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Mínguez-Olaondo A, Días PA, de Munáin EL, Grozeva V, Laspra-Solís C, Villalba IM, García-Martín V, Vila-Pueyo M, Barandiarán M, Zabalza RJ, Bengoetxea A. Behavioral therapy in migraine: Expanding the therapeutic arsenal. Eur J Neurol 2024:e16414. [PMID: 39034641 DOI: 10.1111/ene.16414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND AND PURPOSE The US Headache Consortium developed evidence-based guidelines for the treatment of migraine and found grade A evidence in support of behavior therapy (BT). Understanding the mechanisms of BT may improve the management of migraine and reduce its burden. METHODS We performed a narrative review to define the current evidence of BT and determine its usefulness in migraine management. RESULTS The information was obtained from 116 publications, with 56 of them retrieved through direct searches in PubMed (2011-2020) and the remainder selected by the authors to complete the content. BT might reduce migraine impact by decreasing the sympathetic nervous system's response to stress and increasing pain tolerance. Acting in headache-related surroundings can be improved, together with headache duration and self-efficacy. Applications such as mobile health and electronic health applications can help to carry out healthier lifestyle patterns. Regarding medication overuse, BT seems to be a good choice, with similar results to pharmacological prophylaxis. Advantages of using BT are the lack of adverse effects and the unrestricted use in children, where BT is postulated to be even more effective than the standardized pharmacopeia. CONCLUSIONS BT is an interesting tool that can be used as an add-on therapy in migraine. Through BT, the autonomy and empowerment of migraine patients is enhanced. BT may not cure migraine, but it could help to reduce pain severity perception, disability, and migraine impact, adding an emotive and cognitive approach to the perceptive role of pharmacopeia. Thus, a better approach in migraine, implementing specific therapeutic management, can improve migraine control.
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Affiliation(s)
- Ane Mínguez-Olaondo
- Neurology Department, Hospital Universitario Donostia-Osakidetza , Neuroscience Area, Biogipuzkoa Health Institute, Donostia, Spain
- Athenea Neuroclinics, Donostia, Spain
- Department of Medicine and Department of Physical Therapy, Faculty of Health Sciences, University of Deusto, Bilbao and San Sebastian, Spain
| | - Patricia Alves Días
- Neurology Department, Hospital Universitario Donostia-Osakidetza , Neuroscience Area, Biogipuzkoa Health Institute, Donostia, Spain
- Athenea Neuroclinics, Donostia, Spain
- Department of Medicine and Department of Physical Therapy, Faculty of Health Sciences, University of Deusto, Bilbao and San Sebastian, Spain
| | | | | | - Carmen Laspra-Solís
- Department of Psychiatry and Clinical Psychology, University Clinic of Navarra, Madrid, Spain
| | | | - Valvanuz García-Martín
- Neurology Department, Hospital Universitario Donostia-Osakidetza , Neuroscience Area, Biogipuzkoa Health Institute, Donostia, Spain
| | - Marta Vila-Pueyo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Myriam Barandiarán
- Neurology Department, Hospital Universitario Donostia-Osakidetza , Neuroscience Area, Biogipuzkoa Health Institute, Donostia, Spain
- Athenea Neuroclinics, Donostia, Spain
- Department of Medicine and Department of Physical Therapy, Faculty of Health Sciences, University of Deusto, Bilbao and San Sebastian, Spain
| | - Ramon J Zabalza
- Neurology Department, Hospital Universitario Donostia-Osakidetza , Neuroscience Area, Biogipuzkoa Health Institute, Donostia, Spain
| | - Ana Bengoetxea
- Athenea Neuroclinics, Donostia, Spain
- Unité de Recherche en Sciences de l'Ostéopathie, Faculté des Sciences de la Motricité, Université Libre de Bruxelles, Brussels, Belgium
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Fedeli D, Ciullo G, Demichelis G, Medina Carrion JP, Bruzzone MG, Ciusani E, Erbetta A, Ferraro S, Grisoli M, Guastafierro E, D'Amico D, Raggi A, Nigri A, Grazzi L. Longitudinal neurofunctional changes in medication overuse headache patients after mindfulness practice in a randomized controlled trial (the MIND-CM study). J Headache Pain 2024; 25:97. [PMID: 38858629 PMCID: PMC11165872 DOI: 10.1186/s10194-024-01803-5] [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: 02/20/2024] [Accepted: 05/31/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Mindfulness practice has gained interest in the management of Chronic Migraine associated with Medication Overuse Headache (CM-MOH). Mindfulness is characterized by present-moment self-awareness and relies on attention control and emotion regulation, improving headache-related pain management. Mindfulness modulates the Default Mode Network (DMN), Salience Network (SN), and Fronto-Parietal Network (FPN) functional connectivity. However, the neural mechanisms underlying headache-related pain management with mindfulness are still unclear. In this study, we tested neurofunctional changes after mindfulness practice added to pharmacological treatment as usual in CM-MOH patients. METHODS The present study is a longitudinal phase-III single-blind Randomized Controlled Trial (MIND-CM study; NCT03671681). Patients had a diagnosis of CM-MOH, no history of neurological and severe psychiatric comorbidities, and were attending our specialty headache centre. Patients were divided in Treatment as Usual (TaU) and mindfulness added to TaU (TaU + MIND) groups. Patients underwent a neuroimaging and clinical assessment before the treatment and after one year. Longitudinal comparisons of DMN, SN, and FPN connectivity were performed between groups and correlated with clinical changes. Vertex-wise analysis was performed to assess cortical thickness changes. RESULTS 177 CM-MOH patients were randomized to either TaU group or TaU + MIND group. Thirty-four patients, divided in 17 TaU and 17 TaU + MIND, completed the neuroimaging follow-up. At the follow-up, both groups showed an improvement in most clinical variables, whereas only TaU + MIND patients showed a significant headache frequency reduction (p = 0.028). After one year, TaU + MIND patients showed greater SN functional connectivity with the left posterior insula (p-FWE = 0.007) and sensorimotor cortex (p-FWE = 0.026). In TaU + MIND patients only, greater SN-insular connectivity was associated with improved depression scores (r = -0.51, p = 0.038). A longitudinal increase in cortical thickness was observed in the insular cluster in these patients (p = 0.015). Increased anterior cingulate cortex thickness was also reported in TaU + MIND group (p-FWE = 0.02). CONCLUSIONS Increased SN-insular connectivity might modulate chronic pain perception and the management of negative emotions. Enhanced SN-sensorimotor connectivity could reflect improved body-awareness of painful sensations. Expanded cingulate cortex thickness might sustain improved cognitive processing of nociceptive information. Our findings unveil the therapeutic potential of mindfulness and the underlying neural mechanisms in CM-MOH patients. TRIAL REGISTRATION Name of Registry; MIND-CM study; Registration Number ClinicalTrials.gov identifier: NCT0367168; Registration Date: 14/09/2018.
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Affiliation(s)
- Davide Fedeli
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy
| | - Giuseppe Ciullo
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy
- Department of Medicine and Surgery, University of Parma, Via Volturno 39, Parma, 43125, Italy
| | - Greta Demichelis
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy
| | - Jean Paul Medina Carrion
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy
| | - Maria Grazia Bruzzone
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy
| | - Emilio Ciusani
- Department of Diagnostic and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alessandra Erbetta
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy
| | - Stefania Ferraro
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy
- School of Life Science and Technology, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Marina Grisoli
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy
| | - Erika Guastafierro
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Domenico D'Amico
- Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Anna Nigri
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy.
| | - Licia Grazzi
- Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Grazzi L, Montisano DA, D'Amico D, Altamura C, Raggi A, Rizzoli P, Marcassoli A. Multimodal digital health treatments for Chronic Migraine associated with Medication Overuse Headache: a literature appraisal and results of a single-arm open trial (the BE-HOME program). Neurol Sci 2024:10.1007/s10072-024-07568-8. [PMID: 38771524 DOI: 10.1007/s10072-024-07568-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Mindfulness-based treatments gained popularity for migraine treatment. In this manuscript we report the results of a single-arm open pilot study that evaluated the impact of a multimodal web-based intervention combining home-based medication withdrawal, patients' education, and online mindfulness-based interventions. We aimed to address whether our program had the ability to show a change in the observed parameters and the study should therefore be intended as an early phase trial. METHODS Consecutive patients with chronic migraine associated with medication overuse headache were enrolled, followed-up for 12 months, in a program that included home-based medication withdrawal, education on the correct use of drugs and lifestyle issues, prescription of tailored pharmacological prophylaxis, and attendance to six online mindfulness-based sessions. We tested the effect of the program on improving headache frequency, medication intake, quality of life (QoL), headache impact, depression, self-efficacy, and pain catastrophizing. RESULTS A total of 37 patients completed the study (10 dropped out). We observed a large improvement in headache frequency, medication intake, headache impact, and QoL, a moderate improvement in pain catastrophizing and a mild improvement in depression symptoms; 70% to 76% of patients achieved 50% or more reduction in headache frequency from baseline to each follow-up (p < .01). CONCLUSIONS The results of our multimodal program showed significant improvements in headache frequency, medication intake, and patient-reported outcomes. Future studies are needed to better identify patients who might benefit most from Digital Health Interventions and to demonstrate at least an equivalence in outcome with in-person programs carried out in hospital settings.
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Affiliation(s)
- Licia Grazzi
- Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Danilo Antonio Montisano
- Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Domenico D'Amico
- Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Claudia Altamura
- Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paul Rizzoli
- John Graham Headache Center, Brigham & Women's Faulkner Hospital, Harvard Medical School, Boston, MA, USA
| | - Alessia Marcassoli
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Krymchantowski A, Jevoux C, Krymchantowski AG, Ramos LB, Barbosa JSS, Silva-Neto RP. Medication-overuse headache-a review of different treatment strategies. FRONTIERS IN PAIN RESEARCH 2023; 4:1103497. [PMID: 37881687 PMCID: PMC10597723 DOI: 10.3389/fpain.2023.1103497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/23/2023] [Indexed: 10/27/2023] Open
Abstract
Medication-overuse headache (MOH) can develop from primary headaches. MOH is usually the result of overuse of symptomatic medications. It is a noteworthy personal and societal burden. The identification and treatment of patients at risk for MOH is an essential component of MOH management. Medication overuse can be modifiable and can advance from episodic to chronic migraine. Treatment for MOH is complex, and experts in the field have varied views on the most appropriate strategy for MOH treatment. The objective of this review is to give a comprehensive synopsis of the literature for the management of MOH. Treatment strategies, such as detoxification and prevention, are the debatable issues. Medication withdrawal is the foundation for management. The available literature suggested abrupt withdrawal with preventive approaches for early management. Bridging therapy could be useful to get relief from withdrawal symptoms. Multidisciplinary choices proved beneficial in supporting withdrawal and preventing relapse. Worldwide, the termination of overused medications has been observed as a standard treatment strategy; however, patient-specific approaches should be taken.
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Ljubisavljevic S, Ljubisavljevic M, Damjanovic R, Kalinic S. A Descriptive Review of Medication-Overuse Headache: From Pathophysiology to the Comorbidities. Brain Sci 2023; 13:1408. [PMID: 37891777 PMCID: PMC10605322 DOI: 10.3390/brainsci13101408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE OF REVIEW Medication-overuse headache (MOH) is an important problem worldwide, with different areas of controversy regarding its entity. This article reviews the risk factors, comorbidities, pathophysiology, clinical presentation, effective management, and prognosis of MOH by summarizing and integrating the results and findings from previously performed more than 15,000 studies (from 2010 to 2023) available from the scientific database of the University Medical Library in the University Clinical Center of Niš, which aimed to investigate and define the complexity of this type of headache. RECENT FINDING It has been proposed that all acute migraine medications can lead to MOH, with differences in the propensity of different agents to cause the problem. Early data suggests that triptans and other painkillers used for the acute treatment of migraine may be an exception. Recent studies show that practitioners and the general public are still largely unaware of the problem of medication overuse and its damaging effects. SUMMARY Although it is likely that MOH does occur, restricting the number of acute medications is necessary to prevent it. It is also possible that increasing amounts of acute medications are simply a reflection of poorly controlled headaches rather than a cause. Further research needs to be developed to identify more precise mechanisms for effective MOH management and its evolution.
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Affiliation(s)
- Srdjan Ljubisavljevic
- Department for Neurology, University Clinical Centre of Nis, 18000 Nis, Serbia; (M.L.); (R.D.); (S.K.)
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Polk AN, Smitherman TA. A meta-analytic review of acceptance-based interventions for migraine. Headache 2023; 63:1271-1284. [PMID: 37635382 DOI: 10.1111/head.14614] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To determine the efficacy of acceptance and mindfulness-based interventions on migraine disability, medication use, and attack frequency. BACKGROUND Acceptance-based approaches to headache management are those in which individuals learn to mitigate the influence of pain-related experiences on their general functioning without controlling pain itself. Treatment approaches include acceptance and commitment therapy (ACT) and mindfulness-based practices. Both have shown promise in improving broad functioning and disability among individuals with headache. Despite a growing body of research examining acceptance-based interventions for headache broadly and migraine specifically, no meta-analytic review of ACT interventions for headache exists, and two meta-analytic reviews of mindfulness-based practices yielded conflicting results. METHODS The present study aimed to systematically and quantitatively review the literature related to the efficacy of acceptance-based interventions among adults with migraine. A multi-database search (PubMed/MEDLINE, Scopus, PsycINFO, and the Cochrane Central Register of Controlled Trials) identified clinical trials among individuals with migraine that compared structured ACT or mindfulness-based interventions to control treatment. Random-effects meta-analyses were performed using RevMan 5.4 meta-analytic software, and standardized mean differences (SMD) with 95% confidence intervals (CIs) quantified effect sizes on outcomes of disability, medication use, and headache frequency. Heterogeneity was quantified via I2 index and explored via subgroup analyses. RESULTS Acceptance-based interventions yielded significant improvements in disability (SMD = -0.38, 95% CI = -0.56 to -0.20; I2 = 25%, p = 0.20) but not in medication use (SMD = -0.25, 95% CI: -0.57 to 0.06; I2 = 0%, p = 0.82) or headache frequency (SMD = -0.16, 95% CI = -0.37 to 0.05; I2 = 0%, p = 0.73). CONCLUSION Results suggest that acceptance-based interventions are effective in improving disability among adults with migraine and are a viable non-pharmacological treatment option, in addition to well-established behavioral migraine management approaches, for patients seeking functional improvement.
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Affiliation(s)
- Ashley N Polk
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Todd A Smitherman
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
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Krymchantowski A, Jevoux C, Krymchantowski AG, Silva-Néto RP. Medication Overuse Headache, Chronic Migraine and Monoclonal Antibodies Anti-CGRP: A Real-World Study. Clin Neuropharmacol 2023; 46:181-185. [PMID: 37748000 DOI: 10.1097/wnf.0000000000000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Medication overuse headache (MOH) in chronic migraineurs may be a cause or consequence of the overuse of symptomatic medications for headache attacks. It is highly prevalent in tertiary centers. We compared the efficacy of 3 anti-CGRP monoclonal antibodies with traditional pharmacological agents in patients with chronic migraine (CM) and MOH. METHODS A randomized, cross-sectional, prospective, and open trial with real-world comparison groups was carried out. The sample consisted of 100 consecutive patients having CM and MOH. RESULTS Eighty-eight patients (65 women and 23 men) were included in the study and divided into 4 groups: those having used erenumab (19.3%), galcanezumab (29.6%), fremanezumab (25%) and conventional medications, and the control group (26.1%). Ages ranged from 18 to 78 years (mean, 44.1 ± 13.6 years). In the 6 months of follow-up, there was a significant reduction in the number of headache days in the 3 groups when compared with the control ( P < 0.0001). CONCLUSIONS The small number of patients included in each group and the open design do not allow definitive conclusions, but the use of anti-CGRP monoclonal antibodies in patients with CM and MOH may result in lessening the number of headache days when compared with conventional treatment with drugs.
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8
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Grazzi L, D'Amico D, Guastafierro E, Demichelis G, Erbetta A, Fedeli D, Nigri A, Ciusani E, Barbara C, Raggi A. Efficacy of mindfulness added to treatment as usual in patients with chronic migraine and medication overuse headache: a phase-III single-blind randomized-controlled trial (the MIND-CM study). J Headache Pain 2023; 24:86. [PMID: 37452281 PMCID: PMC10347788 DOI: 10.1186/s10194-023-01630-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Mindfulness gained considerable attention for migraine management, but RCTs are lacking. We aimed to assess the efficacy of a six-sessions mindfulness-based treatment added to treatment as usual (TaU) in patients with Chronic Migraine (CM) and Medication Overuse Headache (MOH) on headache frequency, medication intake, quality of life, disability, depression and anxiety, cutaneous allodynia, awareness of inner states, work-related difficulties, and disease cost. METHODS In this Phase-III single-blind RCT carried out in a specialty Italian headache center, 177 patients with CM and MOH were randomized 1:1 to either TaU (withdrawal from overused drugs, education on proper medication use and lifestyle issues, and tailored prophylaxis) or mindfulness-based intervention added to TaU (TaU + MIND). The mindfulness-based intervention consisted of six group session of mindfulness practice and 7-10 min daily self-practice. The primary endpoint was the achievement of ≥ 50% headache frequency reduction at 12 months compared to baseline, and was analyzed on an intention-to-treat principle using Pearson's Chi-Squared test. Secondary endpoints included medication intake, quality of life (QoL), disability, depression and anxiety, cutaneous allodynia, awareness of inner states, work-related difficulties, and disease cost. The secondary endpoints were analyzed using per-protocol linear mixed models. RESULTS Out of the 177 participants 89 were randomized to TaU and 88 to TaU + MIND. Patients in the TaU + MIND group outperformed those in TaU for the primary endpoint (78.4% vs. 48.3%; p < 0.0001), and showed superior improvement in headache frequency, QoL and disability, headache impact, loss of productive time, medication intake, and in total, indirect and direct healthcare costs. CONCLUSIONS A mindfulness-based treatment composed of six-week session and 7-10 min daily self-practice added on to TaU is superior to TaU alone for the treatment of patients with CM and MOH. TRIAL REGISTRATION MIND-CM was registered on clinicaltrials.gov (NCT03671681) on14/09/2018.
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Affiliation(s)
- Licia Grazzi
- Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Domenico D'Amico
- Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Erika Guastafierro
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milano, Italy
| | - Greta Demichelis
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alessandra Erbetta
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Davide Fedeli
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Anna Nigri
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Emilio Ciusani
- Department of Diagnostic and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Corso Barbara
- Neuroscience Institute, Consiglio Nazionale delle Ricerche, Padova, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milano, Italy.
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Goyal M, Haythornthwaite JA, Jain S, Peterlin BL, Mehrotra M, Levine D, Rosenberg JD, Minges M, Seminowicz DA, Ford DE. Intensive Mindfulness Meditation Reduces Frequency and Burden of Migraine: An Unblinded Single-Arm Trial. Mindfulness (N Y) 2023; 14:406-417. [PMID: 38282695 PMCID: PMC10810247 DOI: 10.1007/s12671-023-02073-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
Objectives Preventing migraine headaches and improving the quality of life for patients with migraine remains a challenge. We hypothesized intensive meditation training would reduce the disease burden of migraine. Method An unblinded trial was analyzed as a single cohort exposed to a silent 10-day Vipassana meditation retreat that included 100 hr of sitting meditation. Participants with chronic or episodic migraine were enrolled and followed for 1 year. The primary outcome was a change in mean monthly migraine days at 12 months from baseline. Secondary outcomes included headache frequency and intensity, acute medication use, work days missed, home meditation, sleep quality, general health, quality of life, migraine impact, positive and negative affect, perceived stress, mindfulness, and pain catastrophizing. Results Three hundred people were screened and 58 (19%) agreed to participate and enrolled in the intensive meditation training. Forty-six participants with chronic migraine (≥ 15 headaches/month of which ≥ 8 were migraines) and 12 with episodic migraine (< 15 and ≥ 4 migraines/month) attended and 45 (78%) completed the retreat. At 12 months, the average migraine frequency was reduced by 2.7 days (from 16.6 at baseline) per 28 days (95%CI - 4.3, - 1.3) and headaches by 3.4 (20.1 at baseline) per 28 days (- 4.9, - 1.9). Fifty percent responder rate was 29% for migraine. Acute medication use dropped by an average of 2.2 days (- 3.9, - 0.5) per 28 days, and participants reported 2.3 fewer days (- 4.0, - 0.5) on which they reduced their activity due to migraines. The most striking and promising effects were in several secondary outcomes, including migraine-specific quality of life, pain catastrophizing, and perceived stress. The significant improvements observed immediately following the intervention were sustained at 12 months follow-up. Conclusions Training in Vipassana meditation via a 10-day retreat may reduce the frequency and burden of migraine. Preregistration ClinicalTrials.gov: NCT00663585.
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Affiliation(s)
- Madhav Goyal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
- Center for Primary Care, NorthBay Healthcare, Vacaville, CA, USA
| | | | - Sharat Jain
- Mid-Atlantic Vipassana Association, Claymont, DE, USA
| | - Barbara Lee Peterlin
- Neuroscience Institute, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Megha Mehrotra
- Department of Epidemiology and Biostatistics, Univ of California, San Francisco, USA
| | - David Levine
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jason D. Rosenberg
- Department of Neurology, Mid-Atantic Permanente Medical Group, MD, Halethorpe, USA
| | - Mary Minges
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| | - David A. Seminowicz
- Department of Neural & Pain Sciences, School of Dentistry, Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, USA
| | - Daniel E. Ford
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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10
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Krymchantowski AV, Jevoux C, Krymchantowski AG, Silva-Néto RP. Monoclonal antibodies for chronic migraine and medication overuse headache: A real-world study. Front Neurol 2023; 14:1129439. [PMID: 36937507 PMCID: PMC10022428 DOI: 10.3389/fneur.2023.1129439] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023] Open
Abstract
Background Medication-overuse headache is highly prevalent in tertiary care centers. It may be a cause or consequence of the overuse of symptomatic medications for migraine attacks. Objective We aimed to compare the efficacy of anti-CGRP monoclonal antibodies (mAbs) added to conventional pharmacological treatments in patients with chronic migraine (CM) and medication overuse headache (MOH). Methods A cross-sectional, prospective, randomized, open study with real-world comparison groups of patients was carried out. The sample consisted of 200 patients with CM and MOH, who received the same approach to withdraw overused medications, started preventative treatment, and either did or did not receive mAbs. Results A total of 172 patients (126 women and 46 men) were included in the study and divided into two groups: group one consisting of 58 patients (control) and group two of 114 patients who used mAbs added to conventional pharmacological agents. The mean age was 44.1 ± 13.6 years, ranging from 18 to 78 years. In the 3 months follow-up after starting the treatment, both groups presented headache frequency reduction, but those with monoclonal antibodies had a significantly higher reduction in the number of headache days and symptomatic medication intake when compared to the control (p < 0.0001). Conclusions The addition of an anti-CGRP monoclonal antibody to the treatment for medication overuse headaches in chronic migraineurs may result in decreasing headache frequency and symptomatic medication use when compared to conventional treatments with drugs.
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Affiliation(s)
| | - Carla Jevoux
- Department of Neurology, Headache Center of Rio, Rio de Janeiro, Brazil
| | | | - Raimundo Pereira Silva-Néto
- Department of Neurology, Federal University of the Parnaíba Delta, Parnaíba, Brazil
- *Correspondence: Raimundo Pereira Silva-Néto
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11
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Diener HC, Rizzoli P. Chronic migraine and medication overuse. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:187-200. [PMID: 38043961 DOI: 10.1016/b978-0-12-823356-6.00008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Though clearly described as far back as the 17th century, chronic migraine has defied precise categorization and has continued to develop as an important diagnostic concept with significant societal impact. Worldwide prevalence is estimated to be between 1% and 3%, and these patients form a dynamic group cycling between chronic and episodic migraine. Theories of pathogenesis are developing supported by recent imaging and other findings. Of the many determinants of progression to chronic migraine, overuse of acute abortive headache medications may be one of the most important modifiable factors. Treatment strategies, in addition to educational measures, have included various preventive migraine medications such as topiramate, valproate, and onabotulinumtoxinA. CGRP monoclonal antibodies are efficacious for the management of chronic migraine both with and without medication overuse.
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Affiliation(s)
- Hans Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Medical Faculty of the University Duisburg-Essen, Essen, Germany.
| | - Paul Rizzoli
- Department of Neurology, Brigham and Women's Hospital; John R Graham Headache Center, Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, MA, United States
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12
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The Role of the Person Focused IARA Model in Reducing Anxiety and Improving Body Awareness and Illness Management in Diabetics with Acquired Lipodystrophy: A Mixed-Method Study. J Pers Med 2022; 12:jpm12111865. [PMID: 36579585 PMCID: PMC9695520 DOI: 10.3390/jpm12111865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/23/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Lipodystrophy is one of the most frequent complications in people with diabetes following subcutaneous insulin therapy, and poor management can lead to several problems, such as impaired glycemic control and adherence to therapy, anxiety, and depression. Poor injection technique represents the main risk factor for lipodystrophies. In order to enhance the patient’s insulin injection technique to heal lipodystrophy, improve psychological indices, and promote involvement in their health and care, the efficacy of emerging person-centered care called the IARA model was tested. Methods: A total of 49 patients were randomly allocated to the IARA group (Experimental; n = 25) or standard education (Control; n = 24). The following questionnaires were used in a mixed-method design: (i) State Anxiety Scale; (ii) Beck Depression Inventory; (iii) Italian Summary of Diabetes Self-Care Activities. An ad hoc open-ended questionnaire was structured for the qualitative analysis. Finally, photos were taken in order to verify if injection sites were changed until the follow-up at 12 months. The number of patients who participated until the completion of the study was 17 in the IARA and 11 in the Control group. Results: State anxiety was significantly reduced in people who followed IARA to follow-up at 3 and 6 months (p < 0.05). The IARA group also demonstrated better compliance in blood glucose monitoring and foot-care compared to Control at follow-up at 12 months. The management of insulin injections dramatically improved in participants who received IARA intervention. Conclusions: IARA could be considered an effective strategy to improve well-being and compliance in people affected with diabetes mellitus and lipodystrophy complications.
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13
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Grazzi L, Raggi A, Guastafierro E, Passavanti M, Marcassoli A, Montisano DA, D’Amico D. A Preliminary Analysis on the Feasibility and Short-Term Efficacy of a Phase-III RCT on Mindfulness Added to Treatment as Usual for Patients with Chronic Migraine and Medication Overuse Headache. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114116. [PMID: 36360996 PMCID: PMC9653620 DOI: 10.3390/ijerph192114116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 06/06/2023]
Abstract
This preliminary analysis of a single-blind phase-III RCT aims to compare the feasibility and short-term efficacy of mindfulness as an add-on to treatment as usual (TaU) in the management of patients with chronic migraine (CM) and medication overuse headache (MOH). Patients were randomized to either TaU (structured withdrawal of overused drugs, patient education and pharmacological prophylaxis) or TaU + MIND, wherein patients additionally received six 90 min weekly group sessions of mindfulness-based therapy. Repeated measures analyses were used to test whether patients in the two arms showed different course with regard to headache frequency and medication intake over a three-month period. Drop-out rates were not different between the two groups: 6/89 (6.7%) and 9/88 (10.2%) among those in TaU and TaU + MIND, respectively. A significant effect of time for all variables was shown, together with a significant effect of time by group, favoring TaU + MIND condition for headache frequency (p = 0.025) and NSAID intake (p = 0.007), controlling for age and CM duration. In total, 45/83 (54.2%) and 69/79 (75.9%) of the patients allocated to TaU and TaU + MIND, respectively, achieved 50% or more headache-day reduction (chi-squared 8.38, p = 0.004). Our preliminary analysis indicates that adding six mindfulness-based sessions to TaU was feasible and showed short-term efficacy in the treatment of patients with CM and MOH.
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Affiliation(s)
- Licia Grazzi
- Centro Cefalee, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Alberto Raggi
- UOC Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Erika Guastafierro
- UOC Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Marco Passavanti
- UOC Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Alessia Marcassoli
- UOC Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | | | - Domenico D’Amico
- Centro Cefalee, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
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14
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Grazzi L. Mindfulness and other behavioral approaches. Neurol Sci 2022; 43:5745-5747. [DOI: 10.1007/s10072-022-06155-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
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15
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Diener HC, Kropp P, Dresler T, Evers S, Förderreuther S, Gaul C, Holle-Lee D, May A, Niederberger U, Moll S, Schankin C, Lampl C. Management of medication overuse (MO) and medication overuse headache (MOH) S1 guideline. Neurol Res Pract 2022; 4:37. [PMID: 36031642 PMCID: PMC9422154 DOI: 10.1186/s42466-022-00200-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Chronic headache due to the overuse of medication for the treatment of migraine attacks has a prevalence of 0.5–2.0%. This guideline provides guidance for the management of medication overuse (MO) and medication overuse headache (MOH).
Recommendations
Treatment of headache due to overuse of analgesics or specific migraine medications involves several stages. Patients with medication overuse (MO) or medication overuse headache (MOH) should be educated about the relationship between frequent use of symptomatic headache medication and the transition from episodic to chronic migraine (chronification), with the aim of reducing and limiting the use of acute medication. In a second step, migraine prophylaxis should be initiated in patients with migraine and overuse of analgesics or specific migraine drugs. Topiramate, onabotulinumtoxinA and the monoclonal antibodies against CGRP or the CGRP-receptor are effective in patients with chronic migraine and medication overuse. In patients with tension-type headache, prophylaxis is performed with amitriptyline. Drug prophylaxis should be supplemented by non-drug interventions. For patients in whom education and prophylactic medication are not effective, pausing acute medication is recommended. This treatment can be performed in an outpatient, day hospital or inpatient setting. Patients with headache due to overuse of opioids should undergo inpatient withdrawal. The success rate of the stepped treatment approach is 50–70% after 6 to 12 months. A high relapse rate is observed in patients with opioid overuse. Tricyclic antidepressants, neuroleptics (antiemetics) and the administration of steroids are recommended for the treatment of withdrawal symptoms or headaches during the medication pause. Consistent patient education and further close monitoring reduce the risk of relapse.
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16
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Begasse de Dhaem O, Rizzoli P. Refractory Headaches. Semin Neurol 2022; 42:512-522. [DOI: 10.1055/s-0042-1757925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractMedication overuse headache (MOH), new daily persistent headache (NDPH), and persistent refractory headache attributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection represent a significant burden in terms of disability and quality of life, and a challenge in terms of definition, pathophysiology, and treatment. Regarding MOH, prevention without withdrawal is not inferior to prevention with withdrawal. Preventive medications like topiramate, onabotulinumtoxinA, and calcitonin gene-related peptide (CGRP) monoclonal antibodies improve chronic migraine with MOH regardless of withdrawal. The differential diagnosis of NDPH is broad and should be carefully examined. There are no guidelines for the treatment of NDPH, but options include a short course of steroids, nerve blocks, topiramate, nortriptyline, gabapentin, CGRP monoclonal antibodies, and onabotulinumtoxinA. The persistence of headache 3 months after SARS-CoV2 infection is a predictor of poor prognosis.
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Affiliation(s)
- Olivia Begasse de Dhaem
- Headache Specialist at Hartford HealthCare, Hartford, Connecticut
- Department of Neurology at the University of Connecticut, Milford, Connecticut
| | - Paul Rizzoli
- Department of Neurology, Brigham and Women's Faulkner Hospital J Graham Headache Center, Boston, Massachusetts
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17
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Saeed H, Tulbah AS, Gamal A, Kamal M. Assessment and Characteristics of Erenumab therapy on migraine management. Saudi Pharm J 2022; 30:1153-1158. [PMID: 36164568 PMCID: PMC9508638 DOI: 10.1016/j.jsps.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 06/17/2022] [Indexed: 11/03/2022] Open
Abstract
Background Methods Results Conclusion
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18
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Kraemer KM, Jain FA, Mehta DH, Fricchione GL. Meditative and Mindfulness-Focused Interventions in Neurology: Principles, Science, and Patient Selection. Semin Neurol 2022; 42:123-135. [PMID: 35139550 PMCID: PMC9177528 DOI: 10.1055/s-0042-1742287] [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] [Indexed: 10/19/2022]
Abstract
A growing body of research suggests that meditative- and mindfulness-focused interventions may improve neuropsychiatric symptoms that commonly occur in a range of neurological disorders. In this article, the principles of meditation and mindfulness are first defined, as well as briefly describing the neurobiological mechanisms implicated in these interventions. Thereafter, a range of meditative- and mindfulness-focused interventions are detailed, along with their supporting evidence to treat neuropsychiatric symptoms in neurological conditions (e.g., headache, movement disorders, chronic pain, etc.). Overall, these interventions warrant further investigation among individuals with neurological conditions. When recommending these interventions, health care professionals must consider a combination of structural (e.g., insurance reimbursement) and patient factors (e.g., ability to tolerate a group setting).
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Affiliation(s)
- Kristen M. Kraemer
- Division of General Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, CO-1309, 2nd Floor, Boston, MA 02215
| | - Felipe A. Jain
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, One Bowdoin Square, 6th Floor, Boston MA 02114
| | - Darshan H. Mehta
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, 151 Merrimac Street, 4th Floor, Boston, MA 02114
- Osher Center for Integrative Medicine, Brigham & Women’s Hospital, 900 Commonwealth Avenue East, 3rd Floor, Boston, MA 02215
| | - Gregory L. Fricchione
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, 151 Merrimac Street, 4th Floor, Boston, MA 02114
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19
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Seng EK, Lipton RB. Do behavioral treatments work for migraine prevention? Headache 2022; 62:402-404. [DOI: 10.1111/head.14290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Elizabeth K. Seng
- Ferkauf Graduate School of Psychology Yeshiva University Bronx New York USA
- Saul R. Korey Department of Neurology Albert Einstein College of Medicine Bronx New York USA
- Montefiore Headache Center Montefiore Medical Center Bronx New York USA
| | - Richard B. Lipton
- Saul R. Korey Department of Neurology Albert Einstein College of Medicine Bronx New York USA
- Montefiore Headache Center Montefiore Medical Center Bronx New York USA
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20
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Rastogi RG, Arnold TL, Borrero-Mejias C, Hastriter EV, Hickman C, Karnik KT, Lewis KS, Little RD. Non-pharmacologic and Mindful-Based Approaches for Pediatric Headache Disorders: a Review. Curr Pain Headache Rep 2021; 25:78. [PMID: 34894314 DOI: 10.1007/s11916-021-00993-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Headache disorders in children and adolescents are common. Among the different headache disorders, migraine and tension headache are highly prevalent and often debilitating. Pharmacological treatments for pediatric patients are often not approved or effective. Practice guidelines for prevention of pediatric headache and migraine are now incorporating information and recommendations regarding non-pharmacologic therapeutic options. Understanding the mechanism of action, safety, and efficacy of the non-pharmacologic as well as mindful-based therapeutic alternatives currently available for the management and treatment of headache and migraine may allow additional treatment alternatives for children with these conditions. RECENT FINDINGS Studies have been published looking at non-pharmacologic treatments, and mindful-based approaches, namely relaxation, mindfulness meditation, yoga, and hypnosis as options for the treatment of headache and migraine, although there are few that examine these in children and adolescents. Several recent studies that have relevance to the care of children with headache and migraine are reviewed. Non-pharmacologic and mindful-based approaches for the prevention and treatment of headache and migraine in children show safety and efficacy data that is promising. Consider incorporating these multi-modal approaches into the therapeutic management strategies for the child or adolescent with headache and migraine. Additional prospective studies and/or randomized-controlled trials are necessary to further assess the efficacy and cost-effectiveness of these methods.
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Affiliation(s)
- Reena Gogia Rastogi
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, 1919 E Thomas Rd, Bldg. B, Phoenix, 85016 AZ, USA.
| | - Tava L Arnold
- Department of Psychology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Clarimar Borrero-Mejias
- Department of Neurology, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Eric V Hastriter
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, 1919 E Thomas Rd, Bldg. B, Phoenix, 85016 AZ, USA
| | - Carolyn Hickman
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, 1919 E Thomas Rd, Bldg. B, Phoenix, 85016 AZ, USA
| | - Kavitha T Karnik
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, 1919 E Thomas Rd, Bldg. B, Phoenix, 85016 AZ, USA
| | - Kara Stuart Lewis
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, 1919 E Thomas Rd, Bldg. B, Phoenix, 85016 AZ, USA
| | - Robert D Little
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, 1919 E Thomas Rd, Bldg. B, Phoenix, 85016 AZ, USA
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21
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Grazzi L, Grignani E, Raggi A, Rizzoli P, Guastafierro E. Effect of a Mindfulness-Based Intervention for Chronic Migraine and High Frequency Episodic Migraine in Adolescents: A Pilot Single-Arm Open-Label Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211739. [PMID: 34831494 PMCID: PMC8619568 DOI: 10.3390/ijerph182211739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 01/03/2023]
Abstract
In this single-arm pilot open-label study we examined the effect of a mindfulness-based intervention on reduction of headache frequency after 12 months in adolescents aged 12-18 with chronic or high-frequency migraine without aura. Adolescents were recruited at the headache center of the C. Besta Neurological Institute and followed-up for 12 months. The mindfulness-based intervention was delivered in small groups and consisted of six weekly group sessions of guided meditation, and one booster session 15 days after. Patients filled in questionnaires assessing headache frequency (primary endpoint), medication intake, disability, anxiety, depression, catastrophizing, and caregivers' burden. Within-person ANOVA was used to address variation of endpoints over time. Thirty-five out of 37 patients completed the study for primary endpoints, and 33 for secondary endpoints. Headache frequency dropped from 21.3 (95% CI 18.5; 24.1) to 9.6 (95% CI 6.1; 13.1) days per month at 12 months (F = 30.5, p < 0.001); 23 patients out of 35 (65.7%) achieved a headache frequency reduction greater than or equal to 50%. Significant improvements were also reported for medication intake (F = 18.7, p < 0.001), disability (F = 3.8, p = 0.027), trait anxiety (F = 5.1, p = 0.009), symptoms of depression (F = 9.5, p < 0.001), and catastrophizing (F = 23.6, p < 0.001). In conclusions, our study shows a reduction of headache attacks in adolescents who follow a mindfulness-based program, suggesting benefit of this nonpharmacological approach.
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Affiliation(s)
- Licia Grazzi
- Dipartimento Neuroalgologia Centro Cefalee, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy;
- Correspondence: ; Tel.: +39-02-2394-2366
| | - Eleonora Grignani
- Dipartimento Neuroalgologia Centro Cefalee, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy;
| | - Alberto Raggi
- UO Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy; (A.R.); (E.G.)
| | - Paul Rizzoli
- John Graham Headache Center, Brigham and Women’s Faulkner Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Erika Guastafierro
- UO Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy; (A.R.); (E.G.)
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22
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Grazzi L, Andrasik F, Rizzoli P, Bernstein C, Sansone E, Raggi A. Acceptance and commitment therapy for high frequency episodic migraine without aura: Findings from a randomized pilot investigation. Headache 2021; 61:895-905. [PMID: 34115399 DOI: 10.1111/head.14139] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/22/2021] [Accepted: 03/25/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We compared the incremental effects of adding acceptance and commitment therapy (ACT) to pharmacological treatment as usual (TAU) in a sample of patients with high frequency episodic migraine without aura (HFEM), assessing impact on a spectrum of measures across multiple domains. BACKGROUND Patients with HFEM are at risk of developing chronic migraine and medication overuse headache. ACT has been shown to be effective for the treatment of various chronic pain conditions, but little attention has been given to its therapeutic value in the management of recurring headaches. METHODS In this single-blind (masking for outcome assessor), open-label, randomized clinical trial, 35 patients with HFEM, with a monthly headache frequency ranging from 9 to 14 days, were recruited at the headache center of C. Besta Neurological Institute and randomized to either TAU (patient education and pharmacological prophylaxis; n = 17) or TAU + ACT (n = 18). Patients assigned to the combined treatment arm additionally received six 90-min weekly group sessions of ACT therapy and two supplementary "booster" sessions. All patients were on a stable course of prophylactic medication in the 3 months prior to initiating either treatment. Monthly headache frequency served as the primary outcome measure, with all other data collected being considered as secondary measures (medication intake, disability, headache impact, anxiety and depression, catastrophizing, allodynia, cognitive inflexibility, pain acceptance, mindful attention and awareness). RESULTS A total of 35 patients were enrolled: 17 randomized to TAU, of whom three dropped out, and 18 to TAU + ACT (no dropouts in this group). Headache frequency and medication intake decreased in both groups over 12 months, with patients in the TAU + ACT group showing statistically significant reduction earlier, that is, by month 3. Headache frequency was reduced by 3.3 days (95% CI: 1.4 to 5.2) among those randomized to ACT + TAU, whereas it increased by 0.7 days (95% CI: -2.7 to 1.3) among those randomized to TAU only (p = 0.007, partial η2 = 0.21), the difference being 4 days (95% CI: 1.2 to 6.8). Medication intake was reduced by 4.1 intakes (95% CI: 2.0 to 6.3) among those randomized to ACT + TAU and by 0.4 intakes (95% CI: -1.8 to 2.5) among those randomized to TAU only (p = 0.016; partial η2 = 0.17), the difference being 3.8 intakes (95% CI: 0.7 to 6.8). At 6 and 12 months, the variations were not different between the two groups for headache frequency and medication intake. The opposite was found for measures of headache impact and pain acceptance, where the differences over time favored patients allocated to TAU. Both groups improved with regard to measures of disability, anxiety and depression, catastrophizing, and cognitive inflexibility, whereas measures of allodynia and pain acceptance were stable over time. CONCLUSIONS Our preliminary findings indicate that supplementing TAU with ACT can enhance the main clinical outcomes, namely headache frequency and medication intake of patients with HFEM.
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Affiliation(s)
- Licia Grazzi
- Dipartimento Neuroalgologia Centro Cefalee, Fondazione IRRCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Frank Andrasik
- Department of Psychology, University of Memphis, Memphis, TN, USA
| | - Paul Rizzoli
- John Graham Headache Center, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, MA, USA
| | - Carolyn Bernstein
- John Graham Headache Center, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, MA, USA
| | - Emanuela Sansone
- UO Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alberto Raggi
- UO Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, Milano, Italy
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23
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Schwedt TJ, Sahai-Srivastava S, Murinova N, Birlea M, Ahmed Z, Digre K, Lopez K, Mullally W, Blaya MT, Pippitt K, Cutrer FM, DeLange J, Schecht H, Rizzoli P, Lane J, Wald J, Cortez MM, Martin VT, Spare NM, Hentz JG, Robert T, Dodick DW. Determinants of pain interference and headache impact in patients who have chronic migraine with medication overuse: Results from the MOTS trial. Cephalalgia 2021; 41:1053-1064. [PMID: 33938249 DOI: 10.1177/03331024211006903] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE "Pain interference" and "headache impact" refer to negative consequences that pain and headache have on one's life. This study investigated determinants of these negative impacts in a large patient cohort who have chronic migraine with medication overuse. METHODS Six hundred and eleven adults were enrolled from 34 headache, neurology, and primary care clinics. Negative consequences of chronic migraine with medication overuse were determined using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference 6b questionnaire and the Headache Impact Test 6. Relationships between PROMIS-6b and Headache Impact Test 6 scores with demographics, headache characteristics, medication use, anxiety symptoms, and depression symptoms were assessed with linear regression. Elastic Net regression was used to develop a multiple regression model. RESULTS PROMIS-6b T-Scores averaged 65.2 (SD 5.4) and Headache Impact Test 6 scores averaged 65.0 (SD 5.3), indicating severe negative consequences of chronic migraine with medication overuse. Chronic migraine with medication overuse interfered with enjoyment of life, concentration, daily activities, doing tasks away from home, and socializing. Depression symptom severity had the strongest relationship with pain interference and headache impact. Moderate-to-severe headache frequency, headache intensity, and anxiety symptoms were also associated with pain interference and headache impact. CONCLUSIONS Chronic migraine with medication overuse is associated with substantial negative consequences, the extent of which is most strongly related to depression symptoms.
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Affiliation(s)
| | | | - Natalia Murinova
- University of Washington, Department of Neurology, Seattle, WA, USA
| | - Marius Birlea
- University of Colorado, Department of Neurology, Denver, CO, USA
| | - Zubair Ahmed
- Cleveland Clinic Foundation, Department of Neurology, Cleveland, OH, USA
| | - Kathleen Digre
- University of Utah, Department of Neurology, Salt Lake City, UT, USA
| | - Kristina Lopez
- West Virginia University, Department of Neurology, Morgantown, WV, USA
| | - William Mullally
- Brigham and Women's Hospital, Department of Neurology, Boston, MA, USA
| | | | - Karly Pippitt
- University of Utah, Department of Family and Preventive Medicine, Salt Lake City, UT, USA
| | | | - Justin DeLange
- Northern Arizona Healthcare, Department of Neurology, Flagstaff, AZ, USA
| | - Howard Schecht
- The Toledo Clinic, Department of Neurology, Toledo, OH, USA
| | - Paul Rizzoli
- Brigham and Women's Hospital, Department of Neurology, Boston, MA, USA
| | - Judy Lane
- Blue Sky Neurology, Department of Neurology, Denver, CO, USA
| | - John Wald
- Henry Ford Allegiance, Department of Neurology, Jackson, MI, USA
| | - Melissa M Cortez
- University of Utah, Department of Neurology, Salt Lake City, UT, USA
| | - Vincent T Martin
- University of Cincinnati, Department of Internal Medicine, Cincinnati, OH, USA
| | - Nicole M Spare
- Thomas Jefferson University, Department of Neurology, Philadelphia, PA, USA
| | | | - Teri Robert
- Patient advocate and educator, Washington, WV, USA
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Wells RE, O'Connell N, Pierce CR, Estave P, Penzien DB, Loder E, Zeidan F, Houle TT. Effectiveness of Mindfulness Meditation vs Headache Education for Adults With Migraine: A Randomized Clinical Trial. JAMA Intern Med 2021; 181:317-328. [PMID: 33315046 PMCID: PMC7737157 DOI: 10.1001/jamainternmed.2020.7090] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Migraine is the second leading cause of disability worldwide. Most patients with migraine discontinue medications due to inefficacy or adverse effects. Mindfulness-based stress reduction (MBSR) may provide benefit. OBJECTIVE To determine if MBSR improves migraine outcomes and affective/cognitive processes compared with headache education. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial of MBSR vs headache education included 89 adults who experienced between 4 and 20 migraine days per month. There was blinding of participants (to active vs comparator group assignments) and principal investigators/data analysts (to group assignment). INTERVENTIONS Participants underwent MBSR (standardized training in mindfulness/yoga) or headache education (migraine information) delivered in groups that met for 2 hours each week for 8 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was change in migraine day frequency (baseline to 12 weeks). Secondary outcomes were changes in disability, quality of life, self-efficacy, pain catastrophizing, depression scores, and experimentally induced pain intensity and unpleasantness (baseline to 12, 24, and 36 weeks). RESULTS Most participants were female (n = 82, 92%), with a mean (SD) age of 43.9 (13.0) years, and had a mean (SD) of 7.3 (2.7) migraine days per month and high disability (Headache Impact Test-6: 63.5 [5.7]), attended class (median attendance, 7 of 8 classes), and followed up through 36 weeks (33 of 45 [73%] of the MBSR group and 32 of 44 [73%] of the headache education group). Participants in both groups had fewer migraine days at 12 weeks (MBSR: -1.6 migraine days per month; 95% CI, -0.7 to -2.5; headache education: -2.0 migraine days per month; 95% CI, -1.1 to -2.9), without group differences (P = .50). Compared with those who participated in headache education, those who participated in MBSR had improvements from baseline at all follow-up time points (reported in terms of point estimates of effect differences between groups) on measures of disability (5.92; 95% CI, 2.8-9.0; P < .001), quality of life (5.1; 95% CI, 1.2-8.9; P = .01), self-efficacy (8.2; 95% CI, 0.3-16.1; P = .04), pain catastrophizing (5.8; 95% CI, 2.9-8.8; P < .001), depression scores (1.6; 95% CI, 0.4-2.7; P = .008), and decreased experimentally induced pain intensity and unpleasantness (MBSR group: 36.3% [95% CI, 12.3% to 60.3%] decrease in intensity and 30.4% [95% CI, 9.9% to 49.4%] decrease in unpleasantness; headache education group: 13.5% [95% CI, -9.9% to 36.8%] increase in intensity and an 11.2% [95% CI, -8.9% to 31.2%] increase in unpleasantness; P = .004 for intensity and .005 for unpleasantness, at 36 weeks). One reported adverse event was deemed unrelated to study protocol. CONCLUSIONS AND RELEVANCE Mindfulness-based stress reduction did not improve migraine frequency more than headache education, as both groups had similar decreases; however, MBSR improved disability, quality of life, self-efficacy, pain catastrophizing, and depression out to 36 weeks, with decreased experimentally induced pain suggesting a potential shift in pain appraisal. In conclusion, MBSR may help treat total migraine burden, but a larger, more definitive study is needed to further investigate these results. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02695498.
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Affiliation(s)
- Rebecca Erwin Wells
- Comprehensive Headache Program, Department of Neurology, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Nathaniel O'Connell
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Charles R Pierce
- Comprehensive Headache Program, Department of Neurology, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Paige Estave
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Donald B Penzien
- Comprehensive Headache Program, Department of Neurology, Wake Forest Baptist Health, Winston-Salem, North Carolina.,Department of Psychiatry and Behavioral Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina.,Department of Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Elizabeth Loder
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Fadel Zeidan
- Department of Anesthesiology, University of California, San Diego, La Jolla
| | - Timothy T Houle
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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Grazzi L, Toppo C, D’Amico D, Leonardi M, Martelletti P, Raggi A, Guastafierro E. Non-Pharmacological Approaches to Headaches: Non-Invasive Neuromodulation, Nutraceuticals, and Behavioral Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1503. [PMID: 33562487 PMCID: PMC7914516 DOI: 10.3390/ijerph18041503] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023]
Abstract
Significant side effects or drug interactions can make pharmacological management of headache disorders very difficult. Non-conventional and non-pharmacological treatments are becoming increasingly used to overcome these issues. In particular, non-invasive neuromodulation, nutraceuticals, and behavioral approaches are well tolerated and indicated for specific patient categories such as adolescents and pregnant women. This paper aims to present the main approaches reported in the literature in the management of headache disorders. We therefore reviewed the available literature published between 2010 and 2020 and performed a narrative presentation for each of the three categories (non-invasive neuromodulation, nutraceuticals, and behavioral therapies). Regarding non-invasive neuromodulation, we selected transcranial magnetic stimulation, supraorbital nerve stimulation, transcranial direct current stimulation, non-invasive vagal nerve stimulation, and caloric vestibular stimulation. For nutraceuticals, we selected Feverfew, Butterbur, Riboflavin, Magnesium, and Coenzyme Q10. Finally, for behavioral approaches, we selected biofeedback, cognitive behavioral therapy, relaxation techniques, mindfulness-based therapy, and acceptance and commitment therapy. These approaches are increasingly seen as a valid treatment option in headache management, especially for patients with medication overuse or contraindications to drug treatment. However, further investigations are needed to consider the effectiveness of these approaches also with respect to the long-term effects.
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Affiliation(s)
- Licia Grazzi
- UOC Neuroalgologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Claudia Toppo
- UOC Neurologia, Salute Pubblica e Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (C.T.); (M.L.); (A.R.); (E.G.)
| | - Domenico D’Amico
- UOC Neuroalgologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Matilde Leonardi
- UOC Neurologia, Salute Pubblica e Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (C.T.); (M.L.); (A.R.); (E.G.)
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, 00185 Rome, Italy;
| | - Alberto Raggi
- UOC Neurologia, Salute Pubblica e Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (C.T.); (M.L.); (A.R.); (E.G.)
| | - Erika Guastafierro
- UOC Neurologia, Salute Pubblica e Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (C.T.); (M.L.); (A.R.); (E.G.)
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Yüksel A, Çetinkaya F, Karakoyun A. The effect of mindfulness-based therapy on psychiatric symptoms, psychological well-being, and pain beliefs in patients with lumbar disk herniation. Perspect Psychiatr Care 2021; 57:335-342. [PMID: 32596823 DOI: 10.1111/ppc.12568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE This study was conducted to determine the impact of mindfulness-based therapy on psychiatric symptoms, psychological well-being, and pain beliefs in patients with lumbar disk hernia. DESIGN AND METHODS The study was a nonrandomized pretest-posttest controlled quasi-experimental research and carried out in a total of 64 patients. A personal information form, the Depression Anxiety Stress Scale, the Psychological Well-Being Scale, and the Pain Beliefs Scale were used for data collection. FINDINGS We observed a statistically significant difference between the intervention and control groups in terms of the posttest mean scores of the psychiatric symptoms, psychological well-being, and pain beliefs. PRACTICE IMPLICATIONS The results revealed that mindfulness-based therapy has a positive impact on pain beliefs and psychological well-being.
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Affiliation(s)
- Arzu Yüksel
- Nursing Department, Faculty of Health Sciences, Aksaray University, Aksaray, Turkey
| | - Funda Çetinkaya
- Nursing Department, Faculty of Health Sciences, Aksaray University, Aksaray, Turkey
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Mapping Assessments Instruments for Headache Disorders against the ICF Biopsychosocial Model of Health and Disability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010246. [PMID: 33396262 PMCID: PMC7795912 DOI: 10.3390/ijerph18010246] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022]
Abstract
Headache disorders have a strong impact on sufferers’ lives. However, the “content” of assessment instruments addressing concepts, such as disability and quality of life (QoL), has not comprehensively been addressed. We searched SCOPUS for research papers in which outcome measures were used in adult populations of patients with migraine, tension-type headache (TTH), and cluster headache (CH). The content of single instruments was then mapped against the International Classification of Functioning, Disability, and Health. A total of 150 papers and 26 instruments were included: 15 addressed disability or impact, two addressed work-related difficulties, and nine addressed QoL. Few instruments were commonly used across the conditions and covered domains of functioning were impact on daily life activities, homework, school, and work-related tasks, leisure time, informal and family relations, pain, emotional difficulties, energy level, and impulse control. Most of the research is based on instruments that were developed for migraine, which is critical for CH, and the impact of headache disorders on work-related activities is poorly acknowledged. Further research is needed to expand the scope of headaches impact on daily life activities, and on environmental factors relevant to headache disorders to raise knowledge on the less represented areas, e.g., TTH impact.
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28
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Donisi V, Mazzi MA, Gandolfi M, Deledda G, Marchioretto F, Battista S, Poli S, Giansante M, Geccherle E, Perlini C, Smania N, Del Piccolo L. Exploring Emotional Distress, Psychological Traits and Attitudes in Patients with Chronic Migraine Undergoing OnabotulinumtoxinA Prophylaxis versus Withdrawal Treatment. Toxins (Basel) 2020; 12:E577. [PMID: 32911799 PMCID: PMC7551686 DOI: 10.3390/toxins12090577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 12/20/2022] Open
Abstract
This explorative cross-sectional study aims at exploring emotional distress, psychological profiles, and the attitude towards receiving psychological support in eighty-seven patients with chronic migraine (CM) undergoing OnabotulinumtoxinA prophylactic treatment (OBT-A, n = 40) or withdrawal treatment (WT, n = 47). The outcomes were explored through a specific battery of questionnaires. 25% of patients undergoing OBT-A and almost half of the patients undergoing WT reported psychological distress of at least moderate-severe level, respectively. Coping strategies, self-efficacy, and perceived social support were similar in the two groups. Patients undergoing OBT-A presented lower psychological inflexibility than patients undergoing WT. Predictors of higher psychological distress were low perceived social support by friends, low self-efficacy, and higher avoidance strategies. In both groups, most of the patients evaluated receiving psychological support to be useful (79%). The potential beneficial effects of OBT-A on the severity of symptoms and psychological distress might further support its role in the multidisciplinary management of patients with CM. Identifying patients with psychological vulnerabilities who may benefit from psychological support is relevant in patients with CM.
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Affiliation(s)
- Valeria Donisi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (V.D.); (M.A.M.); (C.P.); (L.D.P.)
| | - Maria Angela Mazzi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (V.D.); (M.A.M.); (C.P.); (L.D.P.)
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, UOC Neurorehabilitation, AOUI Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy;
| | - Giuseppe Deledda
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy; (G.D.); (S.P.); (M.G.); (E.G.)
| | - Fabio Marchioretto
- Neurological Unit, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy;
| | - Simone Battista
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Via Magliotto, 2, 17100 Savona, Italy;
| | - Sara Poli
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy; (G.D.); (S.P.); (M.G.); (E.G.)
| | - Matteo Giansante
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy; (G.D.); (S.P.); (M.G.); (E.G.)
| | - Eleonora Geccherle
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy; (G.D.); (S.P.); (M.G.); (E.G.)
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (V.D.); (M.A.M.); (C.P.); (L.D.P.)
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, UOC Neurorehabilitation, AOUI Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy;
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (V.D.); (M.A.M.); (C.P.); (L.D.P.)
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Sansone E, Grazzi L, Raggi A, Leonardi M, D’Amico D. Mindfulness as an add-on treatment for patients with chronic migraine and medication overuse: a preliminary analysis. Neurol Sci 2020; 41:469-471. [DOI: 10.1007/s10072-020-04662-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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De Giorgio A. Global Psychological Implications of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Coronavirus Disease-2019 (COVID-19). What Can Be Learned From Italy. Reflections, Perspectives, Opportunities. Front Psychol 2020; 11:1836. [PMID: 32849079 PMCID: PMC7396562 DOI: 10.3389/fpsyg.2020.01836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/03/2020] [Indexed: 12/13/2022] Open
Abstract
On December 31, 2019, the Chinese authorities announced that in the city of Wuhan, Hubei Province, central-eastern China, a cluster of pneumonia cases of unknown etiology had developed. A new coronavirus (SARS-CoV-2) that causes serious problems like pneumonia and even death, has been discovered. This new disease (COVID-19) has spread also in Italy starting from the first recognized case on February 20. Beyond its biological implications, this coronavirus allows us many psychological reflections. A new virus is indeed a potentially serious problem for mankind, but it can also be an opportunity to bring the focus back to us, to observe what is happening, who we are and how we are reacting both as individuals and as a population. Even positive implication of this pandemic was discussed.
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The mindful migraine: does mindfulness-based stress reduction relieve episodic migraine? Pain 2020; 161:1685-1687. [PMID: 32701827 DOI: 10.1097/j.pain.0000000000001859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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David MCMM, Santos BSD, Barros WMA, Silva TRLD, Franco CIF, Matos RJBD. Neuroimaging investigation of memory changes in migraine: a systematic review. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:370-379. [PMID: 32609194 DOI: 10.1590/0004-282x20200025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Individuals with migraine usually complain about lower memory performance. Diagnostic methods such as neuroimaging may help in the understanding of possible morphologic and functional changes related to the memory of those individuals. Therefore, the aim of this review is to analyze the available literature on neuroimaging changes related to memory processing in migraine. METHODS We searched the following databases: Pubmed/Medline, Psycinfo, Science Direct, Cochrane and Web of Science. We used articles without restriction of year of publication. The combination of descriptors used for this systematic review of literature were Neuroimaging OR Imaging OR Brain AND Migraine OR Chronic Migraine AND Memory. RESULTS Of the 306 articles found, nine were selected and all used magnetic resonance imaging (MRI). The studies used structural and functional MRI techniques with a predominance of 3 Tesla equipment and T1-weighted images. According to the results obtained reported by these studies, migraine would alter the activity of memory-related structures, such as the hippocampus, insula and frontal, parietal and temporal cortices, thereby suggesting a possible mechanism by which migraine would influence memory, especially in relation to the memory of pain. CONCLUSIONS Migraine is associated to global dysfunction of multisensory integration and memory processing. This condition changes the activity of structures in various regions related to memory of pain, prospective memory, as well as in short- and long-term verbal and visuospatial memories. However, it is necessary to perform studies with larger samples in association with cognitive tests, and without the interference of medications to verify possible alterations and to draw more concrete conclusions.
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Affiliation(s)
| | | | - Waleska Maria Almeida Barros
- Universidade Federal de Pernambuco, Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, Recife PE, Brazil
| | | | | | - Rhowena Jane Barbosa de Matos
- Universidade Federal de Pernambuco, Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, Recife PE, Brazil
- Universidade Federal de Pernambuco, Centro Acadêmico de Vitória, Núcleo de Educação Física e Ciências do Esporte, Vitória de Santo Antão PB, Brazil
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the role of avoidance behavior in headache-related disability and overview relevant clinical implications. RECENT FINDINGS Avoidance occupies a central role in contemporary psychological perspectives on headache disorders and other chronic pain conditions. Several cognitive constructs of relevance to headache are influenced and maintained by avoidance behavior. A growing body of literature attests to the notion that avoidance of headache triggers, of stimuli that exacerbate headache, and of broader life domains can negatively affect headache progression, disability/quality of life, and comorbid psychiatric symptoms. Interventions targeting avoidance behavior, such as therapeutic exposure to headache triggers, mindfulness, and acceptance and commitment therapy (ACT), hold promise for headache disorders but need to be tested in larger trials. Researchers and clinicians are encouraged to attend to functional impairment as a critically important treatment outcome. Comprehensive understanding of headache disorders necessitates attention not merely to diagnostic symptoms and their reduction, but to patterns of avoidance behavior that inadvertently exacerbate headache and contribute to functional impairment.
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Krymchantowski AV, Jevoux CC, Krymchantowski AG, Vivas RS, Silva-Néto R. Medication overuse headache: an overview of clinical aspects, mechanisms, and treatments. Expert Rev Neurother 2020; 20:591-600. [PMID: 32463304 DOI: 10.1080/14737175.2020.1770084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Medication-overuse headache (MOH) is a common debilitating neurological disorder, with a prevalence of 1% to 7% in general population. It affects more than 60 million people worldwide and provokes substantial burden. Despite that, most practitioners don't know MOH. This review aims at presenting MOH clinical features, pathophysiology insights, and recent knowledge and guidance regarding treatments. AREAS COVERED A literature search in the major medical databases including the terms 'medication overuse headache,' 'chronic daily headache,' 'chronic migraine,' 'symptomatic medication overuse' and others, published between 1990 and 2020, was carried out. EXPERT COMMENTARY Primary headache sufferers such as migraineurs and tension-type headache patients may increase the headache frequency and induce the transition from episodic to chronic forms, as well as develop MOH, in the presence of medication overuse. There is evidence of structural and functional changes in some areas of the brain, which may identify those likely to respond or not to treatments. Despite the geographical differences and lack of consensus regarding approaches, to educate the patients about reducing medication intake, to withdraw overused medications and to start prophylaxis in some sufferers are crucial steps. Emerging treatments as monoclonal antibodies to migraine may result in better adherence and tolerability profiles as well as outcomes.
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Affiliation(s)
| | | | | | | | - Raimundo Silva-Néto
- Department of Neurology, Universidade Federal do Delta do Parnaíba , Piauí, Brazil
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Perlini C, Donisi V, Del Piccolo L. From research to clinical practice: a systematic review of the implementation of psychological interventions for chronic headache in adults. BMC Health Serv Res 2020; 20:459. [PMID: 32450871 PMCID: PMC7247180 DOI: 10.1186/s12913-020-05172-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/30/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Psychological interventions have been proved to be effective in chronic headache (CH) in adults. Nevertheless, no data exist about their actual implementation into standard clinical settings. We aimed at critically depicting the current application of psychological interventions for CH into standard care exploring barriers and facilitators to their implementation. Secondarily, main outcomes of the most recent psychological interventions for CH in adults have been summarized. METHODS We conducted a systematic review through PubMed and PsycINFO in the time range 2008-2018. A quality analysis according to the QATSDD tool and a narrative synthesis were performed. We integrated results by: contacting the corresponding author of each paper; exploring the website of the clinical centers cited in the papers. RESULTS Of the 938 identified studies, 28 papers were selected, whose quality largely varied with an average %QATSDD quality score of 64.88%. Interventions included CBT (42.85%), multi-disciplinary treatments (22.43%), relaxation training (17.86%), biofeedback (7.14%), or other interventions (10.72%). Treatments duration (1 day-9 months) and intensity varied, with a prevalence of individual-basis implementation. The majority of the studies focused on all primary headaches; 4 studies focused on medication-overuse headache. Most of the studies suggest interventions as effective, with the reduction in frequency of attacks as the most reported outcome (46.43%). Studies were distributed in different countries, with a prevalent and balanced distribution in USA and Europe. Ten researches (35.71%) were performed in academic contexts, 11 (39.28%) in clinical settings, 7 (25%) in pain/headache centres. Interventions providers were professionals with certified experience. Most of the studies were funded with private or public funding. Two contacted authors answered to our e-mail survey, with only one intervention implemented in the routine clinical practice. Only in three out of the 16 available websites a reference to the implementation into the clinical setting was reported. CONCLUSION Analysis of contextual barriers/facilitators and cost-effectiveness should be included in future studies, and contents regarding dissemination/implementation of interventions should be incorporated in the professional training of clinical scientists. This can help in filling the gap between the existing published research and treatments actually offered to people with CH.
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Affiliation(s)
- Cinzia Perlini
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
- USD Clinical Psychology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
| | - Valeria Donisi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- USD Clinical Psychology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- USD Clinical Psychology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Diener HC, Antonaci F, Braschinsky M, Evers S, Jensen R, Lainez M, Kristoffersen ES, Tassorelli C, Ryliskiene K, Petersen JA. European Academy of Neurology guideline on the management of medication‐overuse headache. Eur J Neurol 2020; 27:1102-1116. [DOI: 10.1111/ene.14268] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- H. C. Diener
- Institute for Medical Informatics, Biometry and Epidemiology Faculty of Medicine University Duisburg‐Essen Essen Germany
| | - F. Antonaci
- IRCCS C. Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - M. Braschinsky
- Headache Clinic Neurology Clinic Tartu University Hospital Tartu Estonia
| | - S. Evers
- Faculty of Medicine University of Münster MünsterGermany
- Krankenhaus Lindenbrunn Coppenbrügge Germany
| | - R. Jensen
- Danish Headache Center Neurological Clinic Rigshospitalet‐Glostrup University of Copenhagen Copenhagen Denmark
| | - M. Lainez
- Department of Neurology Hospital Clínico Universitario ValenciaSpain
- Department of Neurology Universidad Católica de Valencia Valencia Spain
| | - E. S. Kristoffersen
- Department of Neurology Akershus University Hospital OsloNorway
- Department of General Practice University of Oslo Oslo Norway
| | - C. Tassorelli
- IRCCS C. Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - K. Ryliskiene
- Department of Neurology Institute of Clinical Medicine Faculty of Medicine Vilnius University Vilnius Lithuania
| | - J. A. Petersen
- Department Of Neurology University Hospital Zurich Zurich Switzerland
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Wells RE, Seng EK, Edwards RR, Victorson DE, Pierce CR, Rosenberg L, Napadow V, Schuman-Olivier Z. Mindfulness in migraine: A narrative review. Expert Rev Neurother 2020; 20:207-225. [PMID: 31933391 DOI: 10.1080/14737175.2020.1715212] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Migraine is the second leading cause of disability worldwide, yet many patients are unable to tolerate, benefit from, or afford pharmacological treatment options. Non-pharmacological migraine therapies exist, especially to reduce opioid use, which represents a significant unmet need. Mindfulness-based interventions (MBI) have potential as a non-pharmacological treatment for migraine, primarily through the development of flexible attentional capacity across sensory, cognitive, and emotional experiences.Areas covered: The authors review efficacy and potential mechanisms of MBIs for migraine, including mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT).Expert opinion: While most mindfulness research studies for migraine to date have been pilot trials, which are small and/or lacked rigor, initial evidence suggests there may be improvements in overall headache-related disability and psychological well-being. Many research questions remain to help target the treatment to patients most likely to benefit, including the ideal dosage, duration, delivery method, responder characteristics, and potential mechanisms and biomarkers. A realistic understanding of these factors is important for patients, providers, and the media. Mindfulness will not 'cure' migraine; however, mindfulness may be an important tool as part of a comprehensive treatment approach to help patients 'mindfully' engage in valued life activities.
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Affiliation(s)
- Rebecca Erwin Wells
- Comprehensive Headache Program, Center for Integrative Medicine, Department of Neurology, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Elizabeth K Seng
- Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - David E Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Charles R Pierce
- Department of Neurology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Lauren Rosenberg
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Vitaly Napadow
- Center for Integrative Pain NeuroImaging (CiPNI), Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Zev Schuman-Olivier
- Center for Mindfulness and Compassion, Addictions, Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
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Wells RE. Mindfulness as one component of an integrative approach to migraine treatment in clinical practice: companion editorial. Expert Rev Neurother 2020; 20:199-202. [PMID: 32000542 DOI: 10.1080/14737175.2020.1724783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Rebecca Erwin Wells
- Comprehensive Headache Program, Center for Integrative Medicine, Department of Neurology, Wake Forest Baptist Health, Winston-Salem, NC, USA
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Cho YJ, Sim KL, Cho SJ, Lee G, Jung IK, Yin C, Kim H, Lee JS, Ryu J, Kim WS, Shim I. Effectiveness of training program combining chakrayoga and meditation. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2019; 17:/j/jcim.ahead-of-print/jcim-2018-0167/jcim-2018-0167.xml. [PMID: 31865288 DOI: 10.1515/jcim-2018-0167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 03/13/2019] [Indexed: 11/15/2022]
Abstract
Background This study was designed to examine the effectiveness of program combining chakrayoga and meditation on the physical health and disease-related factors and psychological factors of people. Methods Ninety-seven subjects (32-83 years old) who had free from prior experiences in meditation programs or Chakrayoga training courses were assigned to either the experimental group (EXP) (45 subjects; 13 male subjects and 32 female subjects; average age of 60.67 years, SD=11.09 years) or the control group (CONT) of remaining subjects (52 subjects; 14 male subjects and 38 female subjects; average age of 61.58 years, SD=9.70 years). Subjects in the EXP participated in the Chakrayoga Meditation Program for twice a week for 2 h during 6 weeks in each session consisted of 1 h of Chakrayoga and 1 h of meditation. The measurements in this study included the mindfulness, stress response, subjective quality of life, medical symptom checklist, difficulty in emotional regulation and objective of life and sense of control. Results Results revealed that participants in the EXP reported significantly more relief of mindfulness, stress response, subjective quality of life and medical symptom checklist than those in the CONT. Conclusions These findings provide evidence that the Chakrayoga Meditation Program can help relieve the physical health and disease-related factors and psychological factors.
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Affiliation(s)
- Yoon-Ju Cho
- Department of Physiology, College of Medicine, 26 KyungHee-daero, Kyung Hee University, Seoul, 130-701, Korea
| | - Kyo-Lin Sim
- Department of Psychology, Ajou University, Suwon, Korea
| | - Sung-Ja Cho
- School of Law, Kangwon National University, Kangwon-do, Korea
| | - Gyeongran Lee
- Department of Physiology, College of Medicine, 26 KyungHee-daero, Kyung Hee University, Seoul, 130-701, Korea
| | - Il Kyung Jung
- Acupuncture Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Changshik Yin
- Acupuncture Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Hongman Kim
- Acupuncture Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | | | - Jaehwan Ryu
- Department of Physiology, College of Medicine, 26 KyungHee-daero, Kyung Hee University, Seoul, 130-701, Korea
| | - Wan-Suk Kim
- Department of Psychology, Ajou University, Suwon, Korea
| | - Insop Shim
- Department of Physiology, College of Medicine, 26 KyungHee-daero, Kyung Hee University, Seoul, 130-701, Korea
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Couples Living with Chronic Migraines: A Phenomenological Study. CONTEMPORARY FAMILY THERAPY 2019. [DOI: 10.1007/s10591-019-09513-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kowacs F, Roesler CADP, Piovesan ÉJ, Sarmento EM, Campos HCD, Maciel JA, Calia LC, Barea LM, Ciciarelli MC, Valença MM, Costa MENDM, Peres MFP, Kowacs PA, Rocha-Filho PAS, Silva-Néto RPD, Villa TR, Jurno ME. Consensus of the Brazilian Headache Society on the treatment of chronic migraine. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:509-520. [PMID: 31365643 DOI: 10.1590/0004-282x20190078] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/29/2019] [Indexed: 12/27/2022]
Abstract
Chronic migraine poses a significant personal, social and economic burden and is characterized by headache present on 15 or more days per month for at least three months, with at least eight days of migrainous headache per month. It is frequently associated with analgesic or acute migraine medication overuse and this should not be overlooked. The present consensus was elaborated upon by a group of members of the Brazilian Headache Society in order to describe current evidence and to provide recommendations related to chronic migraine pharmacological and nonpharmacological treatment. Withdrawal strategies in medication overuse headache are also described, as well as treatment risks during pregnancy and breastfeeding. Oral topiramate and onabotulinum toxin A injections are the only treatments granted Class A recommendation, while valproate, gabapentin, and tizanidine received Class B recommendation, along with acupuncture, biofeedback, and mindfulness. The anti-CGRP or anti-CGRPr monoclonal antibodies, still unavailable in Brazil, are promising new drugs already approved elsewhere for migraine prophylactic treatment, the efficacy of which in chronic migraine is still to be definitively proven.
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Affiliation(s)
- Fernando Kowacs
- Departamento Científico de Cefaleia da Academia Brasileira de Neurologia, São Paulo SP, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Irmandade Santa Casa de Misericórdia, Serviço de Neurologia, Porto Alegre RS, Brasil.,Hospital Moinhos de Vento, Serviço de Neurologia e Neurocirurgia, Porto Alegre RS, Brasil
| | - Célia Aparecida de Paula Roesler
- Departamento Científico de Cefaleia da Academia Brasileira de Neurologia, São Paulo SP, Brasil.,Clínica de Cefaleia e Neurologia Dr. Edgard Raffaelli, São Paulo SP, Brasil
| | - Élcio Juliato Piovesan
- Universidade Federal do Paraná, Hospital das Clínicas, Departamento de Clínica Médica, Serviço de Neurologia, Curitiba PR, Brasil
| | - Elder Machado Sarmento
- Centro Universitário de Volta Redonda, Volta Redonda RJ, Brasil.,Fundação Educacional Dom André Arcoverde, Centro de Ensino Superior de Valença, Valença RJ, Brasil
| | | | | | | | - Liselotte Menke Barea
- Universidade Federal de Ciências da Saúde de Porto Alegre, Irmandade Santa Casa de Misericórdia, Serviço de Neurologia, Porto Alegre RS, Brasil
| | | | | | | | - Mário Fernando Prieto Peres
- Hospital Israelita Albert Einstein, São Paulo SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas Instituto de Psiquiatria, São Paulo SP, Brasil
| | - Pedro André Kowacs
- Universidade Federal do Paraná, Hospital das Clínicas, Departamento de Clínica Médica, Serviço de Neurologia, Curitiba PR, Brasil.,Instituto de Neurologia de Curitiba, Curitiba PR, Brasil
| | - Pedro Augusto Sampaio Rocha-Filho
- Universidade Federal de Pernambuco, Recife PE, Brasil.,Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Ambulatório de Cefaleias, Recife PE, Brasil
| | - Raimundo Pereira da Silva-Néto
- Departamento Científico de Cefaleia da Academia Brasileira de Neurologia, São Paulo SP, Brasil.,Universidade Federal do Piauí, Teresina PI, Brasil
| | - Thais Rodrigues Villa
- Universidade Federal de São Paulo, Setor de Cefaleias, São Paulo SP, Brasil.,Headache Center Brasil, São Paulo SP, Brasil
| | - Mauro Eduardo Jurno
- Faculdade de Medicina de Barbacena, Barbacena MG, Brasil.,Fundação Hospital do Estado de Minas Gerais, Hospital Regional de Barbacena Dr. José Américo, São Paulo SP, Brasil
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Chen PK, Wang SJ. Medication Overuse and Medication Overuse Headache: Risk Factors, Comorbidities, Associated Burdens and Nonpharmacologic and Pharmacologic Treatment Approaches. Curr Pain Headache Rep 2019; 23:60. [DOI: 10.1007/s11916-019-0796-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sharpe L, Dudeney J, Williams ACDC, Nicholas M, McPhee I, Baillie A, Welgampola M, McGuire B. Psychological therapies for the prevention of migraine in adults. Cochrane Database Syst Rev 2019; 7:CD012295. [PMID: 31264211 PMCID: PMC6603250 DOI: 10.1002/14651858.cd012295.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Migraine is a common neurological problem associated with the highest burden amongst neurological conditions in terms of years lived with disability. Medications can be used as prophylaxis or rescue medicines, but are costly and not always effective. A range of psychological interventions have been developed to manage migraine. OBJECTIVES The objective was to evaluate the efficacy and adverse events of psychological therapies for the prevention of migraine in adults. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL from their inception until July 2018, and trials registries in the UK, USA, Australia and New Zealand for randomised controlled trials of any psychological intervention for adults with migraine. SELECTION CRITERIA We included randomised controlled trials (RCTs) of a psychological therapy for people with chronic or episodic migraine, with or without aura. Interventions could be compared to another active treatment (psychological or medical), an attention-placebo (e.g. supportive counselling) or other placebo, routine care, or waiting-list control. We excluded studies where fewer than 15 participants completed each arm. DATA COLLECTION AND ANALYSIS We extracted study characteristics and outcome data at post-treatment and the longest available follow-up. We analysed intervention versus control comparisons for the primary outcome of migraine frequency. We measured migraine frequency using days with migraines or number of migraine attacks measured in the four weeks after treatment. In addition, we analysed the following secondary outcomes: responder rate (the proportion of participants with a 50% reduction in migraine frequency between the four weeks prior to and the four weeks after treatment); migraine intensity; migraine duration; migraine medication usage; mood; quality of life; migraine-related disability; and proportion of participants reporting adverse events during the treatment. We included these variables, where available, at follow-up, the timing of which varied between the studies. We used the GRADE approach to judge the quality of the evidence. MAIN RESULTS We found 21 RCTs including 2482 participants with migraine, and we extracted meta-analytic data from 14 of these studies. The majority of studies recruited participants through advertisements, included participants with migraine according to the International Classification of Headache Disorders (ICHD) criteria and those with and without aura. Most intervention arms were a form of behavioural or cognitive-behavioural therapy. The majority of comparator arms were no treatment, routine care or waiting list. Interventions varied from one 20-minute session to 14 hours of intervention. No study had unequivocally low risk of bias; all had at least one domain at high risk of bias, and 20 had two to five domains at high risk. Reporting of randomisation procedures and allocation concealment were at high or unclear risk of bias. We downgraded the quality of evidence for outcomes to very low, due to very serious limitations in study quality and imprecision. Reporting in trials was poor; we found no preregistrations stipulating the outcomes, or demonstrating equivalent expectations between groups. Few studies reported our outcomes of interest, most only reported outcomes post treatment; follow-up data were sparse.Post-treatment effectsWe found no evidence of an effect of psychological interventions for migraine frequency in number of migraines or days with migraine (standardised mean difference (SMD) -0.02, 95% confidence interval (CI) -0.17 to 0.13; 4 studies, 681 participants; very low-quality evidence).The responder rate (proportion of participants with migraine frequency reduction of more than 50%) was greater for those who received a psychological intervention compared to control: 101/186 participants (54%) with psychological therapy; 37/152 participants (24%) with control (risk ratio (RR) 2.21, 95% CI 1.63 to 2.98; 4 studies, 338 participants; very low-quality evidence). We found no effect of psychological therapies on migraine intensity (SMD -0.13, 95% CI -0.28 to 0.02; 4 studies, 685 participants). There were no data for migraine duration (hours of migraine per day). There was no effect on migraine medication usage (SMD -0.06, 95% CI -0.35 to 0.24; 2 studies, 483 participants), mood (mean difference (MD) 0.08, 95% CI -0.33 to 0.49; 4 studies, 432 participants), quality of life (SMD -0.02, 95% CI -0.30 to 0.26; 4 studies, 565 participants), or migraine-related disability (SMD -0.67, 95% CI -1.34 to 0.00; 6 studies, 952 participants). The proportion of participants reporting adverse events did not differ between those receiving psychological treatment (9/107; 8%) and control (30/101; 30%) (RR 0.16, 95% CI 0.00 to 7.85; 2 studies, 208 participants). Only two studies reported adverse events and so we were unable to draw any conclusions.We rated evidence from all studies as very low quality.Follow-upOnly four studies reported any follow-up data. Follow-ups ranged from four months following intervention to 11 months following intervention. There was no evidence of an effect on any outcomes at follow-up (very low-quality evidence). AUTHORS' CONCLUSIONS This review identified 21 studies of psychological interventions for the management of migraine. We did not find evidence that psychological interventions affected migraine frequency, a result based on four studies of primarily brief treatments. Those who received psychological interventions were twice as likely to be classified as responders in the short term, but this was based on very low-quality evidence and there was no evidence of an effect of psychological intervention compared to control at follow-up. There was no evidence of an effect of psychological interventions on medication usage, mood, migraine-related disability or quality of life. There was no evidence of an effect of psychological interventions on migraine frequency in the short-term or long-term. In terms of adverse events, we were unable to draw conclusions as there was insufficient evidence. High and unclear risk of bias in study design and reporting, small numbers of participants, performance and detection bias meant that we rated all evidence as very low quality. Therefore, we conclude that there is an absence of high-quality evidence to determine whether psychological interventions are effective in managing migraine in adults and we are uncertain whether there is any difference between psychological therapies and controls.
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Affiliation(s)
- Louise Sharpe
- University of SydneySchool of PsychologySydneyAustralia
| | - Joanne Dudeney
- Seattle Children's Research InstituteCenter for Child Health, Behavior, and Development2001 8th Avenue, Suite 400SeattleWashingtonUSA
| | - Amanda C de C Williams
- University College LondonResearch Department of Clinical, Educational & Health PsychologyGower StreetLondonUKWC1E 6BT
| | - Michael Nicholas
- University of Sydney and Royal North Shore HospitalPain Management Research InstituteSydneyNSWAustralia2065
| | - Ingrid McPhee
- University of SydneySchool of PsychologySydneyAustralia
| | - Andrew Baillie
- Faculty of Health Sciences, The University of SydneyDiscipline of Behavioural and Social Sciences in HealthRoom J004, Block J75 East Street.LidcombeNSWAustralia2141
| | | | - Brian McGuire
- National University of IrelandSchool of Psychology and Centre for Pain ResearchRoom 2, Floor 4Woodquay CourtGalwayGalwayIreland
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Charleston L, Royce J, Monteith TS, Broner SW, O'Brien HL, Manrriquez SL, Robbins MS. Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 2. Headache 2019; 58:633-647. [PMID: 29878343 DOI: 10.1111/head.13321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review the challenges and potential solutions in treatment options for quality migraine care in adult patients who are under or uninsured. BACKGROUND The Affordable Care Act has improved access to health care for many; however, those who are underserved continue to face treatment disparities and have inadequate access to appropriate migraine management. METHODS This manuscript is the second of a 2-part narrative review which was performed after a series of discussions within the Underserved Populations in Headache Medicine Special Interest Section meetings of the American Headache Society. Literature was reviewed for key concepts underpinning conceptual boundaries and a broad overview of the subject matter. Published guidelines, state-specific Medicaid websites, headache quality measurement sets, literature review, and expert opinion were used to tailor suggested treatment options and therapeutic strategies. In this second part of our narrative review, we explored migraine care strategies and considerations for underserved and vulnerable adult populations with migraine. RESULTS Although common, migraine remains untreated, particularly among those of low socioeconomic status. Low socioeconomic status may play an important role in the disease progression, prescription of hazardous medications such as opioids, outcomes, and quality of life of patients with migraine and other headache disorders. There are some evidence-based and guideline supported treatment options available at low cost that include prescription medications and supplements, though approved devices are costly. Resources available online and simple nonpharmacological strategies may be particularly useful in the underserved migraine population. CONCLUSIONS We identified and discussed migraine treatment barriers that affect underserved populations in the US and summarized practical, cost-effective strategies to surmount them. However, more research is needed to identify the best cost-effective measures for migraine management in underserved and vulnerable patients who are uninsured or underinsured.
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Affiliation(s)
- Larry Charleston
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey Royce
- Neuro and Headache Center, SwedishAmerican Hospital, Rockford, IL, USA
| | - Teshamae S Monteith
- Department of Neurology-Headache Division, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Susan W Broner
- Weill Cornell Medicine Headache Program, Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Hope L O'Brien
- Division of Neurology, Cincinnati Children's Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Salvador L Manrriquez
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Matthew S Robbins
- Department of Neurology, Albert Einstein College of Medicine, Montefiore Headache Center, Bronx, NY, USA
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Does the migraine attack start in the cortex and is the cortex critical in the migraine process? Neurol Sci 2019; 40:31-37. [DOI: 10.1007/s10072-019-03838-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Wells RE, Beuthin J, Granetzke L. Complementary and Integrative Medicine for Episodic Migraine: an Update of Evidence from the Last 3 Years. Curr Pain Headache Rep 2019; 23:10. [PMID: 30790138 PMCID: PMC6559232 DOI: 10.1007/s11916-019-0750-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to evaluate evidence from the last 3 years on complementary and integrative medicine treatment options for episodic migraine. Using Pubmed, Embase, and Cochrane databases, research published from 2015-2018 evaluating the modalities of mind/body therapies, supplements, and manual therapies for treatment of migraine were assessed. RECENT FINDINGS Although many studies had major methodological challenges that limit interpretation, several studies reported decreased headache frequency, improved quality of life, or less affective responses to pain. The evidence is currently most promising for the mind/body treatment options of mindfulness, yoga, and tai chi. Mindfulness meditation may be as effective as pharmacological treatment for medication-overuse headache after the offending medication is withdrawn. While older research has shown magnesium, riboflavin, feverfew, and butterbur to be helpful in migraine treatment, new research is promising to suggest potential benefit with melatonin, vitamin D, higher dosages of vitamin B6 (80 mg)/folic acid 5 mg combinations, and the combination of magnesium 112.5 mg/CoQ10 100 mg/feverfew 100 mg. Omega 3s have limited evidence of efficacy in migraine. Butterbur needs to be free of pyrrolizidine alkaloids (PA) to ensure safety given their hepatotoxicity. Physical therapy (PT) continues to have strong evidence of support, and acupuncture is superior to sham acupuncture and placebo. Side effects and risks reported were minimal and well tolerated overall, with the exception of the life-threatening risk of cervical artery dissection with high-velocity chiropractic manipulation and hepatotoxicity with the PAs in butterbur. Several studies are ongoing to further evaluate mindfulness, melatonin, PT, exercise, chiropractic manipulation, and acupuncture. The American Academy of Neurology (AAN) and American Headache Society (AHS) are currently updating the guidelines for integrative treatment options for migraine, so additional recommendations may be available soon. In conclusion, many complementary and integrative treatment options may be helpful for patients with migraines, and understanding potential efficacy, benefits, and risks can help providers discuss these modalities with their patients. Such a conversation can empower patients, build the therapeutic relationship, and increase self-efficacy, thus improving outcomes and patient-centered care.
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Affiliation(s)
- Rebecca Erwin Wells
- Department of Neurology, Wake Forest Baptist Health, Winston-Salem, NC, USA.
| | - Justin Beuthin
- Department of Neurology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Laura Granetzke
- Department of Neurology, Wake Forest Baptist Health, Winston-Salem, NC, USA
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Grazzi L, Raggi A, D’Amico D, Sansone E, Leonardi M, Andrasik F, Gucciardi A, Guido D, D’Andrea G. A prospective pilot study of the effect on catecholamines of mindfulness training vs pharmacological prophylaxis in patients with chronic migraine and medication overuse headache. Cephalalgia 2018; 39:655-664. [DOI: 10.1177/0333102418801584] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aim To address whether, in patients with chronic migraine and medication overuse headache, mindfulness-based treatment is associated with changes in plasma levels of catecholamines and elusive amines that are similar to those observed in patients undergoing pharmacological prophylaxis. Methods In this non-randomized, clinic-based effectiveness study, patients aged 18–65, with a history of chronic migraine ≥ 10 years and overuse of triptans or non-steroidal anti-inflammatory drugs ≥ 5 years, were enrolled. Upon completion of a structured withdrawal program, patients received either pharmacological prophylaxis or six weekly sessions of mindfulness-based treatment and were followed for 12 months. Daily headache diaries were used to record headache frequency and medication intake; catecholamines (noradrenaline, epinephrine and dopamine) and levels of elusive amines were assayed from poor platelet plasma. Results Complete follow-up data were available for 15 patients in the pharmacological prophylaxis-group (14 females, average age 44.1) and 14 in the mindfulness treatment-group (all females, average age 46.4), and all variables were comparable between groups at baseline. At 12 months, significant improvement ( p < .001) was found in the pharmacological prophylaxis group for headache frequency and medication intake (by 51% and 48.7%, respectively), noradrenaline, epinephrine and dopamine (by 98.7%, 120.8% and 501.9%, respectively); patients in the mindfulness treatment-group performed similarly. For elusive amines, no longitudinal changes were found. Conclusions The similar improvement trends observed in the two groups of patients further support the utility of mindfulness-based treatment in migraine care, and reinforce the hypothesis that alteration and normalization of tyrosine metabolism are implicated in migraine chronification and in remission of chronic migraine.
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Affiliation(s)
- Licia Grazzi
- Division of Neuroalgology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Domenico D’Amico
- Division of Neuroalgology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Emanuela Sansone
- Division of Neuroalgology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Frank Andrasik
- Department of Psychology, University of Memphis, Memphis, TN, USA
| | | | - Davide Guido
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Raggi A, Grignani E, Leonardi M, Andrasik F, Sansone E, Grazzi L, D'Amico D. Behavioral Approaches for Primary Headaches: Recent Advances. Headache 2018; 58:913-925. [DOI: 10.1111/head.13337] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/27/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - Eleonora Grignani
- Neurology, Public Health and Disability Unit; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - Frank Andrasik
- Department of Psychology; University of Memphis; Memphis TN USA
| | - Emanuela Sansone
- Division of Neuroalgology; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - Licia Grazzi
- Division of Neuroalgology; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - Domenico D'Amico
- Division of Neuroalgology; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
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Kuvačić G, Fratini P, Padulo J, Antonio DI, De Giorgio A. Effectiveness of yoga and educational intervention on disability, anxiety, depression, and pain in people with CLBP: A randomized controlled trial. Complement Ther Clin Pract 2018; 31:262-267. [DOI: 10.1016/j.ctcp.2018.03.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/07/2018] [Accepted: 03/14/2018] [Indexed: 12/13/2022]
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