, 95% CI = 1.46 to 12.00 compared to placebo). Furthermore, oral melatonin 3 mg (immediate-release) at bedtime was the most preferred pharmacological intervention among all of the investigated interventions when improvements in migraine frequency, response rate, dropout rate, and rates of any adverse events were taken into account. This pilot NMA suggests the potential prophylactic role of exogenous melatonin supplementation in patients with episodic migraine.
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Affiliation(s)
- Ping-Tao Tseng
- WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chun-Pai Yang
- Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan
- Department of Nutrition, Huang-Kuang University, Taichung, Taiwan
| | - Kuan-Pin Su
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Faculty of Health, Social Care Medicine and Education, Positive Ageing Research Institute (PARI), Anglia Ruskin University, Chelmsford, UK
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
| | - Yutaka J Matsuoka
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Dian-Jeng Li
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
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40
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Filatova EG, Osipova VV, Tabeeva GR, Parfenov VA, Ekusheva EV, Azimova YE, Latysheva NV, Naprienko MV, Skorobogatykh KV, Sergeev AV, Golovacheva VA, Lebedeva ER, Artyomenko AR, Kurushina OV, Koreshkina MI, Amelin AV, Akhmadeeva LR, Rachin AR, Isagulyan ED, Danilov AB, Gekht AB. Diagnosis and treatment of migraine: Russian experts' recommendations. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2020. [DOI: 10.14412/2074-2711-2020-4-4-14] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Migraine is one of the most common types of headache, which can lead to a significant decrease in quality of life. Researchers identify migraine with aura, migraine without aura, and chronic migraine that substantially reduces the ability of patients to work and is frequently concurrent with mental disorders and drug-induced headache. The complications of migraine include status migrainosus, persistent aura without infarction, migrainous infarction (stroke), and a migraine aura-induced seizure. The diagnosis of migraine is based on complaints, past medical history, objective examination data, and the diagnostic criteria as laid down in the International Classification of Headache Disorders, 3 rd edition. Add-on trials are recommended only in the presence of red flags, such as the symptoms warning about the secondary nature of headache. Migraine treatment is aimed at reducing the frequency and intensity of attacks and the amount of analgesics taken. It includes three main approaches: behavioral therapy, seizure relief therapy, and preventive therapy. Behavioral therapy focuses on lifestyle modification. Nonsteroidal anti-inflammatory drugs, simple and combined analgesics, triptans, and antiemetic drugs for severe nausea or vomiting are recommended for seizure relief. Preventive therapy which includes antidepressants, anticonvulsants, beta-blockers, angiotensin II receptor antagonists, botulinum toxin type A-hemagglutinin complex and monoclonal antibodies to calcitonin gene-related peptide or its receptors, is indicated for frequent or severe migraine attacks and for chronic migraine. Pharmacotherapy is recommended to be combined with non-drug methods that involves cognitive behavioral therapy; progressive muscle relaxation; mindfulness; biofeedback; post-isometric relaxation; acupuncture; therapeutic exercises; greater occipital nerve block; non-invasive high-frequency repetitive transcranial magnetic stimulation; external stimulation of first trigeminal branch; and electrical stimulation of the occipital nerves (neurostimulation).
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Affiliation(s)
- E. G. Filatova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - V. V. Osipova
- Z.P. Solovyev Research and Practical Center of Psychoneurology, Moscow Healthcare Department; University Headache Clinic
| | - G. R. Tabeeva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - V. A. Parfenov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - E. V. Ekusheva
- Academy of Postgraduate Education «Federal Research and Clinical Center for Specialized Medical Care Types and Medical Technologies, Federal Biomedical Agency of Russia»
| | | | - N. V. Latysheva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - M. V. Naprienko
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | | | - A. V. Sergeev
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - V. A. Golovacheva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - E. R. Lebedeva
- Ural State Medical University, Ministry of Health of Russia
| | - A. R. Artyomenko
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - O. V. Kurushina
- Volgograd State Medical University, Ministry of Health of Russia
| | | | - A. V. Amelin
- Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | | | - A. R. Rachin
- National Medical Research Center for Rehabilitation and Balneology, Ministry of Health of Russia
| | - E. D. Isagulyan
- Academician N.N. Burdenko National Medical Research Center of Neurosurgery
| | - Al. B. Danilov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - A. B. Gekht
- Z.P. Solovyev Research and Practical Center of Psychoneurology, Moscow Healthcare Department
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41
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Parikh SK, Delbono MV, Silberstein SD. Managing migraine in pregnancy and breastfeeding. PROGRESS IN BRAIN RESEARCH 2020; 255:275-309. [PMID: 33008509 DOI: 10.1016/bs.pbr.2020.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/16/2020] [Accepted: 05/01/2020] [Indexed: 02/08/2023]
Abstract
The disproportionate prevalence of migraine among women in their reproductive years underscores the clinical significance of migraine during pregnancy. This paper discusses how migraine evolves during pregnancy, secondary headache disorders presenting in pregnancy and puerperium, and acute and preventive options for migraine management during pregnancy and lactation. Migraine is influenced by rising estrogen levels during pregnancy and their sharp decline in puerperium. Migraine, and migraine aura, can present for the first time during pregnancy and puerperium. There is also a higher risk for the development of preeclampsia and cerebrovascular headache during these periods. New or refractory headache, hypertension, and abnormal neurological signs are important "red flags" to consider. This paper reviews the diagnostic utility of neuroimaging studies and the risks of each during pregnancy. Untreated migraine can itself lead to preterm delivery, preeclampsia, and low birth weight infants. Behavioral interventions and lifestyle modifications are the cornerstone for migraine treatment during pregnancy. In addition, one should consider the risks and efficacy of each treatment during pregnancy on an individual basis. The protective nature of breastfeeding for migraine is debated, but there is no evidence to suggest breastfeeding worsens migraine. Acute and preventive migraine treatment options are available for nursing mothers. Neuromodulation and neurostimulation devices are additional options for treatment during pregnancy and lactation, while the safety of using calcitonin gene-related peptide receptor antagonists during these times remains to be determined.
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Affiliation(s)
- Simy K Parikh
- Thomas Jefferson University, Philadelphia, PA, United States
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42
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Urits I, Gress K, Charipova K, Zamarripa AM, Patel PM, Lassiter G, Jung JW, Kaye AD, Viswanath O. Pharmacological options for the treatment of chronic migraine pain. Best Pract Res Clin Anaesthesiol 2020; 34:383-407. [PMID: 33004155 DOI: 10.1016/j.bpa.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 12/29/2022]
Abstract
Migraine is a debilitating neurological condition with symptoms typically consisting of unilateral and pulsating headache, sensitivity to sensory stimuli, nausea, and vomiting. The World Health Organization (WHO) reports that migraine is the third most prevalent medical disorder and second most disabling neurological condition in the world. There are several options for preventive migraine treatments that include, but are not limited to, anticonvulsants, antidepressants, beta blockers, calcium channel blockers, botulinum toxins, NSAIDs, riboflavin, and magnesium. Patients may also benefit from adjunct nonpharmacological options in the comprehensive prevention of migraines, such as cognitive behavior therapy, relaxation therapies, biofeedback, lifestyle guidance, and education. Preventative therapies are an essential component of the overall approach to the pharmacological treatment of migraine. Comparative studies of newer therapies are needed to help patients receive the best treatment option for chronic migraine pain.
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Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
| | - Kyle Gress
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Alec M Zamarripa
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Parth M Patel
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Grace Lassiter
- Georgetown University School of Medicine, Washington, DC, USA
| | - Jai Won Jung
- Georgetown University School of Medicine, Washington, DC, USA
| | - Alan D Kaye
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Omar Viswanath
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA; Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA
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43
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Seminowicz DA, Burrowes SAB, Kearson A, Zhang J, Krimmel SR, Samawi L, Furman AJ, Keaser ML, Gould NF, Magyari T, White L, Goloubeva O, Goyal M, Peterlin BL, Haythornthwaite JA. Enhanced mindfulness-based stress reduction in episodic migraine: a randomized clinical trial with magnetic resonance imaging outcomes. Pain 2020; 161:1837-1846. [PMID: 32701843 PMCID: PMC7487005 DOI: 10.1097/j.pain.0000000000001860] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We aimed to evaluate the efficacy of an enhanced mindfulness-based stress reduction (MBSR+) vs stress management for headache (SMH). We performed a randomized, assessor-blind, clinical trial of 98 adults with episodic migraine recruited at a single academic center comparing MBSR+ (n = 50) with SMH (n = 48). MBSR+ and SMH were delivered weekly by group for 8 weeks, then biweekly for another 8 weeks. The primary clinical outcome was reduction in headache days from baseline to 20 weeks. Magnetic resonance imaging (MRI) outcomes included activity of left dorsolateral prefrontal cortex (DLPFC) and cognitive task network during cognitive challenge, resting state connectivity of right dorsal anterior insula to DLPFC and cognitive task network, and gray matter volume of DLPFC, dorsal anterior insula, and anterior midcingulate. Secondary outcomes were headache-related disability, pain severity, response to treatment, migraine days, and MRI whole-brain analyses. Reduction in headache days from baseline to 20 weeks was greater for MBSR+ (7.8 [95% CI, 6.9-8.8] to 4.6 [95% CI, 3.7-5.6]) than for SMH (7.7 [95% CI 6.7-8.7] to 6.0 [95% CI, 4.9-7.0]) (P = 0.04). Fifty-two percent of the MBSR+ group showed a response to treatment (50% reduction in headache days) compared with 23% in the SMH group (P = 0.004). Reduction in headache-related disability was greater for MBSR+ (59.6 [95% CI, 57.9-61.3] to 54.6 [95% CI, 52.9-56.4]) than SMH (59.6 [95% CI, 57.7-61.5] to 57.5 [95% CI, 55.5-59.4]) (P = 0.02). There were no differences in clinical outcomes at 52 weeks or MRI outcomes at 20 weeks, although changes related to cognitive networks with MBSR+ were observed. Enhanced mindfulness-based stress reduction is an effective treatment option for episodic migraine.
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Affiliation(s)
- David A. Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Shana AB Burrowes
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Alexandra Kearson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21224
| | - Jing Zhang
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Samuel R Krimmel
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Program in Neuroscience, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Luma Samawi
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Andrew J Furman
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Program in Neuroscience, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Michael L Keaser
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Neda F. Gould
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21224
| | - Trish Magyari
- Private Mindfulness-based Psychotherapy Practice, 3511 N Calvert St, Baltimore, MD 21218
| | - Linda White
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21224
| | - Olga Goloubeva
- University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Madhav Goyal
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
| | - B. Lee Peterlin
- Neuroscience Institute, Penn Medicine Lancaster General Health, Lancaster, PA, USA 17601
| | - Jennifer A. Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21224
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44
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Messina R, Lastarria Perez CP, Filippi M, Goadsby PJ. Candesartan in migraine prevention: results from a retrospective real-world study. J Neurol 2020; 267:3243-3247. [PMID: 32542525 DOI: 10.1007/s00415-020-09989-9] [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: 05/07/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 01/03/2023]
Abstract
Randomized studies have reported a positive effect of candesartan, an angiotensin II receptor antagonist, in migraine prevention. The aim of our study was to explore patient subjective efficacy of candesartan in a real-world sample of migraine patients and try to identify predictors of candesartan response. We audited the clinical records of 253 patients who attended the King's College Hospital, London, from February 2015 to December 2017, looking specifically at their response to candesartan. Univariate and multivariate logistic regression models were used to identify predictors of headache benefit. Odds ratios (OR) with confidence intervals (CI) 95% were calculated. Eighty-one patients (chronic migraine, n = 68) were included in the final analysis. Thirty-eight patients reported a positive response to candesartan, while 43 patients did not have a meaningful therapeutic effect. The median dose of candesartan was 8 mg and the median treatment period was 6 months. In a univariate logistic regression model, the presence of daily headache was associated with reduced odds of headache benefit (OR 0.39, 95% CI 0.16-0.96, p = 0.04). In multivariate logistic regression model, younger age (OR 0.92, 95% CI 0.87-0.98, p = 0.006) and longer disease duration (OR 1.06, 95% CI 1.01-1.12, p = 0.03) were associated with a good response to candesartan, while the presence of daily headache was associated with reduced odds of headache benefit (OR 0.16, 95% CI 0.04-0.71, p = 0.01). Having failed up to nine preventives in patients did not predict a treatment failure with candesartan as well. Candesartan yields clinical benefits in difficult-to-treat migraine patients, irrespective of previous failed preventives.
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Affiliation(s)
- Roberta Messina
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy. .,Neurology Unit, Milan, Italy. .,NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK.
| | - Carlo P Lastarria Perez
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK.,Department of Neurology, AUNA, Clinica Valle Sur, Arequipa, Peru
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,Neurology Unit, Milan, Italy.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Peter J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK
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45
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Diener HC. The Risks or Lack Thereof of Migraine Treatments in Vascular Disease. Headache 2020; 60:649-653. [PMID: 31967337 DOI: 10.1111/head.13749] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 12/22/2022]
Abstract
PREMISES Patients with migraine have a co-morbidity with vascular diseases such as hypertension, coronary heart disease, and stroke. PROBLEM This overview gives recommendations for the therapy of acute migraine attacks and for migraine prevention in patients with vascular diseases. In particular, the use of triptans in patients with vascular diseases is discussed. POTENTIAL SOLUTIONS Currently, there is a contraindication for the use of the triptans in patients with vascular disease, although there is no evidence that triptans increase the risk of heart attacks or stroke.
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Affiliation(s)
- Hans-Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty of the University Duisburg-Essen, Essen, Germany
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46
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Buda V, Baul B, Andor M, Man DE, Ledeţi A, Vlase G, Vlase T, Danciu C, Matusz P, Peter F, Ledeţi I. Solid State Stability and Kinetics of Degradation for Candesartan-Pure Compound and Pharmaceutical Formulation. Pharmaceutics 2020; 12:pharmaceutics12020086. [PMID: 31972960 PMCID: PMC7076474 DOI: 10.3390/pharmaceutics12020086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/11/2020] [Accepted: 01/15/2020] [Indexed: 12/28/2022] Open
Abstract
The aim of this work was to assess the impact of an excipient in a pharmaceutical formulation containing candesartan cilexetil over the decomposition of the active pharmaceutical ingredient and to comparatively investigate the kinetics of degradation during thermolysis in an oxidative atmosphere under controlled thermal stress. To achieve this, the samples were chosen as follows: pure candesartan cilexetil and a commercial tablet of 32 mg strength. As a first investigational tool, Universal attenuated total reflection Fourier transform infrared (UATR-FTIR) spectroscopy was chosen in order to confirm the purity and identity of the samples, as well as to check if any interactions took place in the tablet between candesartan cilexetil and excipients under ambient conditions. Later on, samples were investigated by thermal analysis, and the elucidation of the decomposition mechanism was achieved solely after performing an in-depth kinetic study, namely the use of the modified non-parametric kinetics (NPK) method, since other kinetic methods (American Society for Testing and Materials—ASTM E698, Friedman and Flynn–Wall–Ozawa) led to inadvertencies. The NPK method suggested that candesartan cilexetil and the tablet were degraded by the contribution of two steps, the main being represented by chemical degradation and the secondary being a physical transformation. The excipients chosen in the formulation seemed to have a stabilizing effect on the decomposition of the candesartan cilexetil that was incorporated into the tablet, relative to pure active pharmaceutical ingredient (API), since the apparent activation energy for the decomposition of the tablet was 192.5 kJ/mol, in comparison to 154.5 kJ/mol for the pure API.
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Affiliation(s)
- Valentina Buda
- Faculty of Pharmacy, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (V.B.); (C.D.)
| | - Bianca Baul
- Faculty of Industrial Chemistry and Environmental Engineering, Politehnica University of Timișoara, Vasile Parvan Street 6, 300223 Timisoara, Romania (F.P.)
| | - Minodora Andor
- Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (M.A.); (D.E.M.); (P.M.)
| | - Dana Emilia Man
- Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (M.A.); (D.E.M.); (P.M.)
| | - Adriana Ledeţi
- Faculty of Pharmacy, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (V.B.); (C.D.)
- Correspondence: (A.L.); (I.L.); Tel.: +40-256-204-476 (A.L. & I.L.)
| | - Gabriela Vlase
- Research Centre for Thermal Analysis in Environmental Problems, West University of Timişoara, 300115 Timisoara, Romania; (G.V.); (T.V.)
| | - Titus Vlase
- Research Centre for Thermal Analysis in Environmental Problems, West University of Timişoara, 300115 Timisoara, Romania; (G.V.); (T.V.)
| | - Corina Danciu
- Faculty of Pharmacy, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (V.B.); (C.D.)
| | - Petru Matusz
- Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (M.A.); (D.E.M.); (P.M.)
| | - Francisc Peter
- Faculty of Industrial Chemistry and Environmental Engineering, Politehnica University of Timișoara, Vasile Parvan Street 6, 300223 Timisoara, Romania (F.P.)
| | - Ionuţ Ledeţi
- Faculty of Pharmacy, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (V.B.); (C.D.)
- Faculty of Industrial Chemistry and Environmental Engineering, Politehnica University of Timișoara, Vasile Parvan Street 6, 300223 Timisoara, Romania (F.P.)
- Correspondence: (A.L.); (I.L.); Tel.: +40-256-204-476 (A.L. & I.L.)
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Jenssen AB, Stovner LJ, Tronvik E, Sand T, Helde G, Gravdahl GB, Hagen K. The crossover design for migraine preventives: an analyses of four randomized placebo-controlled trials. J Headache Pain 2019; 20:119. [PMID: 31881823 PMCID: PMC6935071 DOI: 10.1186/s10194-019-1067-z] [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: 11/11/2019] [Accepted: 12/15/2019] [Indexed: 11/20/2022] Open
Abstract
Aims To evaluate the crossover design in migraine preventive treatment trials by assessing dropout rate, and potential period and carryover effect in four placebo-controlled randomized controlled trials (RCTs). Methods In order to increase statistical power, the study combined data from four different RCTs performed from 1998 to 2015 at St. Olavs Hospital, Norway. Among 264 randomized patients, 120 received placebo treatment before and 144 after active treatment. Results Only 26 (10%) dropped out during the follow-up period of 30–48 weeks, the majority (n = 19) in the first 12 weeks. No period effect was found, since the treatment sequence did not influence the responder rate after placebo treatment, being respectively for migraine 30.5% vs. 27.4% (p = 0.59) and for headache 25.0% vs. 24.8% (p = 0.97, Chi-square test) when placebo occurred early or late. Furthermore, no carryover effect was identified, since the treatment sequence did not influence the treatment effect (difference between placebo and active treatment). There was no significant difference between those who received active treatment first and those who received placebo first with respect to change in number of days per 4 week of headache (− 0.9 vs. -1.3, p = 0.46) and migraine (− 1.2 vs. -0.9, p = 0.35, Student’s t-test). Conclusions Summary data from four crossover trials evaluating preventive treatment in adult migraine showed that few dropped out after the first period. No period or carryover effect was found. RCT studies with crossover design can be recommended as an efficient and cost-saving way to evaluate potential new preventive medicines for migraine in adults.
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Affiliation(s)
- Astrid Bjørke Jenssen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7489, Trondheim, Norway
| | - Lars Jacob Stovner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7489, Trondheim, Norway.,Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
| | - Erling Tronvik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7489, Trondheim, Norway.,Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7489, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs University Hospital, Trondheim, Norway
| | - Grethe Helde
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7489, Trondheim, Norway
| | - Gøril Bruvik Gravdahl
- Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
| | - Knut Hagen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7489, Trondheim, Norway. .,Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway. .,Clinical Research Unit Central Norway, St. Olavs Hospital, Trondheim, Norway.
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48
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Kouremenos E, Arvaniti C, Constantinidis TS, Giannouli E, Fakas N, Kalamatas T, Kararizou E, Naoumis D, Mitsikostas DD. Consensus of the Hellenic Headache Society on the diagnosis and treatment of migraine. J Headache Pain 2019; 20:113. [PMID: 31835997 PMCID: PMC6911284 DOI: 10.1186/s10194-019-1060-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/18/2019] [Indexed: 01/03/2023] Open
Abstract
More than 0.6 million people suffer from disabling migraines in Greece causing a dramatic work loss, but only a small proportion of migraineurs attend headache centres, most of them being treated by non-experts. On behalf of the Hellenic Headache Society, we report here a consensus on the diagnosis and treatment of adult migraine that is based on the recent guidelines of the European Headache Federation, on the principles of Good Clinical Practice and on the Greek regulatory affairs. The purposes are three-fold: (1) to increase awareness for migraine in Greece; (2) to support Greek practitioners who are treating migraineurs; and (3) to help Greek migraineurs to get the most appropriate treatment. For mild migraine, symptomatic treatment with high dose simple analgesics is suggested, while for moderate to severe migraines triptans or non-steroidal anti-inflammatory drugs, or both, should be administered following an individually tailored therapeutic strategy. A rescue acute treatment option should always be advised. For episodic migraine prevention, metoprolol (50–200 mg/d), propranolol (40–240 mg/d), flunarizine (5–10 mg/d), valproate (500–1800 mg/d), topiramate (25–100 mg/d) and candesartan (16–32 mg/d) are the drugs of first choice. For chronic migraine prevention topiramate (100-200 mg/d), valproate (500–1800 mg/d), flunarizine (5–10 mg/d) and venlafaxine (150 mg/d) may be used, but the evidence is very limited. Botulinum toxin type A and monoclonal antibodies targeting the CGRP pathway (anti-CGRP mAbs) are recommended for patients suffering from chronic migraine (with or without medication overuse) who failed or did not tolerate two previous treatments. Anti-CGRP mAbs are also suggested for patients suffering from high frequency episodic migraine (≥8 migraine days per month and less than 14) who failed or did not tolerate two previous treatments.
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Affiliation(s)
| | - Chrysa Arvaniti
- Second Neurology Department, School of Medicine, National & Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | | | | | - Nikolaos Fakas
- Neurology Department, 401 Military General Hospital, Athens, Greece
| | | | - Evangelia Kararizou
- First Neurology Department, School of Medicine, National & Kapodistrian University of Athens, Aeginition Hospital, 72-74 Vl Sofia's Avenue, 11528, Athens, Greece
| | - Dimitrios Naoumis
- Neurology Department, 251 Air Force General Hospital, Athens, Greece
| | - Dimos D Mitsikostas
- First Neurology Department, School of Medicine, National & Kapodistrian University of Athens, Aeginition Hospital, 72-74 Vl Sofia's Avenue, 11528, Athens, Greece.
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Abstract
Migraine affects over a billion people worldwide in any year and is the second most common cause of years lost due to disability. Not "just a headache", morbidity washes though society and carries a substantial economic and social cost. Understanding of migraine pathophysiology has progressed significantly. Animal models and functional neuroimaging have yielded significant insight into brain structures that mediate migraine symptoms. The role of small peptides as neurotransmitters within this network has been elucidated, allowing the generation of novel therapeutic approaches that have been validated by randomised placebo-controlled trials. Migraine is underdiagnosed and undertreated. Treatment of migraine should be proactive. An acute and, when indicated, preventive strategy should be formulated with the patient. Comorbid medication overuse must be supportively managed. Migraine-specific medications are making their way from bench to bedside. They promise an improved safety profile and ease of use in comparison to older, repurposed medications. Devices promise a non-drug alternative should patients prefer. The migraine understanding and treatment landscape is changing rapidly.
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50
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Hulla R, Liegey-Dougall A. A systematic review of high-frequency transcranial magnetic stimulation on motor cortex areas as a migraine preventive treatment. CEPHALALGIA REPORTS 2019. [DOI: 10.1177/2515816319889971] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: The results of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex for migraine have been inconsistent. However, high-frequency rTMS over the motor cortex is a treatment that may be effective in relieving symptoms of migraine with a low risk of side effects. Methods: A systematic review of high-frequency rTMS over the brain motor cortex areas in human participants was conducted to assess efficacy in treating migraine. Articles that were not looking at migraine patients, stimulation over the left motor cortex, or were not in English were excluded. Nine articles representing eight experiments using high-frequency rTMS over the motor cortex areas for migraine in human participants were extracted from the databases of PubMed, PsycINFO, MedLine, CINAHL, and BioMed Central. Results: Two-hundred and seven of 213 patients completed treatment throughout all the studies examined. High-frequency rTMS over the motor cortex areas for migraine improved migraine frequency in seven of eight studies. Two of the eight studies were randomized controlled trials at low risk for biases and found high-frequency rTMS over the motor cortex areas effective in improving migraine frequency and severity. Other details of treatment prescription and symptoms were also examined. Conclusion: High-frequency rTMS over the motor cortex areas for migraine demonstrated efficacy as a migraine treatment, had minimal side effects, and should be further investigated.
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Affiliation(s)
- Ryan Hulla
- Department of Psychology, University of Texas at Arlington, Arlington, TX, USA
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