1
|
Mistry H, Naghdi S, Brown A, Rees S, Madan J, Grove A, Khanal S, Duncan C, Matharu M, Cooklin A, Aksentyte A, Davies N, Underwood M. Preventive drug treatments for adults with chronic migraine: a systematic review with economic modelling. Health Technol Assess 2024; 28:1-329. [PMID: 39365169 DOI: 10.3310/aywa5297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024] Open
Abstract
Background Chronic migraine is a disabling condition, affecting 2-4% of adults globally. With the introduction of expensive calcitonin gene-related peptide monoclonal antibodies, it is timely to compare the clinical effectiveness and cost-effectiveness of preventive drugs for chronic migraine. Objective To assess the clinical effectiveness and cost-effectiveness of medications used for chronic migraine through systematic reviews and economic modelling. Eligibility criteria Randomised controlled trials of drug treatments for efficacy with > 100 participants with chronic migraine per arm; for adverse events > 100 participants with episodic or chronic migraine per arm. Previous economic analyses of preventive drugs for chronic migraine. Data sources Eight databases. Reviews methods Systematic reviews, network meta-analysis and economic modelling. Outcomes Monthly headache days, monthly migraine days, headache-related quality of life, cost-effectiveness. Results We found 51 individual articles, reporting 11 randomised controlled trials, testing 6 drugs (topiramate, Botox, eptinezumab, erenumab, fremanezumab, galcanezumab), versus placebo, on 7352 adults with chronic migraine. Calcitonin gene-related peptide monoclonal antibodies, Botox and topiramate reduced headache/migraine days by 2.0-2.5, just under two, or by less than 1.5 days per month, respectively. In the network meta-analysis, eptinezumab 300 mg and fremanezumab monthly ranked in first place in both monthly headache day and monthly migraine day analyses. The calcitonin gene-related peptide monoclonal antibodies were consistently the best choices for headache/migraine days and headache-related quality of life. Topiramate was very unlikely to be the best choice for headache/migraine days and headache-related quality of life when compared to calcitonin gene-related peptide monoclonal antibodies or Botox. We found no trials of the commonly used drugs, such as propranolol or amitriptyline, to include in the analysis. The adverse events review included 40 randomised controlled trials with 25,891 participants; 3 additional drugs, amitriptyline, atogepant and rimegepant, were included. There were very few serious adverse events - none of which were linked to the use of these medications. Adverse events were common. Most people using some calcitonin gene-related peptide monoclonal antibodies reported injection site issues; and people using topiramate or amitriptyline had nervous system or gastrointestinal issues. The cost-effectiveness review identified 16 studies evaluating chronic migraine medications in adults. The newer, injected drugs are more costly than the oral preventatives, but they were cost-effective. Our economic model showed that topiramate was the least costly option and had the fewest quality-adjusted life-year gains, whereas eptinezumab 300 mg was more costly but generated the most quality-adjusted life-year gains. The cost-effectiveness acceptability frontier showed that topiramate was the most cost-effective medication if the decision maker is willing to pay up to £50,000 per quality-adjusted life-year. Our consensus workshop brought together people with chronic migraine and headache experts. Consensus was reached on the top three recommendations for future research on medications to prevent chronic migraine: (1) calcitonin gene-related peptide monoclonal antibodies and Botox versus calcitonin gene-related peptide monoclonal antibodies, (2) candesartan versus placebo and (3) flunarizine versus placebo. Limitations Topiramate was the only oral drug for which we were able to include data. We did not find sufficient quality evidence to support the use of other oral drugs. Conclusions We did not find evidence that the calcitonin gene-related peptide monoclonal antibodies are more clinically and cost-effective when compared to topiramate or Botox. We identified directions for future research these drugs might take. Study registration This study is registered as PROSPERO CRD42021265990, CRD42021265993 and CRD42021265995. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR132803) and is published in full in Health Technology Assessment; Vol. 28, No. 63. See the NIHR Funding and Awards website for further award information.
Collapse
MESH Headings
- Humans
- Migraine Disorders/drug therapy
- Migraine Disorders/prevention & control
- Cost-Benefit Analysis
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal/economics
- Topiramate/therapeutic use
- Chronic Disease
- Quality of Life
- Randomized Controlled Trials as Topic
- Models, Economic
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/economics
- Antibodies, Monoclonal, Humanized/adverse effects
- Quality-Adjusted Life Years
- Adult
- Botulinum Toxins, Type A/therapeutic use
- Botulinum Toxins, Type A/economics
- Fructose/analogs & derivatives
- Fructose/therapeutic use
- Calcitonin Gene-Related Peptide/antagonists & inhibitors
- Network Meta-Analysis
- Technology Assessment, Biomedical
- Calcitonin Gene-Related Peptide Receptor Antagonists/therapeutic use
Collapse
Affiliation(s)
- Hema Mistry
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Seyran Naghdi
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Anna Brown
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sophie Rees
- Bristol Clinical Trials Unit, University of Bristol, Bristol, UK
| | - Jason Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Amy Grove
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Saval Khanal
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Callum Duncan
- Department of Neurology, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Andrew Cooklin
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Aiva Aksentyte
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Natasha Davies
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| |
Collapse
|
2
|
Bhardwaj R, Donohue M, Madonia J, Anderson MS, Matschke K, Bertz R, Croop R, Liu J. Mass balance and pharmacokinetic characterization of zavegepant in healthy male subjects. Clin Transl Sci 2024; 17:e70015. [PMID: 39348235 PMCID: PMC11441388 DOI: 10.1111/cts.70015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/29/2024] [Accepted: 08/04/2024] [Indexed: 10/02/2024] Open
Abstract
Zavegepant, a high-affinity, selective, small-molecule calcitonin gene-related peptide receptor antagonist, is approved as a nasal spray for acute treatment of migraine in adults. This phase I, open-label, single-center, single-period, nonrandomized study in six healthy male subjects assessed mass balance recovery after a single 15-min intravenous (IV) infusion dose of carbon-14 ([14C])-zavegepant. Blood, urine, and fecal samples were collected over 192 h for analysis of zavegepant in plasma and urine; total radioactivity (TR) in plasma, whole blood, urine, and feces; and zavegepant metabolite profiling and structural identification in plasma, urine, and feces. An average of 96.6% of radioactivity administered was recovered in excreta. Most TR (mean 84.9%) was recovered in the feces, indicating that biliary/fecal elimination was the main route. Volume of distribution of zavegepant based on the terminal phase (129 L) was higher than total body water (42 L), indicating substantial distribution into tissue. Total plasma clearance of zavegepant (220 mL/min) is identical to whole blood clearance given the blood/plasma partition ratio of 1, lower than typical hepatic blood flow (1450 mL/min). The observed plasma terminal half-life of zavegepant was 6.8 h. Exposure to zavegepant accounted for ~90% of circulating plasma TR, suggesting that very low levels of uncharacterized circulating metabolites were present. Metabolite profiling did not identify any metabolites representing ≥10% of radioactivity in plasma, urine, or feces. A single IV infusion of 5 mg [14C]-zavegepant was well tolerated in healthy male subjects. Disposition findings of IV [14C]-zavegepant are applicable to the disposition of the approved zavegepant nasal spray.
Collapse
Affiliation(s)
| | - Mary Donohue
- Biohaven Pharmaceuticals, Inc.New HavenConnecticutUSA
| | | | | | | | - Richard Bertz
- Biohaven Pharmaceuticals, Inc.New HavenConnecticutUSA
| | - Robert Croop
- Biohaven Pharmaceuticals, Inc.New HavenConnecticutUSA
| | | |
Collapse
|
3
|
Shiha MG, Hadjisavvas N, Sanders DS, Penny HA. Optimising the Diagnosis of Adult Coeliac Disease: Current Evidence and Future Directions. Br J Hosp Med (Lond) 2024; 85:1-21. [PMID: 39347683 DOI: 10.12968/hmed.2024.0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Coeliac disease is a common autoimmune disorder that affects nearly 1% of the general population. Current diagnostic strategies involve active case finding, serological tests, and endoscopy with biopsies. However, many patients with coeliac disease remain undiagnosed due to a wide gap between clinical guidelines and real-world practice in the diagnosis of adult coeliac disease. This highlights the need for increased education, training, and targeted quality-improvement interventions to optimise the diagnosis of coeliac disease.
Collapse
Affiliation(s)
- Mohamed G Shiha
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | | | - David S Sanders
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Hugo A Penny
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| |
Collapse
|
4
|
Hajishizari S, Mirzababaei A, Abaj F, Bahrampour N, Moradi S, C T Clark C, Mirzaei K. The association between dietary antioxidant quality score and intensity and frequency of migraine headaches among women: a cross-sectional study. BMC Womens Health 2024; 24:497. [PMID: 39252003 PMCID: PMC11382410 DOI: 10.1186/s12905-024-03260-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/15/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Migraine is an episodic disorder and a frequent form of headache. An impaired balance between free radical production and an impaired antioxidant defense system leading to oxidative damage may play a major role in migraine etiology. We sought to investigate whether dietary antioxidant quality score (DAQS) is associated with migraine intensity and frequency among women suffering from migraine. METHODS This cross-sectional study was conducted on 265 women. The data related to anthropometric measures and dietary intake were collected. DAQS score was calculated based on FFQ (food frequency questionnaire) vs. the reference daily intake (RDI) quantity. To measure migraine intensity, the migraine disability assessment questionnaire (MIDAS) and visual analog scale (VAS) were used. The frequency of headaches was defined as the days the participants had headaches in the last month and a 30-day headache diary was used. RESULTS The results of the study demonstrated that VAS, MIDAS, and frequency of headaches were reduced significantly from the low DAQS (poor quality of antioxidants) to high DAQS (high quality of antioxidants) after adjusting covariates. Also, multinomial regression showed there was an inverse association between higher DAQS and the frequency of headaches. In the adjusted model, subjects with the higher DAQS were 69% less likely to have moderate migraine disability, compared with those with the lower DAQS. Linear regression showed, there was an inverse association between vitamin C intake and the grades of pain severity.َAlso in a crude model, a negative association was found between vitamin E and the frequency of headaches. CONCLUSION In conclusion, Participants with higher DAQS had lower migraine intensity and headache frequency. In addition, the consumption of vitamin C may potentially associate with decreasing the severity of headaches. Dietary antioxidants should be monitored closely in individuals suffering from migraine.
Collapse
Affiliation(s)
- Sara Hajishizari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O.Box:14155-6117, Tehran, Iran
| | - Atieh Mirzababaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O.Box:14155-6117, Tehran, Iran
| | - Faezeh Abaj
- Victorian Heart Institute, Monash university, Melbourne, Australia
| | - Niki Bahrampour
- Department of Nutrition, Science and Research Branch, Islamic Azad University (SRBIAU), Tehran, Iran
| | - Sajjad Moradi
- Department of Nutrition and Food Sciences, Research Center for Evidence-Based Health Management, Maragheh, University of Medical Sciences, Maragheh, Iran
| | - Cain C T Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, UK
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O.Box:14155-6117, Tehran, Iran.
| |
Collapse
|
5
|
Rezaee H, Behkar A, Tafakhori A, Zardoui A, Farahmand G, Ranji S. Relationship of myofascial trigger points with related disability, anxiety, and depression in patients with migraine headaches. Head Face Med 2024; 20:47. [PMID: 39238006 PMCID: PMC11378560 DOI: 10.1186/s13005-024-00454-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 08/28/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Migraine affects one in ten individuals worldwide and is the second leading cause of disability. Studies have shown an association between migraine and the musculoskeletal system, and myofascial trigger points (MTrPs) play an essential role. Additionally, those with myofascial pain have been proven to experience higher levels of depression and anxiety. Understanding the association between MTrPs and migraine is crucial for developing targeted treatment strategies. Additionally, recognizing the link between MTrPs and migraine-related depression and anxiety underscores the importance of a holistic approach to migraine management. By addressing both musculoskeletal and neurological factors, healthcare providers can provide more effective and personalized care for migraine patients. This study aims to determine the association between MTrPs with migraine-related disability, anxiety, depression, and migraine characteristics. METHODS This cross-sectional study included 68 migraine patients from an outpatient neurology clinic. The number of MTrPs was determined through examination by an experienced neurologist during a migraine-free period using the recommended international criteria. We evaluated anxiety and depression with the Hospital Anxiety and Depression Scale (HADS) and disability with the Migraine Disability Assessment Scale (MIDAS). RESULTS We enrolled 68 patients (22 males) with a mean age of 36.23 ± 9.63 years. The mean number of MTrPs was 2.75 ± 2.934. MTrPs were positively correlated with severity (CC: 0.576, P-value < 0.001). There was no association between MTrPs and HADS-D or MIDAS, but migraine patients with abnormal HADS-A scores had more MTrPs than patients with normal HADS-A scores (0.6 ± 0.84 vs 3.56 ± 3.11, P-value:0.013). CONCLUSIONS The number of MTrPs is associated with higher anxiety levels and headache intensity. Further research could investigate the impact of MTrP-based therapies on anxiety among individuals suffering from migraines.
Collapse
Affiliation(s)
- Hesan Rezaee
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Behkar
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Tafakhori
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arshia Zardoui
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasem Farahmand
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Ranji
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
6
|
Casas-Limón J, Quintas S, López-Bravo A, Alpuente A, Andrés-López A, Castro-Sánchez MV, Membrilla JA, Morales-Hernández C, González-García N, Irimia P. Unravelling Migraine Stigma: A Comprehensive Review of Its Impact and Strategies for Change. J Clin Med 2024; 13:5222. [PMID: 39274435 PMCID: PMC11396411 DOI: 10.3390/jcm13175222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/30/2024] [Accepted: 08/31/2024] [Indexed: 09/16/2024] Open
Abstract
Migraine-related stigma is a pervasive issue impacting nearly half of chronic migraine patients, with significant consequences for their quality of life, disability and mental health. Despite its profound effects, migraine stigma remains under-recognised in both clinical practice and research. This narrative review explores the three primary types of stigmas affecting migraine patients: public, structural and internalised. Public stigma involves negative societal attitudes and stereotypes that trivialise the condition. Structural stigma is reflected in policies that restrict access to necessary care and resources. Internalised stigma occurs when patients absorb these negative views, leading to self-blame and diminished self-worth. Addressing these different types of stigmas is crucial for improving the understanding, diagnosis and treatment of migraine. Educational efforts, advocacy and policy reform are essential strategies in this context. A deep understanding of stigma is vital for developing effective interventions that enhance clinical management and patient quality of life. Ultimately, reducing stigma can lead to better health outcomes and a more comprehensive approach to migraine care.
Collapse
Affiliation(s)
- Javier Casas-Limón
- Headache Unit, Hospital Universitario Fundación Alcorcón, 28922 Alcorcón, Spain
| | - Sonia Quintas
- Headache Unit, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain
| | | | - Alicia Alpuente
- Headache Unit, Hospital Universitario Vall d'Hebron, 08035 Barcelona, Spain
| | - Alberto Andrés-López
- Headache Unit, Complejo Hospitalario Universitario de Albacete, 02006 Albacete, Spain
| | | | | | | | | | - Pablo Irimia
- Headache Unit, Clínica Universitaria de Navarra, 31008 Pamplona, Spain
| |
Collapse
|
7
|
Nyberg J, Rosenbacke R, Ben-Menachem E. Digital clinics for diagnosing and treating migraine. Curr Opin Support Palliat Care 2024; 18:107-112. [PMID: 38990711 DOI: 10.1097/spc.0000000000000715] [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: 07/13/2024]
Abstract
PURPOSE OF REVIEW Several innovative digital technologies have begun to be applied to diagnosing and treating migraine. We reviewed the potential benefits and opportunities from delivering migraine care through comprehensive digital clinics. RECENT FINDINGS There are increasing applications of digitization to migraine diagnosis and management, including e-diaries, and patient self-management, especially after the COVID-19 pandemic. Digital care delivery appears to better engage chronic migraine sufferers who may struggle to present to physical clinics. SUMMARY Digital clinics appear to be a promising treatment modality for patients with chronic migraine. They potentially minimize travel time, shorten waiting periods, improve usability, and increase access to neurologists. Additionally, they have the potential to provide care at a much lower cost than traditional physical clinics. However, the current state of evidence mostly draws on case-reports, suggesting a need for future randomized trials comparing digital interventions with standard care pathways.
Collapse
Affiliation(s)
- Johan Nyberg
- Stortorgets neurologmottagning, Helsingborg, Sweden
| | - Rikard Rosenbacke
- Centre for Corporate Governance, Department of Accounting, Copenhagen Business School, Copenhagen, Denmark
| | - Elinor Ben-Menachem
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden
| |
Collapse
|
8
|
Liu J, Guo Y, Huang Z, Zhu J, Li Y. Childhood abuse and risk of migraine: A systematic review and meta-analysis. CHILD ABUSE & NEGLECT 2024; 155:106961. [PMID: 39096662 DOI: 10.1016/j.chiabu.2024.106961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 05/29/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Childhood abuse is associated with an increased risk of migraines. However, the literature on this association is limited. OBJECTIVE To determine the pooled effect size of the association between childhood abuse and migraines. PARTICIPANTS AND SETTING System review and meta-analysis. METHODS A systematic literature search for studies published until September 20, 2023, was performed using the Embase, PubMed, and Web of Science databases. Specifically, original articles reporting the statistical effect size (odds ratio) of the association between childhood abuse and migraines were selected. Pooled odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated using random- or fixed-effects models. Publication bias was examined using funnel plots, and sensitivity analysis was used to explore the stability of the pooled results. RESULTS Twelve studies involving 110,776 participants were included. Individuals with childhood abuse (OR = 1.60, 95 % CI: 1.49, 1.71) were at increased risk of migraine when compared with individuals with no childhood abuse. Of the different types of childhood abuse examined, sexual abuse (OR = 1.71, 95 % CI: 1.43, 2.04), physical abuse (OR = 1.47, 95 % CI: 1.38, 1.56), and emotional abuse (OR = 1.71, 95 % CI: 1.52, 1.93) were associated with an increased risk of migraine. CONCLUSIONS Childhood abuse increases migraine risk. Multifaceted interventions to curb abuse and related behaviors can effectively reduce migraine risk. However, considering that multiple factors, such as obesity and anxiety, are causatively associated with both childhood abuse and migraines, our findings should be interpreted with caution.
Collapse
Affiliation(s)
- Jianyi Liu
- Changde Hospital, Xiangya School of Medicine, Central South University, Changde, China; The First People's Hospital of Changde City, Changde, China.
| | - Yizhi Guo
- Changde Hospital, Xiangya School of Medicine, Central South University, Changde, China; The First People's Hospital of Changde City, Changde, China.
| | - Zhihua Huang
- Changde Hospital, Xiangya School of Medicine, Central South University, Changde, China; The First People's Hospital of Changde City, Changde, China
| | - Jianming Zhu
- Changde Hospital, Xiangya School of Medicine, Central South University, Changde, China; The First People's Hospital of Changde City, Changde, China
| | - Yandeng Li
- Changde Hospital, Xiangya School of Medicine, Central South University, Changde, China; The First People's Hospital of Changde City, Changde, China
| |
Collapse
|
9
|
Patzkó Á, Pfund Z, Csutak A, Tóth N, Kölkedi Z, Kis-Jakab G, Bosnyák E, Rozgonyi R, Szalai E. Neurovascular changes of the retina and optic nerve head in episodic migraine. Sci Rep 2024; 14:20243. [PMID: 39215112 PMCID: PMC11364758 DOI: 10.1038/s41598-024-71388-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024] Open
Abstract
To investigate neurovascular changes; including macular vascular density (VD), thickness of the ganglion cell layer (GCL) and optic nerve head (ONH) parameters in episodic migraine patients. 80 eyes of 40 episodic migraine patients were recruited. Thirty patients having a dominant side of migraine headache were statistically analyzed (5 male and 25 female; mean age 31.67 ± 9.54 years) and compared to 25 eyes of 25 healthy volunteers (5 male and 20 female; mean age of 34.4 ± 12.11 years, p = 0.361). The posterior segment was imaged with Topcon DRI optical coherence tomography (OCT) (Triton Swept source OCT Topcon, Japan), and OCT angiography (OCTA). Comparing the dominant side of migraine patients to controls we found a significant decrease of the VD in the central zone of the superficial and deep capillary plexus (SCP, p = 0.01; DCP, p = 0.004) and an enlarged foveal avascular zone (FAZ, p = 0.054). The GCL thickness was significantly reduced in the central ring (GCL + p = 0.042, GCL + + p = 0.029), as well as the retinal nerve fiber layer (RNFL) thickness in the temporal quadrant (p = 0.021) and border tissue of Elschnig diameter (BTE, p = 0.035). The duration of migraine showed an inverse correlation with SCP in the nasal quadrant (p = 0.016, r = - 0.445) and with all DCP regions [DCP superior (p = 0.004, r = - 0.519), DCP inferior (p = 0.004, r = - 0.519), DCP nasal (p = 0.006, r = - 0.496), DCP temporal (p = 0.005, r = - 0.508), DCP CSF (p < 0.001, r = - 0.634)]. The dominant side compared to the non-dominant side showed a significant deterioration of the VD in the inferior (p = 0.04) and temporal quadrants (p = 0.023); furthermore, a significant decrease in the GCL + + inner ring thickness (p = 0.046). Microvascular damage and consequent structural alterations of the retina and optic nerve head occur in the eyes of episodic migraine patient in association with the lateralization of the headache.
Collapse
Affiliation(s)
- Ágnes Patzkó
- Department of Ophthalmology, University of Pécs Medical School, Rákóczi U. 2, Pécs, 7623, Hungary
| | - Zoltán Pfund
- Department of Neurology, University of Pécs Medical School, Pécs, Hungary
| | - Adrienne Csutak
- Department of Ophthalmology, University of Pécs Medical School, Rákóczi U. 2, Pécs, 7623, Hungary
| | - Noémi Tóth
- Department of Ophthalmology, University of Pécs Medical School, Rákóczi U. 2, Pécs, 7623, Hungary
| | - Zsófia Kölkedi
- Department of Ophthalmology, University of Pécs Medical School, Rákóczi U. 2, Pécs, 7623, Hungary
| | - Gréta Kis-Jakab
- HUN-REN-PTE Clinical Neuroscience MR Research Group, Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
| | - Edit Bosnyák
- Department of Neurology, University of Pécs Medical School, Pécs, Hungary
| | - Renáta Rozgonyi
- Department of Neurology, University of Pécs Medical School, Pécs, Hungary
| | - Eszter Szalai
- Department of Ophthalmology, University of Pécs Medical School, Rákóczi U. 2, Pécs, 7623, Hungary.
| |
Collapse
|
10
|
Shen Y, Li Z, Wang J, Qiu Z. Study on the comprehensive treatment of migraine with traditional Chinese medicine based on the new pathophysiological mechanism: A review. Medicine (Baltimore) 2024; 103:e39487. [PMID: 39213252 PMCID: PMC11365636 DOI: 10.1097/md.0000000000039487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 08/05/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024] Open
Abstract
Migraine is a ubiquitous neurological disorder that affects approximately 1 billion people worldwide. Migraine is the second leading cause of illness in people of all ages worldwide. Uncertainty in migraine diagnosis leads to unnecessary testing and increases the treatment costs. To date, the pathogenesis of migraine is not fully understood, but it is generally believed that migraine involves the trigeminal nerve and its axonal projections to intracranial blood vessels. Pain signals from the trigeminal neurovascular system are transmitted to the brain, resulting in migraines. As an important component of complementary and alternative medicine, traditional Chinese medicine (TCM) has shown significant efficacy in the treatment of migraine, and has attracted increasing attention worldwide. This review is based on the pathophysiology of migraines in modern medicine. To explore the comprehensive treatment of migraine using TCM, acupuncture, and various other TCM treatments.
Collapse
Affiliation(s)
- Yue Shen
- Graduate School, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
| | - Zeguang Li
- First Affiliated Hospital, Heilongjiang University of Chinese, Harbin, Heilongjiang Province, China
| | - Jing Wang
- Graduate School, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
| | - Zitong Qiu
- Graduate School, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
| |
Collapse
|
11
|
Guidotti S, Torelli P, Ambiveri G, Fiduccia A, Castaldo M, Pruneti C. From the latin "re-cordis, passing through the heart": autonomic modulation differentiates migraineurs from controls when recounting a significant life event. Neurol Sci 2024:10.1007/s10072-024-07739-7. [PMID: 39187673 DOI: 10.1007/s10072-024-07739-7] [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: 05/29/2024] [Accepted: 08/19/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVE The literature on clinical psychophysiology highlights the possibility of using Heart Rate Variability (HRV) as an index of psychophysical balance and resilience to stress. This study investigates the differences in stress reactivity and subsequent recovery between a group of migraineurs and healthy controls. METHODS Socio-demographic (i.e., sex, age, profession, marital status, and level of education) and psychophysiological (HR and HRV) measures of a group of thirty subjects with migraine (26 migraineurs without aura (86.7%), 2 migraineurs with aura (6.7%), and 2 migraineurs with and without aura (6.7%)) and from thirty healthy control subjects were collected. In particular, HRV was analyzed through frequency-domain parameters, including Low-Frequency (LF; 0.04-0.15 Hz) and High-Frequency (HF; 0.15-0.4 Hz) bands as well as LF/HF ratio during a Psychophysiological Stress Profile (PSP) structured in seven phases: (1) Baseline, (2) Objective stressor 1 (Stroop Test), (3) Rest 1, (4) Objective stressor 2 (Mental Arithmetic Task), (5) Rest 2, (6) Subjective stressor (recount a significant life event), and (7) Rest 3. The LF, HF, and LF/HF ratio values were transformed into a logarithmic scale (i.e., log-LF, log-HF, and log LF/HF ratio). Additionally, LF and HF were converted into normalized units (0-100) (i.e., LF% and HF%) which, in turn, were used to obtain reactivity and recovery to stress through delta values (Δ) calculation. RESULTS Subjects with migraine reported greater ΔLF% levels of reactivity and recovery to subjective stressor, demonstrating a prevalence of sympathetic activity while recounting a personal life event. At the same time, a lowering of the same values was found in the subjects of the group control. DISCUSSION Our results underline the importance of conducting a psychophysiological assessment in patients with headaches because reduced stress management skills could influence the clinical manifestations of the disease, considering stress as one of the most common triggers for migraine patients.
Collapse
Affiliation(s)
- Sara Guidotti
- Clinical Psychology, Clinical Psychophysiology, and Clinical Neuropsychology Labs., Dept. of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Paola Torelli
- Headache Center, Neurology Unit, University Hospital of Parma, Parma, Italy
| | | | - Alice Fiduccia
- Clinical Psychology, Clinical Psychophysiology, and Clinical Neuropsychology Labs., Dept. of Medicine and Surgery, University of Parma, Parma, Italy
| | - Matteo Castaldo
- Clinical Psychology, Clinical Psychophysiology, and Clinical Neuropsychology Labs., Dept. of Medicine and Surgery, University of Parma, Parma, Italy
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Carlo Pruneti
- Clinical Psychology, Clinical Psychophysiology, and Clinical Neuropsychology Labs., Dept. of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
12
|
Chen ZF, Kong XM, Yang CH, Li XY, Guo H, Wang ZW. Global, regional, and national burden and trends of migraine among youths and young adults aged 15-39 years from 1990 to 2021: findings from the global burden of disease study 2021. J Headache Pain 2024; 25:131. [PMID: 39134934 PMCID: PMC11318134 DOI: 10.1186/s10194-024-01832-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 07/18/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Migraine, a widespread neurological condition, substantially affects the quality of life, particularly for adolescents and young adults. While its impact is significant, there remains a paucity of comprehensive global research on the burden of migraine in younger demographics. Our study sought to elucidate the global prevalence, incidence, and disability-adjusted life-years (DALYs) associated with migraine in the 15-39 age group from 1990 to 2021, utilizing data from the Global Burden of Disease (GBD) 2021 study. METHODS Our comprehensive study analyzed migraine data from the GBD 2021 report, examining the prevalence, incidence, and DALYs across 204 countries and territories over a 32-year span. We stratified the information by age, sex, year, geographical region, and Socio-demographic Index (SDI). To evaluate temporal trends in these metrics, we employed the estimated annual percentage change (EAPC) calculation. RESULTS Between 1990 and 2021, the worldwide prevalence of migraine among 15-39 year-olds increased substantially. By 2021, an estimated 593.8 million cases were reported, representing a 39.52% rise from 425.6 million cases in 1990. Global trends showed increases in age-standardized prevalence rate, incidence rate, and DALY rate for migraine during this period. The EAPC were positive for all three metrics: 0.09 for ASPR, 0.03 for ASIR, and 0.09 for DALY rate. Regions with medium SDI reported the highest absolute numbers of prevalent cases, incident cases, and DALYs in 2021. However, high SDI regions demonstrated the most elevated rates overall. Across the globe, migraine prevalence peaked in the 35-39 age group. Notably, female rates consistently exceeded male rates across all age categories. CONCLUSION The global impact of migraine on youths and young adults has grown considerably from 1990 to 2021, revealing notable variations across SDI regions, countries, age groups, and sexes. This escalating burden necessitates targeted interventions and public health initiatives, especially in areas and populations disproportionately affected by migraine.
Collapse
Affiliation(s)
- Zhi-Feng Chen
- Department of Anesthesiology, School of Medicine, Shanghai Putuo People's Hospital, Tongji University, Shanghai, China
| | - Xiang-Meng Kong
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Huangpu District, No.639 Zhizaoju Road, Shanghai, 200011, China
| | - Cheng-Hao Yang
- Department of Vascular Surgery, School of Medicine, Shanghai Putuo People's Hospital, Tongji University, Shanghai, China
| | - Xin-Yu Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, PR China.
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
| | - Hong Guo
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Zhao-Wei Wang
- Department of Neurology, Qianjiang Central Hospital of Hubei Province, Hubei, China.
| |
Collapse
|
13
|
Schütz P, Lob S, Chahed H, Dathe L, Löwer M, Reiß H, Weigel A, Albrecht J, Tokgöz P, Dockweiler C. ChatGPT as an Information Source for Patients with Migraines: A Qualitative Case Study. Healthcare (Basel) 2024; 12:1594. [PMID: 39201153 PMCID: PMC11354001 DOI: 10.3390/healthcare12161594] [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: 06/30/2024] [Revised: 08/07/2024] [Accepted: 08/08/2024] [Indexed: 09/02/2024] Open
Abstract
Migraines are one of the most common and expensive neurological diseases worldwide. Non-pharmacological and digitally delivered treatment options have long been used in the treatment of migraines. For instance, migraine management tools, online migraine diagnosis or digitally networked patients have been used. Recently, applications of ChatGPT are used in fields of healthcare ranging from identifying potential research topics to assisting professionals in clinical diagnosis and helping patients in managing their health. Despite advances in migraine management, only a minority of patients are adequately informed and treated. It is important to provide these patients with information to help them manage the symptoms and their daily activities. The primary aim of this case study was to examine the appropriateness of ChatGPT to handle symptom descriptions responsibly, suggest supplementary assistance from credible sources, provide valuable perspectives on treatment options, and exhibit potential influences on daily life for patients with migraines. Using a deductive, qualitative study, ten interactions with ChatGPT on different migraine types were analyzed through semi-structured interviews. ChatGPT provided relevant information aligned with common scientific patient resources. Responses were generally intelligible and situationally appropriate, providing personalized insights despite occasional discrepancies in interaction. ChatGPT's empathetic tone and linguistic clarity encouraged user engagement. However, source citations were found to be inconsistent and, in some cases, not comprehensible, which affected the overall comprehensibility of the information. ChatGPT might be promising for patients seeking information on migraine conditions. Its user-specific responses demonstrate potential benefits over static web-based sources. However, reproducibility and accuracy issues highlight the need for digital health literacy. The findings underscore the necessity for continuously evaluating AI systems and their broader societal implications in health communication.
Collapse
Affiliation(s)
- Pascal Schütz
- Department Digital Health Sciences and Biomedicine, Professorship of Digital Public Health, School of Life Sciences, University of Siegen, 57076 Siegen, Germany; (S.L.); (H.C.); (L.D.); (M.L.); (H.R.); (A.W.); (J.A.); (P.T.); (C.D.)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Li WW, Zhang JX, Wang J, Chen YQ, Lai S, Qiu ZK. Bidirectional two-sample Mendelian randomization analysis identifies causal associations between migraine and five psychiatric disorders. Front Neurol 2024; 15:1432966. [PMID: 39161872 PMCID: PMC11330824 DOI: 10.3389/fneur.2024.1432966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/22/2024] [Indexed: 08/21/2024] Open
Abstract
Background The question of whether a correlation exists between migraine and five psychiatric disorders, including posttraumatic stress disorder (PTSD), major depressive disorder (MDD), anorexia nervosa (AN), bipolar disorder (BIP), and schizophrenia (SCZ), remains a matter of controversy. Hence, this research aims to investigate whether there is a possible association between migraine and five psychiatric disorders. Methods We performed a bidirectional 2-sample Mendelian randomization (MR) analysis to assess the causality between migraine and five psychiatric disorders. Genetic associations of PTSD, MDD, AN, BIP, and SCZ were obtained from the Psychiatric Genomics Consortium (PGC) database and genetic associations of migraine with aura and migraine without aura were obtained from the FinnGen dataset. We used the inverse-variance weighted (IVW), weighted median, weighted mode, MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO), and MR Egger regression methods to evaluate the association of genetically predicted exposure with the risk of outcome. Results MR demonstrated that MDD was associated with a high risk of migraine without aura (OR = 1.930578, 95% confidence interview (CI): 1.224510, 3.043550, p < 0.05), but BIP was related to a low risk of migraine without aura (OR = 0.758650, 95%CI: 0.639601, 0.899858, p < 0.05). According to the results of reverse MR, migraine with aura was associated with a high risk of BIP (OR = 1.019100, 95%CI: 1.002538, 1.035935, p < 0.05), and migraine without aura was associated with an increased risk of AN (OR = 1.055634, 95%CI: 1.023859, 1.088394, p < 0.05). Conclusion Our results provide evidence of the potential causal association between migraine and some psychiatric disorders. It may contribute to the prevention of migraine and some psychiatric disorders.
Collapse
Affiliation(s)
| | | | | | | | - Sha Lai
- *Correspondence: Sha Lai, ; Zhi-Kun Qiu,
| | | |
Collapse
|
15
|
Al-Hashel JY, Alroughani R, Alshaf F, Ashkanani HK, Akl A, AlMutairi O, Alwazzan S, Ahmed SF. Real-world experiences of migraine patients on Erenumab: a Kuwait single center cohort. Neurol Res 2024; 46:772-780. [PMID: 38909320 DOI: 10.1080/01616412.2024.2354618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 05/07/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Migraine is a prevalent headache disorder with a significant impact on the quality of life. This study aims to investigate the effectiveness and safety of erenumab, mAb targeting the CGRP receptor, in treating chronic (CM) and episodic (EM) migraine in clinical practice Kuwait, providing region-specific insights to treatment options. METHOD This was a prospective observational cohort study of patients diagnosed with EM or CM treated with erenumab. The primary outcome of the study was to assess the proportion of patients achieving ≥ 50% reduction in monthly mean migraine days, and several changes including the mean number of monthly migraine days, the frequency of analgesic use, attack severity, AEs, and QoL. RESULTS The study included 151 patients with a mean age of 44.0±11.4 years, and 81.9% female. The primary outcome was achieved in 74.2% of patients, with a significant (p < 0.001) reduction in headache frequency, pain severity, analgesic use, and improvement in QoL. Age and duration of migraine were significant predictors of achieving a ≥ 50% reduction in headache frequency after therapy (OR = 0.955; p = 0.009) and (OR = 0.965; p = 0.025), respectively. Treatment compliance was observed in 76.2% of patients, and 24.5% discontinued treatment. Constipation was the most commonly reported AEs (6.0%), and conservative management was the most common approach to managing AEs. CONCLUSION Erenumab was effective in reducing the frequency and severity of migraine attacks and improving QoL, and safe with manageable AEs in a real-world setting in Kuwait. Further research is needed to better understand erenumab's effectiveness and safety in different populations and settings, as well as to compare it with other migraine prophylactic treatments.
Collapse
Affiliation(s)
- Jasem Youssef Al-Hashel
- Neurology Department, Ibn Sina Hospital, Safat, Kuwait City, Kuwait
- Faculty of Medicine, Kuwait University, Safat, Kuwait City, Kuwait
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait City, Kuwait
| | - Fatemah Alshaf
- Neurology Department, Ibn Sina Hospital, Safat, Kuwait City, Kuwait
| | | | - Amr Akl
- Medicine Department, Farwaniya Hospital, Farwaniya, Kuwait
| | | | - Sawsan Alwazzan
- Faculty of Medicine, Kuwait University, Safat, Kuwait City, Kuwait
| | - Samar Farouk Ahmed
- Neurology Department, Ibn Sina Hospital, Safat, Kuwait City, Kuwait
- Neuropsychiatry Department, Faculty of Medicine, Al-Minia University, Minia City, Minia, Egypt
| |
Collapse
|
16
|
Göbel CH, Heinze A, Cirkel A, Göbel H. Rizatriptan as an Over-the-Counter Triptan in the Treatment of Migraine Attacks. Pain Ther 2024; 13:813-827. [PMID: 38886287 PMCID: PMC11255172 DOI: 10.1007/s40122-024-00625-2] [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: 05/12/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Abstract
Around 91% of migraine patients use over-the-counter medicines to treat attacks, often without further treatment or medical consultation. This therapeutic principle is established in most countries, regardless of how the healthcare system is otherwise structured or financed. Using Germany as an example, the basis for an expansion of attack therapy with rizatriptan as an over-the-counter triptan is described. To achieve the best possible tolerability and safety in the context of self-medication, the lowest possible dose should be selected to provide the most favourable tolerability and safety profile in the context of self-medication through low dosages. The lowest approved dose of rizatriptan is 5 mg. This was investigated in three randomized controlled trials with 752 patients. The results show that rizatriptan at a dose of 5 mg is more effective than the triptans naratriptan 2.5 mg, almotriptan 12.5 mg and sumatriptan 50 mg, which were previously available for self-medication in Germany. There was no significant difference in the frequency of adverse events with rizatriptan 5 mg compared to placebo. Rizatriptan 5 mg does not have a higher side effect potential than sumatriptan 50 mg, which is already exempt from the prescription requirement. The reasons given show that rizatriptan in a dose of 5 mg for the treatment of acute migraine attacks fulfils the requirements for a transfer from prescription to pharmacy-only status at least as well as sumatriptan 50 mg, naratriptan 2.5 mg and almotriptan 12.5 mg. From a clinical care perspective, it is desirable for affected patients to have other options available for self-medication. Non-responders to other substances also have a further treatment option with rizatriptan 5 mg, with the same or even better risk-benefit profile, to treat migraine attacks safely, effectively and in a tolerable manner as part of self-medication.
Collapse
Affiliation(s)
- Carl H Göbel
- Kiel Migraine and Headache Centre, Heikendorfer Weg 9-27, 24149, Kiel, Germany.
| | - Axel Heinze
- Kiel Migraine and Headache Centre, Heikendorfer Weg 9-27, 24149, Kiel, Germany
| | - Anna Cirkel
- Kiel Migraine and Headache Centre, Heikendorfer Weg 9-27, 24149, Kiel, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Hartmut Göbel
- Kiel Migraine and Headache Centre, Heikendorfer Weg 9-27, 24149, Kiel, Germany
| |
Collapse
|
17
|
Liu L, Li H, Wang Z, Yao X, Xiao W, Yu Y. Exploring the anti-migraine effects of Tianshu capsule: chemical profile, metabolic behavior, and therapeutic mechanisms. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 131:155766. [PMID: 38865935 DOI: 10.1016/j.phymed.2024.155766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/02/2024] [Accepted: 05/20/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Migraine is widely recognized as the third most prevalent medical condition globally. Tianshu capsule (TSC), derived from "Da Chuan Xiong Fang" of the Jin dynasty, is integral in the clinical treatment of migraine. However, the chemical properties and therapeutic mechanisms of TSC different portions remain unclear. PURPOSE This study was designed to investigate the effects of TSC different portions (including small molecular TSCP-SM and polysaccharides TSC-P) on migraine and explore the underlying mechanisms. STUDY DESIGN AND METHODS First of all, migraine rats were established by nitroglycerin injection and treated with TSC, TSC-P, and TSC-SM. ELISA, qPCR, and immunofluorescence were used to evaluate the pharmacological effects on migraine rats. Secondly, UPLC-Q/TOF-MS and GC--MS were employed to detect the components of TSC-SM. PMP-HPLC, NMR, FT-IR, UV-Vis, AFM, and SEM were used for the chemical profiling of polysaccharides. Thirdly, the metabolic behavior profile of TSC-P was characterized by oral administrated fluorescence-labeled TSC-P and detected by NIRF imaging. Finally, the anti-migraine mechanisms were explored by determining the composition of gut microbiota, analyzing colonic short-chain fatty acids (SCFAs), and examining serum tryptophan-related metabolites. RESULTS Both small molecules (45 volatiles and 114 small molecules) and polysaccharides (including Glc, Ara, Gal, and Gal A) have exhibited effectiveness in alleviating migraine, and this efficacy is associated with reduced CGRP and iNOS levels, along with increased β-EP expressions. Further mechanistic exploration revealed that small-molecules exhibited effectiveness in migraine treatment by exerting antioxidative actions, while polysaccharides demonstrated superior therapeutic effects in regulating 5-HT levels. By monitoring the metabolic behavior of polysaccharides with fluorescent labeling, it was observed that TSC-P exhibited poor absorption. Instead, TSC-P demonstrated its therapeutic effects by modulating the aberrations in gut microbiota (including Alloprevotella, Muribaculaceae_ge, and Ruminococcaceae_UCG-005), cecum short-chain fatty acids (such as isobutyric, isovaleric, and valeric acids), and serum tryptophan-related metabolites (including indole-3-acetamide, tryptophol, and indole-3-propionic acid). CONCLUSION This research provides innovative insights into chemical composition, metabolic behavior, and proposed anti-migraine mechanisms of TSC from a polarity-based perspective, and pioneering an exploration focused on the polysaccharide components within TSC for the first time.
Collapse
Affiliation(s)
- Lingxian Liu
- Institute of Traditional Chinese Medicine & Natural Products, College of Pharmacy ; State Key Laboratory of Bioactive Molecules and Druggability Assessment; International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Ministry of Education (MOE) of China; and Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drugs Research, Jinan University, Guangzhou, 510632, China
| | - Haibo Li
- National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture and Jiangsu Kanion Pharmaceutical Co. Ltd., Jiangsu, Lianyungang, 222001, China
| | - Zhenzhong Wang
- National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture and Jiangsu Kanion Pharmaceutical Co. Ltd., Jiangsu, Lianyungang, 222001, China
| | - Xinsheng Yao
- Institute of Traditional Chinese Medicine & Natural Products, College of Pharmacy ; State Key Laboratory of Bioactive Molecules and Druggability Assessment; International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Ministry of Education (MOE) of China; and Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drugs Research, Jinan University, Guangzhou, 510632, China.
| | - Wei Xiao
- National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture and Jiangsu Kanion Pharmaceutical Co. Ltd., Jiangsu, Lianyungang, 222001, China.
| | - Yang Yu
- Institute of Traditional Chinese Medicine & Natural Products, College of Pharmacy ; State Key Laboratory of Bioactive Molecules and Druggability Assessment; International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Ministry of Education (MOE) of China; and Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drugs Research, Jinan University, Guangzhou, 510632, China.
| |
Collapse
|
18
|
Ha WS, Chu MK. Advances in Exercise in the Clinical Trials of Migraine: A Scoping Review. Curr Pain Headache Rep 2024; 28:753-767. [PMID: 38761296 DOI: 10.1007/s11916-024-01269-9] [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] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE OF REVIEW This review aimed to investigate emerging evidence regarding the effectiveness of exercise for migraines, focusing on the results of recent trials. Additionally, it explored the possibility of exercise as a treatment for migraines. RECENT FINDINGS Between 2020 and 2023, five, four, one, and two trials were conducted regarding the effect of aerobic exercise, anaerobic exercise, Tai Chi, and yoga, respectively, on migraine; all studies showed significant effects. Two trials on aerobic exercise showed that high-intensity exercise was similar to or slightly more effective than moderate-intensity exercise as a treatment for migraines. Three trials on anaerobic exercise reported its effectiveness in preventing migraines. Regarding efficacy, side effects, and health benefits, aerobic exercises and yoga are potentially beneficial strategies for the prevention of migraines. Further studies are needed to develop evidence-based exercise programs for the treatment of migraines.
Collapse
Affiliation(s)
- Woo-Seok Ha
- Department of Neurology, Severance Hospital Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
| |
Collapse
|
19
|
Katsarava Z, Buse DC, Leroux E, Lanteri-Minet M, Sakai F, Matharu MS, Adams AM, Carr K, Fanning KM, Lipton RB. Disability in migraine: Multicountry results from the Chronic Migraine Epidemiology and Outcomes - International (CaMEO-I) Study. Cephalalgia 2024; 44:3331024241274343. [PMID: 39175365 DOI: 10.1177/03331024241274343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
BACKGROUND Few studies of migraine have evaluated migraine disability across multiple countries using the same methodology. METHODS This cross-sectional, web-based survey was conducted in 2021-2022 in Canada, France, Germany, Japan, UK and USA. Respondents with migraine were identified based on modified International Classification of Headache Disorders, 3rd edition, criteria. Headache features (Migraine Symptom Severity Score (MSSS, range: 0-21), presence of allodynia (Allodynia Symptom Checklist, ASC-12)) and migraine burden (Patient Health Questionnaire-4 (PHQ-4), Migraine-Specific Quality of Life questionnaire version 2.1 (MSQ v2.1), Work Productivity and Activity Impairment (WPAI) questionnaire) were evaluated. RESULTS Among 14,492 respondents with migraine across countries, the mean ± SD MSSS was 15.4 ± 3.2 and 48.5% (7026/14,492) of respondents had allodynia based on ASC-12. Of all respondents living with migraine, 35.5% (5146/14,492) reported moderate to severe anxiety and/or depression symptoms. Mean ± SD MSQ v2.1 Role Function-Restrictive, Role Function-Preventive and Emotional Function domain scores were 60.7 ± 22.9, 71.5 ± 23.0 and 65.1 ± 27.2, respectively. The WPAI mean ± SD percentages of respondents who missed work or worked impaired as a result of migraine were 6.8 ± 18.1% and 41.0 ± 30.1%, respectively. CONCLUSIONS For every country surveyed, migraine was associated with high levels of symptom severity, with allodynia and with substantial burden.
Collapse
Affiliation(s)
- Zaza Katsarava
- Department of Neurology, Christian Hospital Unna, Unna, Germany
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - Dawn C Buse
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elizabeth Leroux
- Department of Neurology, Montreal Neurological Clinic, Montreal, QC, Canada
| | - Michel Lanteri-Minet
- Pain Department and FHU InovPain, CHU Nice and Côte Azur University, Nice, France
- INSERM U1107 Migraine and Trigeminal Pain, Auvergne University, Clermont-Ferrand, France
| | - Fumihiko Sakai
- Saitama International Headache Center, Chuo-ku, Saitama City, Japan
| | | | | | | | | | - Richard B Lipton
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
20
|
Lipton RB, Thiry A, Morris BA, Croop R. Efficacy and Safety of Rimegepant 75 mg Oral Tablet, a CGRP Receptor Antagonist, for the Acute Treatment of Migraine: A Randomized, Double-Blind, Placebo-Controlled Trial. J Pain Res 2024; 17:2431-2441. [PMID: 39070853 PMCID: PMC11277999 DOI: 10.2147/jpr.s453806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 07/08/2024] [Indexed: 07/30/2024] Open
Abstract
Purpose This study compared the efficacy, tolerability, and safety of rimegepant 75 mg oral tablet - a small molecule calcitonin-gene receptor peptide (CGRP) receptor antagonist - with placebo in the acute treatment of migraine. Methods This double-blind, randomized, placebo-controlled trial enrolled adults aged ≥18 years with at least a 1-year history of migraine. Participants randomized to rimegepant 75 mg oral tablet or placebo treated a single migraine attack of moderate or severe pain intensity. The coprimary endpoints, pain freedom and freedom from the most bothersome symptom ([MBS] nausea, photophobia, or phonophobia) at 2 hours postdose, were evaluated using Mantel-Haenszel risk estimation. Results Of the 1485 participants enrolled, 1162 (78.2%) were randomized to rimegepant (n = 582) or placebo (n = 580). Most participants (85.5%) were female; the population had a mean (SD) age of 41.6 (12.2) years and a history of 4.7 (1.8) migraine attacks per month. At 2 hours postdose, rimegepant-treated participants had higher pain freedom rates (19.2% [104/543] vs 14.2% [77/541]; risk difference 4.9; 95% confidence interval [CI] 0.5 to 9.3; P=0.0298) and MBS freedom rates (36.6% [199/543] vs 27.7% [150/541]; risk difference 8.9; 95% CI 3.4 to 14.4; P=0.0016) than placebo-treated participants. Rimegepant-treated participants also had higher rates of pain relief (56.0% [304/543] vs 45.7% [247/541]; risk difference 10.3; 95% CI 4.4 to 16.2, P=0.0006) at 2 hours postdose. The most common adverse events were nausea (0.9% [5/546] vs 1.1% [6/549]) and dizziness (0.7% [4/546] vs 0.4% [2/549]). No signal of drug-induced liver injury due to rimegepant was identified. Conclusion Rimegepant 75 mg oral tablet was effective in the acute treatment of migraine. Tolerability and safety were similar to placebo, with no evidence of hepatotoxicity. Trial Registration Clinicaltrials.gov Identifier: NCT03235479.
Collapse
Affiliation(s)
- Richard B Lipton
- Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Beth A Morris
- Clinical Operations (BM) and Development (RC), Biohaven Pharmaceuticals, Inc., New Haven, CT, USA
| | - Robert Croop
- Clinical Operations (BM) and Development (RC), Biohaven Pharmaceuticals, Inc., New Haven, CT, USA
| |
Collapse
|
21
|
Giannouli E, Giannouli E, Alexoudi A, Arvaniti C, Fakas N, Constantinidis TS, Kouremenos E, Mitsikostas DD. Validity and reliability of the Greek Migraine-Specific Quality of Life Questionnaire (MSQ Version 2.1-GR). J Patient Rep Outcomes 2024; 8:72. [PMID: 39007966 PMCID: PMC11250746 DOI: 10.1186/s41687-024-00762-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 07/08/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND To assess the validity and reliability of the Migraine-Specific Quality of Life Questionnaire 2.1 (MSQv.2.1) in a group of Greek migraineurs. DESIGN-SAMPLE-METHODS The Greek version of MSQv.2.1 (MSQv.2.1-GR), a self-report measure with 14 items in 3 domains (Role Restrictive (RR), Role Preventive (RP) and Emotional Function (EF)), was administered during a cross-sectional study to 141 Greek adult migraineurs and 135 controls without migraine or any other primary headache disorder, along with Migraine Disability Assessment Scale (MIDAS) and Short Form Health Survey (SF-12) to assess validity. MSQv.2.1-GR was re-administered in a group of participants with migraine two weeks afterwards to assess reliability. Content and construct validity was assessed using Intraclass Correlation Coefficient (ICC), Spearman rho, McDonald's omega, Cronbach's alpha. Confirmatory factor analysis (CFA) was used to test the latent structure of the MSQv.2.1-GR in migraineurs. RESULTS A total of 276 adults participated in the study. Internal consistency of the three MSQv.2.1-GR scales RR, RP and EF yielded a range of McDonald's omega from 0.832 to 0.923 (Cronbach's alpha from 0.814 to 0.923). CFA confirmed the proposed three-factor MSQv.2.1-GR latent structure with acceptable goodness of fit indices and factor loadings. Correlations were established between MSQv2.1-GR component and MIDAS scores, showing moderate and statistically significant relationships (from - 0.519 to -0.562, all p < 0.001) for RR, RP and EF. Correlations between MSQv2.1-GR and SF-12 component scores were identified, with values from 0.1 to 0.4, indicating low to moderate associations. ICC was calculated at 0.997, indicating a high level of reliability between the measures. Notably, all MSQv2.1-GR scores (RR, RP, EF) were significantly higher in the controls compared to migraineurs (p < 0.001 for all scales). These findings suggest that MSQv2.1-GR is internally consistent, shows significant correlations with relevant measures, and is effective in discriminating controls from migraineurs. CONCLUSION MSQv2.1-GR is a valid and reliable tool to determine the effect migraine has on the quality of life of Greek-speaking migraineurs.
Collapse
Affiliation(s)
- Ermioni Giannouli
- Headache Clinic, Athens Medical Centre: Omilos Iatrikou Athinon, 5-7 Distomou Street, Marousi, Athens, Greece.
| | - Eleni Giannouli
- 1st Psychiatric Clinic, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasia Alexoudi
- First Department of Neurosurgery, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Neurological Institute of Athens, Athens, Greece
| | - Chryssa Arvaniti
- Second Department, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Fakas
- Neurology Department, 401 General Military Hospital, Athens, Greece
| | | | | | - Dimos-Dimitrios Mitsikostas
- First Department of Neurology, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
22
|
Zang X, Du Y, Jiang M, Zhou S, Wang L, Han X. A thorough investigation into the correlation between migraines and the gut microbiome: an in-depth analysis using Mendelian randomization studies. Front Neurol 2024; 15:1356974. [PMID: 39015315 PMCID: PMC11250663 DOI: 10.3389/fneur.2024.1356974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/29/2024] [Indexed: 07/18/2024] Open
Abstract
Objective A growing body of evidence underscores a significant association between neurological disorders, particularly migraines, and the gut microbiota. However, a research gap persists in understanding the cause-and-effect dynamics between these elements. Therefore, we employed robust methodologies aimed at thoroughly exploring the causal relationship between the gut microbiome and migraines. Methods Employing bidirectional Two Sample Mendelian Randomization (TSMR) analysis, we investigated the causal association between the composition of the gut microbiota and migraines. Data summarizing the relationship between gut microbiota and migraines were extracted from one or more genome-wide association studies. The TSMR analysis employed five methods to assess the correlation between the gut microbiota and migraines, with the inverse variance-weighted method serving as the primary approach for analyzing causal links. Sensitivity analyses were applied to address horizontal pleiotropy and heterogeneity. Simultaneously, a meta-analysis was performed to strengthen the robustness of the findings. Additionally, a reverse TSMR was carried out to explore potential occurrences of reverse causal relationships. Results The ongoing TSMR analysis identified a collection of 14 bacterial taxa connected to migraines. Among these, 8 taxa exhibited a protective effect, while 5 taxa had a detrimental impact, and 1 taxon maintained a neutral relationship. The reverse Mendelian randomization analysis highlighted stable outcomes for only one bacterial taxonomic group. Conclusion The study confirms a causal relationship between the gut microbiota and migraines, offering a new perspective for migraine research. Strategically targeting specific bacterial taxa with dysregulation may be effective in both preventing and treating migraines, thus opening new avenues for therapeutic strategies.
Collapse
Affiliation(s)
- Xuege Zang
- Department of Critical Care Medicine, China-Japan Union Hospital of Jilin University, Changchuan, Jilin, China
| | - Yongkun Du
- Department of Critical Care Medicine, China-Japan Union Hospital of Jilin University, Changchuan, Jilin, China
| | - Mengshu Jiang
- Department of Critical Care Medicine, China-Japan Union Hospital of Jilin University, Changchuan, Jilin, China
| | | | - Libo Wang
- Unity Health Toronto, Toronto, ON, Canada
| | - Xuemei Han
- Unity Health Toronto, Toronto, ON, Canada
| |
Collapse
|
23
|
Bhardwaj R, Donohue MK, Madonia J, Morris B, Marbury TC, Matschke KT, Croop R, Bertz R, Liu J. Reduced hepatic impairment study to evaluate pharmacokinetics and safety of zavegepant and to inform dosing recommendation for hepatic impairment. Clin Transl Sci 2024; 17:e13813. [PMID: 39014555 PMCID: PMC11252018 DOI: 10.1111/cts.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 07/18/2024] Open
Abstract
Zavegepant, a high-affinity, selective, small-molecule calcitonin gene-related peptide (CGRP) receptor antagonist, is approved in the United States for acute treatment of migraine in adults. The effects of moderate hepatic impairment (8 participants with Child-Pugh score 7-9 points) on the pharmacokinetics of a single 10-mg intranasal dose of zavegepant versus eight matched participants with normal hepatic function were evaluated in a phase I study. Pharmacokinetic sampling determined total and unbound plasma zavegepant concentrations. Moderate hepatic impairment increased the exposure of total zavegepant (~2-fold increase in AUC0-inf and 16% increase in Cmax) versus normal hepatic function, which is not considered clinically meaningful. The geometric least squares mean ratios (moderate impairment/normal) of plasma zavegepant AUC0-inf and Cmax were 193% (90% confidence interval [CI]: 112, 333; p = 0.051) and 116% (90% CI: 69, 195; p = 0.630), respectively. The geometric mean fraction unbound of zavegepant was similar for participants with moderate hepatic impairment (0.13; coefficient of variation [CV] 13.71%) versus those with normal hepatic function (0.11; CV 21.43%). Similar exposure findings were observed with unbound zavegepant versus normal hepatic function (~2.3-fold increase in AUC0-inf and 39% increase in Cmax). One treatment-emergent adverse event (mild, treatment-related headache) was reported in a participant with normal hepatic function. No dosage adjustment of intranasal zavegepant is required in adults with mild or moderate hepatic impairment.
Collapse
Affiliation(s)
| | | | | | - Beth Morris
- Biohaven Pharmaceuticals, Inc.New HavenConnecticutUSA
| | | | | | - Robert Croop
- Biohaven Pharmaceuticals, Inc.New HavenConnecticutUSA
| | - Richard Bertz
- Biohaven Pharmaceuticals, Inc.New HavenConnecticutUSA
| | | |
Collapse
|
24
|
Balali A, Karimi E, Kazemi M, Hadi A, Askari G, Khorvash F, Arab A. Associations between diet quality and migraine headaches: a cross-sectional study. Nutr Neurosci 2024; 27:677-687. [PMID: 37542451 DOI: 10.1080/1028415x.2023.2244260] [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: 08/07/2023]
Abstract
AIMS We evaluated associations between diet quality and migraine outcomes. METHODS The current work represented a cross-sectional study on 262 patients with migraine (20-50 y). Diet quality was assessed using the standard healthy eating index 2015 (HEI-2015) and alternative healthy eating index 2010 (AHEI-2010). A validated 168-item food frequency questionnaire was used to assess dietary intake. Migraine outcomes included clinical factors (severity, duration, frequency, and disability related to migraine) and serum nitric oxide (NO). Associations between diet quality indices and migraine outcomes were evaluated using linear regressions, and β and 95% corresponding confidence interval (CI) were reported. RESULTS HEI-2015 was inversely associated with migraine frequency (β = -4.75, 95% CI: -6.73, -2.76) in patients with the highest HEI scores (third tertile) vs. those with the lowest scores (first tertile) after adjusting for relevant confounders. AHEI-2010 was inversely associated with migraine frequency (β = -3.67, 95% CI: -5.65, -1.69) and migraine-related disability (β = -2.74, 95% CI: -4.79, -0.68) in adjusted models. Also, AHEI-2010 was inversely associated with migraine severity in patients in the second vs. first tertile (β = -0.56; 95% CI: -1.08, -0.05). We detected no associations between diet quality and NO levels (All P > 0.14). CONCLUSIONS Improved diet quality may be associated with favorable migraine outcomes (lower headache frequency, severity, and migraine-related disability). Future studies are required to confirm and delineate the causal mechanisms of our observations.
Collapse
Affiliation(s)
- Arghavan Balali
- Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Karimi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Kazemi
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Amir Hadi
- Halal Research Center of IRI, Food and Drug Administration, Ministry of Health and Medical Education, Tehran, Iran
| | - Gholamreza Askari
- Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arman Arab
- Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
25
|
Marelli A, Grazzi L, Visco MA, Crescenzo P, Bavagnoli A, Sirotich C, Covelli V. Alternative Treatments for Emotional Experiencing and Processing in People with Migraine or Tension-Type Headache: A Scoping Review. Healthcare (Basel) 2024; 12:1302. [PMID: 38998837 PMCID: PMC11241822 DOI: 10.3390/healthcare12131302] [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: 03/26/2024] [Revised: 05/28/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
This narrative review aims to summarize the use of alternative treatments (e.g., relaxation training, meditation, written intervention) for emotional expression, processing, control, or management in patients with migraine and tension-type headaches, which the previous literature has shown to be related to migraine pain perception and headache symptoms. Online databases including PubMed, Scopus, Web of Science, PsycINFO, and Medline were searched to identify studies published between 2000 and 2023. A descriptive synthesis of the included studies was conducted. We included seven articles after screening 1.173 records. A total of 610 patients with a diagnosis of migraine or tension-type headache, and an average age of 19-45.5 years (68-90.4% females) were recruited in the selected studies. Overall, the results show that alternative approaches to headache treatment contribute to the management, reduction, or control of negative emotions and at the same time have a positive impact on pain perception and headache symptoms. However, in some cases, the effects are more promising than others, depending on the peculiarities or limitations of each approach considered. This review provides useful insights from a methodological point of view for future studies on the management or control of negative emotions in patients with migraine and tension-type headache.
Collapse
Affiliation(s)
| | - Licia Grazzi
- Neuroalgology Unit, Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | | | - Pietro Crescenzo
- Department of Education, Psychology and Communication Sciences, University of Bari 'Aldo Moro', 70121 Bari, Italy
| | | | - Cristal Sirotich
- Faculty of Psychology, e-Campus University, 22060 Novedrate, Italy
| | - Venusia Covelli
- Faculty of Psychology, e-Campus University, 22060 Novedrate, Italy
| |
Collapse
|
26
|
Wolters S, Carpay JA, Pronk MH, Zuurbier KWM, Driessen MT, Lyras L, Postma MJ. A Dutch cost-effectiveness analysis of fremanezumab versus best supportive care in patients with chronic migraine and inadequate response to prior preventive therapy. BMC Neurol 2024; 24:214. [PMID: 38914929 PMCID: PMC11194870 DOI: 10.1186/s12883-024-03697-x] [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: 10/20/2023] [Accepted: 05/29/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Chronic migraine (CM) is the most severe and burdensome subtype of migraine. Fremanezumab is a monoclonal antibody that targets the calcitonin gene-related peptide pathway as a migraine preventive therapy. This study aimed to conduct a cost-effectiveness analysis of fremanezumab from a societal perspective in the Netherlands, using a Markov cohort simulation model. METHODS The base-case cost-effectiveness analysis adhered to the Netherlands Authority guidelines. Fremanezumab was compared with best supportive care (BSC; acute migraine treatment only) in patients with CM and an inadequate response to topiramate or valproate and onabotulinumtoxinA (Dutch patient group [DPG]). A supportive analysis was conducted in the broader group of CM patients with prior inadequate response to 2-4 different classes of migraine preventive treatments. One-way sensitivity, probabilistic sensitivity, and scenario analyses were conducted. RESULTS Over a lifetime horizon, fremanezumab is cost saving compared with BSC in the DPG (saving of €2514 per patient) and led to an increase of 1.45 quality-adjusted life-years (QALYs). In the broader supportive analysis, fremanezumab was cost effective compared with BSC, with an incremental cost-effectiveness ratio of €2547/QALY gained. Fremanezumab remained cost effective in all sensitivity and scenario analyses. CONCLUSION In comparison to BSC, fremanezumab is cost saving in the DPG and cost effective in the broader population.
Collapse
Affiliation(s)
- Sharon Wolters
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands.
- Asc Academics B.V., Hereweg 120, Groningen, 9725 AK, The Netherlands.
| | - Johannes A Carpay
- The Migraine Clinic, Mariotteplein 60, Amsterdam, 1098 PA, The Netherlands
| | - Marja H Pronk
- MH Pronk Health Care Consultancy Foundation, Leidsestraatweg, Woerden, 41D, 3443 BP, The Netherlands
| | | | - Maurice T Driessen
- Teva Pharmaceuticals, Piet Heinkade 107, Amsterdam, 1019 BR, The Netherlands
| | - Leonidas Lyras
- Teva Pharmaceuticals, Piet Heinkade 107, Amsterdam, 1019 BR, The Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
- Department of Economics, Econometrics and Finance, University of Groningen, Antonius Deusinglaan 1, Groningen, 9713 AV, The Netherlands
| |
Collapse
|
27
|
Ilgaz Aydinlar E, Erdogan Soyukibar T, Yalinay Dikmen P. The effectiveness and predictors influencing the outcome of onabotulinumtoxinA treatment in chronic migraine: understanding from diverse patient profiles in a single session. Front Neurol 2024; 15:1417303. [PMID: 38962481 PMCID: PMC11219632 DOI: 10.3389/fneur.2024.1417303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/31/2024] [Indexed: 07/05/2024] Open
Abstract
Objective This real-world study aimed to investigate how onabotulinumtoxinA affects the outcome of migraine, along with accompanying anxiety, depression, and bruxism among a group of patients with chronic migraine (CM) and define predictors of good response. Methods Patients diagnosed with CM who received onabotulinumtoxinA were included in this single-center, real-world retrospective cohort study. Monthly headache days (MHDs), monthly migraine days (MMDs), headache intensity (numeric rating scale-NRS) and headache characteristics were evaluated at baseline and 12 weeks post-treatment. Patient-reported outcome measures (PROMs) included Migraine Disability Assessment Scale (MIDAS), Headache Impact Test-6 (HIT-6) scores, 12-item Allodynia Symptom Checklist (ASC-12), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). Response to onabotulinumtoxinA (% reduction in MHDs) and treatment-related adverse events (TRAEs) were also evaluated. OnabotulinumA was applied to the masseter muscles in patients complaining of bruxism. Results A total of 72 patients (mean ± SD age: 36.3 ± 8.5 years; 91.7% were female) diagnosed with CM were included. OnabotulinumtoxinA revealed significant decrease in median (IQR) MHDs [from 20(15-25) at baseline to 6(4-10), p < 0.001], MMDs [from 9(6-12) to 3(1-6), p < 0.001] and NRS [from 9(8-10) to 7(6-8), p < 0.001], and the MIDAS [from 54(30-81) to 16(7-24), p < 0.001], HIT-6 [from 67(65-69) to 58(54-64), p < 0.001], ASC-12 [from 6(1.5-9) to 2(0-9), p = 0.002], BAI [from 12(6.5-19) to 9(3-17), p < 0.001] and BDI [from 11(6.5-17) to 3(2-7) p < 0.001] scores at 12 weeks post-treatment. Patients complaining of bruxism received onabotulinumtoxinA injections in the first n = 27 (37.5%) and 12. week post-treatment n = 19 (70.4%) periods. Overall, 70.8% of patients responded (≥50% reduction in MHDs), while 29.2% did not (<50% reduction). Both groups showed similar characteristics in demographics, migraine history, baseline PROMs scores, comorbidities, and prior treatments. Conclusion OnabotulinumtoxinA is an effective treatment option that rapidly improves migraine outcomes, disability, and impact while also alleviating comorbid depression and/or anxiety. This study's noteworthy finding is that onabotulinumtoxinA is effective in a majority of CM patients, irrespective of their prior treatment history, migraine characteristics, or concurrent comorbidities. Furthermore, we identified no specific predictors for a favorable response to onabotulinumtoxinA. Applying onabotulinumtoxinA to the masseter muscles can relieve discomfort associated with concurrent bruxism; however, it does not impact migraine outcomes.
Collapse
Affiliation(s)
- Elif Ilgaz Aydinlar
- Department of Neurology, Acıbadem University School of Medicine, Istanbul, Türkiye
| | | | | |
Collapse
|
28
|
Del Moro L, Pirovano E, Rota E. Mind the Metabolic Gap: Bridging Migraine and Alzheimer's disease through Brain Insulin Resistance. Aging Dis 2024:AD.2024.0351. [PMID: 38913047 DOI: 10.14336/ad.2024.0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/11/2024] [Indexed: 06/25/2024] Open
Abstract
Brain insulin resistance has recently been described as a metabolic abnormality of brain glucose homeostasis that has been proven to downregulate insulin receptors, both in astrocytes and neurons, triggering a reduction in glucose uptake and glycogen synthesis. This condition may generate a mismatch between brain's energy reserve and expenditure, mainly during high metabolic demand, which could be involved in the chronification of migraine and, in the long run, at least in certain subsets of patients, in the prodromic phase of Alzheimer's disease, along a putative metabolic physiopathological continuum. Indeed, the persistent disruption of glucose homeostasis and energy supply to neurons may eventually impair protein folding, an energy-requiring process, promoting pathological changes in Alzheimer's disease, such as amyloid-β deposition and tau hyperphosphorylation. Hopefully, the "neuroenergetic hypothesis" presented herein will provide further insight on there being a conceivable metabolic bridge between chronic migraine and Alzheimer's disease, elucidating novel potential targets for the prophylactic treatment of both diseases.
Collapse
Affiliation(s)
- Lorenzo Del Moro
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Elenamaria Pirovano
- Center for Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Eugenia Rota
- Neurology Unit, San Giacomo Hospital, Novi Ligure, ASL AL, Italy
| |
Collapse
|
29
|
Cha C, Kim O, Pang Y, Jeong H, Lee JE, Lee H, Dan H. Migraine incidence and coffee consumption among child-bearing age women: the Korea Nurses' Health Study. Sci Rep 2024; 14:12760. [PMID: 38834559 DOI: 10.1038/s41598-024-53302-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/30/2024] [Indexed: 06/06/2024] Open
Abstract
This longitudinal study aimed to identify factors that influence migraines in Korean women nurses using data from the Korea Nurses' Health Study. Among those who participated in Survey 1 (2013-2014) and the follow-up survey (2015-2019), we selected 2605 participants for Cox proportional hazard regression analysis, 521 participants who were newly diagnosed with migraine and 2084 controls using a 1:4 incidence density sampling approach. Consuming coffee (≥ 3 cups: RR = 1.666; 95% CI = 1.175-2.362, < 3 cups: RR = 1.439; 95% CI = 1.053-1.966), being obese (BMI ≥ 25: RR = 1.341, 95% CI = 1.003-1.793), and engaging in vigorous physical activity (RR = 1.010; 95% CI = 1.000-1.019) increased the risk of developing a migraine. Nurses with an annual salary greater than $3500 were less likely to develop migraines (RR = 0.786, 95% CI = 0.631-0.979). The results imply that lifestyle factors, such as the amount of coffee consumption, BMI level, and degree of physical activity could be considered when formulating treatment plans for women who have newly developed migraines.
Collapse
Grants
- 2013-E63006-00, 2016-ER-6305-00, 2016-ER-6305-02, 2019-ER-7101-02 Research of the Korea National Institute of Health
- 2013-E63006-00, 2016-ER-6305-00, 2016-ER-6305-02, 2019-ER-7101-02 Research of the Korea National Institute of Health
- 2013-E63006-00, 2016-ER-6305-00, 2016-ER-6305-02, 2019-ER-7101-02 Research of the Korea National Institute of Health
- 2013-E63006-00, 2016-ER-6305-00, 2016-ER-6305-02, 2019-ER-7101-02 Research of the Korea National Institute of Health
- 2013-E63006-00, 2016-ER-6305-00, 2016-ER-6305-02, 2019-ER-7101-02 Research of the Korea National Institute of Health
- 2013-E63006-00, 2016-ER-6305-00, 2016-ER-6305-02, 2019-ER-7101-02 Research of the Korea National Institute of Health
- 2013-E63006-00, 2016-ER-6305-00, 2016-ER-6305-02, 2019-ER-7101-02 Research of the Korea National Institute of Health
Collapse
Affiliation(s)
- Chiyoung Cha
- College of Nursing, Ewha Womans University, Seoul, Korea
- System Health and Engineering Major in Graduate School, Ewha Research Institute of Nursing Science, Ewha Womans University, Seoul, Korea
| | - Oksoo Kim
- College of Nursing, Ewha Womans University, Seoul, Korea
| | - Yanghee Pang
- Department of Nursing, Seoil University, Seoul, Korea
| | - Hyunseon Jeong
- College of Nursing, Seoul Woman's College of Nursing, Seoul, Korea
| | - Jung Eun Lee
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Korea
- Research Institute of Human Ecology, Seoul National University, Seoul, Korea
| | - Heayoung Lee
- Department of Nursing, Doowon Technical University, AnSung-Si, Korea
| | - Hyunju Dan
- Department of Nursing, Hwasung Medi-Science University, 400-5, Namyangchungang-Ro, Namyang-Eup, Hwasung-Si, 18274, Kyunggi-Do, Korea.
| |
Collapse
|
30
|
Steiner TJ, Husøy A, Stovner LJ. GBD2021: headache disorders and global lost health - a focus on children, and a view forward. J Headache Pain 2024; 25:91. [PMID: 38831407 PMCID: PMC11145804 DOI: 10.1186/s10194-024-01795-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Affiliation(s)
- Timothy J Steiner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway.
- Department of Neurology, University of Copenhagen, Copenhagen, Denmark.
- Division of Brain Sciences, Imperial College London, London, UK.
| | - Andreas Husøy
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway
| | - Lars Jacob Stovner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway
| |
Collapse
|
31
|
Zhang X, Zhang W, Wang Y, Zhang Y, Zhang D, Qin G, Zhou J, Chen L. SIRT1-regulated ROS generation activates NMDAR2B phosphorylation to promote central sensitization and allodynia in a male chronic migraine rat model. Front Mol Neurosci 2024; 17:1387481. [PMID: 38840778 PMCID: PMC11150646 DOI: 10.3389/fnmol.2024.1387481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/25/2024] [Indexed: 06/07/2024] Open
Abstract
Background Central sensitization is one of the pivotal pathological mechanisms in chronic migraine (CM). Silent information regulator 1 (SIRT1) was shown to be involved in CM, but its specific mechanism is unclear. Reactive oxygen species (ROS) are increasingly regarded as important signaling molecules in several models of pain. However, studies about the role of ROS in the central sensitization of CM model are rare. We thus explored the specific process of SIRT1 involvement in the central sensitization of CM, focusing on the ROS pathway. Methods Inflammatory soup was repeatedly administered to male Sprague-Dawley rats to establish a CM model. The SIRT1 expression level in trigeminal nucleus caudalis (TNC) tissues was assessed by qRT-PCR and Western blotting analysis. The levels of ROS were detected by a Tissue Reactive Oxygen Detection Kit, DHE staining, and the fluorescence signal intensity of 8-OHdG. A ROS scavenger (tempol), a SIRT1 activator (SRT1720), a SIRT1 inhibitor (EX527), and a mitochondrial fission inhibitor (Mdivi-1) were used to investigate the specific molecular mechanisms involved. NMDAR2B, CGRP, ERK, and mitochondrial fission-related protein were evaluated by Western blotting, and the CGRP level in frozen sections of the TNC was detected via immunofluorescence staining. Results After repeated inflammatory soup infusion and successful establishment of the CM rat model, SIRT1 expression was found to be significantly reduced, accompanied by elevated ROS levels. Treatment with Tempol, SRT1720, or Mdivi-1 alleviated allodynia and reduced the increase in NMDAR2B phosphorylation and CGRP and ERK phosphorylation in the CM rat. In contrast, EX527 had the opposite effect in CM rat. SRT1720 and EX527 decreased and increased ROS levels, respectively, in CM rats, and tempol reversed the aggravating effect of EX527 in CM rats. Furthermore, the regulatory effect of SIRT1 on ROS may include the involvement of the mitochondrial fission protein DRP1. Conclusion The results indicate the importance of SIRT1 in CM may be due to its role in regulating the production of ROS, which are involved in modulating central sensitization in CM. These findings could lead to new ideas for CM treatment with the use of SIRT1 agonists and antioxidants.
Collapse
Affiliation(s)
- Xiaoyan Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Zhang
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanyun Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yun Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dunke Zhang
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guangcheng Qin
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiying Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lixue Chen
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
32
|
Rushendran R, Singh A, Ankul Singh S, Chitra V, Ilango K. A role of NLRP3 and MMP9 in migraine progression: a systematic review of translational study. Front Neurol 2024; 15:1307319. [PMID: 38836002 PMCID: PMC11148868 DOI: 10.3389/fneur.2024.1307319] [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: 10/04/2023] [Accepted: 04/24/2024] [Indexed: 06/06/2024] Open
Abstract
Background Migraines affect one billion individuals globally, with a higher occurrence among young adults and women. A significant survey in the United States indicated that 17.1% of women and 5.6% of men suffer from migraines. This study seeks to investigate the potential connection between NLRP3 and MMP9 in migraine pathology. Methods The research involved searching databases such as PubMed, Scopus, Science Direct, Google Scholar, and Proquest, with the search concluding on March 31, 2024. Following PRISMA guidelines, PICO data were collected, focusing exclusively on animal models induced by Nitroglycerine (10 mg/kg), while excluding clinical studies. Results The study, originally registered in Prospero Reg. No. CRD42022355893, conducted bias analysis using SYRCLE's RoB tool and evaluated author consensus using GraphPad v9.5.1. Out of 7,359 search results, 22 papers met the inclusion criteria. Inter-rater reliability among reviewers was assessed using Cohen's kappa statistics. Conclusion This review summarizes 22 preclinical studies on Nitroglycerin (NTG), NLRP3, MMP9, and related biomarkers in migraine. They reveal that NTG, especially at 10 mg/kg, consistently induces migraine-like symptoms in rodents by activating NLRP3 inflammasome and stimulating proinflammatory molecule production. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, CRD42022355893.
Collapse
Affiliation(s)
- Rapuru Rushendran
- Department of Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Chennai, India
| | - Anuragh Singh
- Department of Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Chennai, India
| | - S Ankul Singh
- Department of Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Chennai, India
| | - Vellapandian Chitra
- Department of Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Chennai, India
| | - Kaliappan Ilango
- Department of Pharmaceutical Chemistry, Tagore College of Pharmacy, Chennai, India
| |
Collapse
|
33
|
Hussein M, Hassan A, Nada MAF, Mohammed Z, Abdel Ghaffar NF, Kedah H, Fathy W, Magdy R. Reliability, validity, and responsiveness of the Arabic version of HIT-6 questionnaire in patients with migraine indicated for preventive therapy: A multi-center study. Headache 2024; 64:500-508. [PMID: 38651363 DOI: 10.1111/head.14719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The Headache Impact Test (HIT-6) is an important patient-reported outcome measure (PROM) in migraine prevention trials. OBJECTIVES This study aimed to (i) assess the reliability and validity of the Arabic version of HIT-6 in Arabic-speaking patients experiencing migraine, and (ii) evaluate the responsiveness of HIT-6 following migraine preventive therapy. METHODS In this prospective study, patients with migraine (n = 145) were requested to fill out a headache diary, the Arabic version of HIT-6, and Migraine Disability Assessment Scale (MIDAS) at two time points (baseline and 3 months after initiation of prophylactic treatment). Some respondents (n = 73) were requested to fill out HIT-6 again 1 week from the baseline for test-retest reliability. The intensity of migraine headache attacks was evaluated using the Visual Analogue Scale (VAS). An anchor-based method was used to establish the minimal important change (MIC) value and responsiveness of HIT-6. RESULTS The total scores of HIT-6 were significantly correlated to a fair degree with MIDAS (r = 0.41), as well as VAS (r = 0.53), and monthly migraine days (r = 0.38) at the baseline while at the follow-up (after 3 months), the correlations were of moderate degree with MIDAS scores (r = 0.62) and monthly migraine days (r = 0.60; convergent validity). Reliability estimates of the Arabic HIT-6 were excellent (Cronbach's α = 0.91 at baseline and 0.89 at follow-up). The average measure interclass correlation coefficient (ICC) value for the test-retest reliability was 0.96 (95% confidence interval = 0.94-0.98, p < 0.001). The HIT-6 total score is sensitive to change, being significantly reduced after prophylactic treatment compared to before (effect size = 1.5, standardized response mean = 1.3). A reduction from baseline of 4.5 on HIT-6 showed the highest responsiveness to predict improvement with an area under the curve equal to 0.66, sensitivity of 80%, specificity of 45%, and significance at 0.021. Changes in the HIT-6 total score were positively correlated with changes in monthly migraine days (r = 0.40) and VAS scores (r = 0.69) but not with changes in the score of MIDAS (r = 0.07). CONCLUSION The Arabic version of HIT-6 is valid, reliable, and sensitive to detect clinical changes following migraine prophylactic treatment with a MIC of 4.5 points.
Collapse
Affiliation(s)
- Mona Hussein
- Department of Neurology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Amr Hassan
- Department of Neurology, Cairo University, Cairo, Egypt
| | - Mona A F Nada
- Department of Neurology, Cairo University, Cairo, Egypt
| | - Zeinab Mohammed
- Department of Public Health and Community Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Nawal F Abdel Ghaffar
- Department of Neurology, Cairo University, Cairo, Egypt
- Aseer Central Hospital, Abha, Saudi Arabia
| | | | - Wael Fathy
- Department of Anesthesiology, Surgical ICU and Pain Management, Beni-Suef University, Beni-Suef, Egypt
| | - Rehab Magdy
- Department of Neurology, Cairo University, Cairo, Egypt
| |
Collapse
|
34
|
Waliszewska-Prosół M, Montisano DA, Antolak M, Bighiani F, Cammarota F, Cetta I, Corrado M, Ihara K, Kartamysheva R, Petrušić I, Pocora MM, Takizawa T, Vaghi G, Martelletti P, Corso B, Raggi A. The impact of primary headaches on disability outcomes: a literature review and meta-analysis to inform future iterations of the Global Burden of Disease study. J Headache Pain 2024; 25:27. [PMID: 38433202 PMCID: PMC10910736 DOI: 10.1186/s10194-024-01735-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/23/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The burden and disability associated with headaches are conceptualized and measured differently at patients' and populations' levels. At the patients' level, through patient-reported outcome measures (PROMs); at population level, through disability weights (DW) and years lived with a disability (YLDs) developed by the Global Burden of Disease Study (GBD). DW are 0-1 coefficients that address health loss and have been defined through lay descriptions. With this literature review, we aimed to provide a comprehensive analysis of disability in headache disorders, and to present a coefficient referring to patients' disability which might inform future GBD definitions of DW for headache disorders. METHODS We searched SCOPUS and PubMed for papers published between 2015 and 2023 addressing disability in headache disorders. The selected manuscript included a reference to headache frequency and at least one PROM. A meta-analytic approach was carried out to address relevant differences for the most commonly used PROMs (by headache type, tertiles of medication intake, tertiles of females' percentage in the sample, and age). We developed a 0-1 coefficient based on the MIDAS, on the HIT-6, and on MIDAS + HIT-6 which was intended to promote future DW iterations by the GBD consortium. RESULTS A total of 366 studies, 596 sub-samples, and more than 133,000 single patients were available, mostly referred to cases with migraine. Almost all PROMs showed the ability to differentiate disability severity across conditions and tertiles of medication intake. The indexes we developed can be used to inform future iterations of DW, in particular considering their ability to differentiate across age and tertiles of medication intake. CONCLUSIONS Our review provides reference values for the most commonly used PROMS and a data-driven coefficient whose main added value is its ability to differentiate across tertiles of age and medication intake which underlie on one side the increased burden due to aging (it is likely connected to the increased impact of common comorbidities), and by the other side the increased burden due to medication consumption, which can be considered as a proxy for headache severity. Both elements should be considered when describing disability of headache disorders at population levels.
Collapse
Affiliation(s)
| | - Danilo Antonio Montisano
- Dipartimento Di Neuroalgologia, Centro Cefalee, Fondazione IRRCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Mariola Antolak
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Federico Bighiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Francescantonio Cammarota
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Ilaria Cetta
- Neuroimaging Research Unit and Neurology Unit, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Michele Corrado
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Keiko Ihara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
- Japanese Red Cross, Ashikaga Hospital, Tochigi, Japan
| | - Regina Kartamysheva
- Department of Neurology, University Clinic of Kazan Federal University, Kazan, Russian Federation
| | - Igor Petrušić
- Faculty of Physical Chemistry, Laboratory for Advanced Analysis of Neuroimages, University of Belgrade, Belgrade, Serbia
| | - Maria Magdalena Pocora
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Gloria Vaghi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Barbara Corso
- Neuroscience Institute, National Research Council, Padua, Italy
| | - Alberto Raggi
- SC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| |
Collapse
|
35
|
Lipton RB, Albrecht D, Bermudez M, Hu J, Hussey E, Levy J. A randomized, open-label, 5-period crossover study evaluating the pharmacokinetics and safety of a single dose of intranasal dihydroergotamine (DHE) powder (STS101), intramuscular DHE mesylate, and liquid nasal spray DHE in healthy adults. Headache 2024; 64:266-275. [PMID: 38413540 DOI: 10.1111/head.14685] [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: 10/18/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To compare the safety and pharmacokinetics (PK) of dihydroergotamine (DHE) after administration of intranasal DHE powder (STS101), liquid nasal spray (LNS) DHE mesylate, and intramuscular (IM) DHE mesylate injection in healthy participants. BACKGROUND DHE is an effective acute migraine treatment; however, self-administration difficulties have prevented its broader role in the management of migraine. METHODS This randomized, active-controlled, five-period crossover study was conducted over 5 weeks separated by 1-week washout periods. Three STS101 dosage strengths (5.2, 7.0, 8.6 mg), and one dose each of LNS DHE 2.0 mg, and IM DHE 1.0 mg, were administered to 36 healthy participants. Liquid chromatography, tandem mass spectrometry was used to determine DHE (including its 8'OH-DHE metabolite) plasma levels and to calculate PK parameters (Cmax , Tmax , AUC0-2h , AUC0-last , AUC0-inf , and t1/2 ). Safety was evaluated by monitoring adverse events (AEs), vital signs, electrocardiograms, nasal examinations, and laboratory parameters. RESULTS Thirty-six participants (mean age 36 years; 19% Hispanic Black and 81% Hispanic White) were enrolled. DHE plasma concentrations rose rapidly after STS101 5.2, 7.0, and 8.6 mg and IM DHE injection, with mean concentrations greater than 2000 pg/mL for all STS101 dose strengths at 20 min. All STS101 dose strengths showed approximately 3-fold higher Cmax , AUC0-2h , and AUC0-inf , than the LNS DHE. The mean AUC0-inf of STS101 7.0 and 8.6 mg were comparable to IM DHE (12,600 and 13,200 vs. 13,400 h × pg/mL). All STS101 dose strengths showed substantially lower variability (CV%) compared to LNS DHE for Cmax (35%-41% vs. 87%), and AUC0-inf (37%-46% vs. 65%). STS101 was well tolerated, and all treatment-emergent AEs were mild and transient. CONCLUSION STS101 showed rapid absorption and was well tolerated with mild and transient treatment-emergent AEs. Achieving effective DHE plasma concentrations within 10 min, STS101 displayed a favorable PK profile relative to the LNS with higher Cmax , AUC0-2h , and AUC0inf , and with greater response consistency. The AUC0-inf was comparable to IM DHE.
Collapse
Affiliation(s)
- Richard B Lipton
- Department of Neurology Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | - Jerry Hu
- Allucent, Gary, North Carolina, USA
| | | | - Jeff Levy
- Quotient Sciences, Miami, Florida, USA
| |
Collapse
|
36
|
Dione MN, Donelle L, Smye V, Befus D. Self-management Experience of Nurses Living with Migraine: A Qualitative Study. Can J Nurs Res 2024; 56:38-48. [PMID: 37700606 DOI: 10.1177/08445621231199652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Migraine is a neurobiological condition characterized by a constellation of unpredictable symptoms and is the second cause of disability worldwide. Migraine is prevalent among nurses. However, literature exploring nurses' experience of living with migraine is scarce which has important individual and systems implications for health and wellness and patient safety. Self-management is essential in chronic disease management as the patient engages in various strategies to be able to live with their condition. PURPOSE This study explored the experiences of living and working with migraine among female nurses in Ontario, with particular attention to their priorities and strategies for self-management. METHODS Interpretive description methodology was employed to guide this study and informed a thematic analysis approach to examine the self-management experiences of nurses living with migraine. RESULTS Nurses engaged in various self-management strategies including pharmacological and non-pharmacological strategies and highlighted the role of technology in migraine self-management. Participants described experiences of living with migraine as an invisible condition including feelings of not being understood, stigmatization, and the absence of formal support at the workplace. CONCLUSION The implications of these findings support the incorporation of a critical approach to relational engagement that is person-centred including nonjudgemental, strength-based care as a practice approach when caring for persons living with migraines and the need to include experiential learning in educational curriculums as a strategy to reduce stigma against migraines.
Collapse
Affiliation(s)
| | - Lorie Donelle
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Victoria Smye
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Deanna Befus
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| |
Collapse
|
37
|
Lazaro-Hernandez C, Caronna E, Rosell-Mirmi J, Gallardo VJ, Alpuente A, Torres-Ferrus M, Pozo-Rosich P. Early and annual projected savings from anti-CGRP monoclonal antibodies in migraine prevention: a cost-benefit analysis in the working-age population. J Headache Pain 2024; 25:21. [PMID: 38347485 PMCID: PMC10860274 DOI: 10.1186/s10194-024-01727-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Migraine is one of the main causes of disability worldwide. Anti-CGRP monoclonal antibodies (MAbs) have proven to be safe and efficacious as preventive migraine treatments. However, their use is restricted in many countries due to their apparently high cost. Cost-benefit studies are needed. OBJECTIVE To study the cost-benefit of anti-CGRP MAbs in working-age patients with migraine. METHODS This is a prospective cohort study of consecutive migraine patients treated with anti-CGRP MAbs (erenumab, fremanezumab and galcanezumab) following National reimbursement policy in a specialized headache clinic. Migraine characteristics and the work impact scale (WPAI) were compared between baseline (M0) and after 3 (M3) and 6 months (M6) of treatment. Using WPAI and the municipal average hourly wage, we calculated indirect costs (absenteeism and presenteeism) at each time point. Direct costs (emergency visits, acute medication use) were also analysed. A cost-benefit study was performed considering the different costs and savings of treating with MAbs. Based on these data an annual projection was conducted. RESULTS From 256 treated working-age patients, 148 were employed (89.2% women; mean age 48.0 ± 8.5 years), of which 41.2% (61/148) were responders (> 50% reduction in monthly headache days (MHD)). Statistically significant reductions between M0 and M3/M6 were found in absenteeism (p < 0.001) and presenteeism (p < 0.001). Average savings in indirect costs per patient at M3 were absenteeism 105.4 euros/month and presenteeism 394.3 euros/month, similar for M6. Considering the monthly cost of anti-CGRP MAbs, the cost-benefit analysis showed savings of 159.8 euros per patient at M3, with an annual projected savings of 639.2 euros/patient. Both responders and partial responders (30-50% reduction in MHD) presented a positive cost-benefit balance. The overall savings of the cohort at M3/M6 compensated the negative cost-benefit balance for non-responders (< 30% reduction in MHD). CONCLUSION Anti-CGRP MAbs have a positive impact in the workforce significantly reducing absenteeism and presenteeism. In Spain, this benefit overcomes the expenses derived from their use already at 3 months and is potentially sustainable at longer term; also in patients who are only partial responders, prompting reconsideration of current reimbursement criteria and motivating the extension of similar cost-benefit studies in other countries.
Collapse
Affiliation(s)
| | - Edoardo Caronna
- Headache Clinic, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joana Rosell-Mirmi
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alicia Alpuente
- Headache Clinic, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Headache Clinic, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache Clinic, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| |
Collapse
|
38
|
de Vries T, Rubio-Beltrán E, van den Bogaerdt A, Dammers R, Danser AHJ, Snellman J, Bussiere J, MaassenVanDenBrink A. Pharmacology of erenumab in human isolated coronary and meningeal arteries: Additional effect of gepants on top of a maximum effect of erenumab. Br J Pharmacol 2024. [PMID: 38320397 DOI: 10.1111/bph.16322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/17/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND AND PURPOSE Multiple drugs targeting the calcitonin gene-related peptide (CGRP) receptor have been developed for migraine treatment. Here, the effect of the monoclonal antibody erenumab on CGRP-induced vasorelaxation was investigated in human isolated blood vessels, as well as the effect of combining erenumab with the small molecule drugs, namely rimegepant, olcegepant, or sumatriptan. EXPERIMENTAL APPROACH Concentration-response curves to CGRP, adrenomedullin or pramlintide were constructed in human coronary artery (HCA) and human middle meningeal artery (HMMA) segments, incubated with or without erenumab and/or olcegepant. pA2 or pKb values were calculated to determine the potency of erenumab in both tissues. To study whether acutely acting antimigraine drugs exerted additional CGRP-blocking effects on top of erenumab, HCA segments were incubated with a maximally effective concentration of erenumab (3 μM), precontracted with KCl and exposed to CGRP, followed by rimegepant, olcegepant, or sumatriptan in increasing concentrations. KEY RESULTS Erenumab shifted the concentration-response curve to CGRP in both vascular tissues. However, in HCA, the Schild plot slope was significantly smaller than unity, whereas this was not the case in HMMA, indicating different CGRP receptor mechanisms in these tissues. In HCA, rimegepant, olcegepant and sumatriptan exerted additional effects on CGRP on top of a maximal effect of erenumab. CONCLUSIONS AND IMPLICATIONS Gepants have additional effects on top of erenumab for CGRP-induced relaxation and could be effective in treating migraine attacks in patients already using erenumab as prophylaxis.
Collapse
Affiliation(s)
- Tessa de Vries
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eloísa Rubio-Beltrán
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Ruben Dammers
- Department of Neurosurgery, Erasmus University Medical Center, The Netherlands
| | - A H Jan Danser
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
39
|
Domitrz I. Clinical guidance for choosing the right pharmacotherapy for migraine attacks. Expert Opin Pharmacother 2024; 25:37-44. [PMID: 38189111 DOI: 10.1080/14656566.2024.2303425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/05/2024] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Migraine as headache attacks with autonomic symptoms is a serious condition and it is important to treat a single attack effectively in order to improve not only the patient's quality of life at a given moment but also to prevent the migraine from becoming a chronic one. AREA COVERED The article briefly presents the guidance in selecting the most appropriate pharmacological treatment of migraine attack, indicating a personalized approach to migraine patient. EXPERT OPINION In this short paper, we show the implementation of new drugs into everyday clinical practice. Good cooperation between the physician and the patient and having the patient's trust is one of the elements of a personalized therapeutic approach and the key to achieving satisfaction of both the patient and the doctor.
Collapse
Affiliation(s)
- Izabela Domitrz
- Department of Neurology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Bielanski Hospital, Warsaw, Poland
| |
Collapse
|
40
|
Moore E, Bell IM, Fraley ME, Burgey CS, White RB, Li CC, Regan CP, Danziger A, McGaraughty SP, Naseri Kouzehgarani G, Salvatore C, Banerjee P. Pharmacologic characterization of atogepant: A potent and selective calcitonin gene-related peptide receptor antagonist. Cephalalgia 2024; 44:3331024231226186. [PMID: 38215228 DOI: 10.1177/03331024231226186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
BACKGROUND The trigeminal sensory neuropeptide calcitonin gene-related peptide (CGRP) is identified as an essential element in migraine pathogenesis. METHODS In vitro and in vivo studies evaluated pharmacologic properties of the CGRP receptor antagonist atogepant. Radioligand binding using 125I-CGRP and cyclic adenosine monophosphate (cAMP) accumulation assays were conducted in human embryonic kidney 293 cells to assess affinity, functional potency and selectivity. Atogepant in vivo potency was assessed in the rat nitroglycerine model of facial allodynia and primate capsaicin-induced dermal vasodilation (CIDV) pharmacodynamic model. Cerebrospinal fluid/brain penetration and behavioral effects of chronic dosing and upon withdrawal were evaluated in rats. RESULTS Atogepant exhibited high human CGRP receptor-binding affinity and potently inhibited human α-CGRP-stimulated cAMP responses. Atogepant exhibited significant affinity for the amylin1 receptor but lacked appreciable affinities for adrenomedullin, calcitonin and other known neurotransmitter receptor targets. Atogepant dose-dependently inhibited facial allodynia in the rat nitroglycerine model and produced significant CIDV inhibition in primates. Brain penetration and behavioral/physical signs during chronic dosing and abrupt withdrawal were minimal in rats. CONCLUSIONS Atogepant is a competitive antagonist with high affinity, potency and selectivity for the human CGRP receptor. Atogepant demonstrated a potent, concentration-dependent exposure/efficacy relationship between atogepant plasma concentrations and inhibition of CGRP-dependent effects.
Collapse
|
41
|
De Matteis E, Ornello R, Sacco S. Menstrually associated migraine. HANDBOOK OF CLINICAL NEUROLOGY 2024; 199:331-351. [PMID: 38307655 DOI: 10.1016/b978-0-12-823357-3.00023-9] [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: 02/04/2024]
Abstract
Menstrually related migraine is a disabling condition affecting 35% to 54% females with migraine during their fertile years. The International Headache Classification distinguishes menstrually related migraine from pure menstrual migraine based on the occurrence of the attacks even outside the perimenstrual periods. Hormonal fluctuations are the main driver for the disease in subjects with genetic susceptibility and alterations of brain structures and connectivity. Menstrually related attacks are often particularly severe and disabling requiring proper management. Acute treatment mainly consists of nonsteroidal anti-inflammatory drugs (NSAIDs), recommended in patients also suffering from dysmenorrhea, and triptans. Prevention is specifically indicated in women with high monthly headache frequency or burdensome attacks during perimenstrual periods. Trials proved the efficacy of short-term prevention with triptans and NSAIDs but did not evaluate possible long-term effectiveness and tolerability. Evidence of prevention using hormonal treatments is poor, but extended-cycle treatments might be suitable for women requiring hormonal replacement for concomitant conditions. Few data are available on treatments targeting CGRP, among whom gepants are the most promising because of their utility both in migraine acute and preventive treatment. A greater recognition of disease and a deep knowledge of patients' comorbidities are essential to its proper management.
Collapse
Affiliation(s)
- Eleonora De Matteis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| |
Collapse
|
42
|
Fishman MA, Chitneni A, Abd-Elsayed A, Grodofsky S, Scherer AM, Schetzner B, Klusek M, Popielarski SR, Meloni S, Falowski S, Kim P, Slavin KV, Silberstein SD. Drug-Free Noninvasive Thermal Nerve Block: Validation of Sham Devices. Brain Sci 2023; 13:1718. [PMID: 38137166 PMCID: PMC10741966 DOI: 10.3390/brainsci13121718] [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: 10/12/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Headache is a leading cause of disability and suffering. One major challenge in developing device treatments is demonstrating their efficacy given devices' often-high placebo rate. This paper reviews the importance of validating sham devices as part of finalizing the design for larger-scale prospective randomized controlled trials in patients with chronic headache as well as the results of a prospective, single-blind trial to validate two potential sham noninvasive thermal nerve block devices. Study participants were trained to self-administer thermal nerve block treatment using sham devices in an office visit. Two different sham systems with different temperature profiles were assessed. Devices were offered for patients to use daily at-home for one week to assess the durability of sham placebo effects before participants were given active treatment in a second office visit followed by another optional week of self-administered active treatment at-home use. Sham treatments reduced pain scores by an average of 31% from 6.0 ± 2.3 to 4.3 ± 3.3, including two participants who fell asleep during the in-office treatment and woke up with no pain, but whose pain recurred after returning home during at-home use of the sham system. In-office active treatments reduced pain scores by 52% from 6.7 ± 2.1 to 3.3 ± 2.9 with sustained pain relief during optional at-home use. Successful blinding for the study was confirmed with an ideal Bang's Blinding Index of 0 and an ideal James' Blinding Index of 1. Both the sham and active treatments were viewed by participants as highly credible, and credibility increased from the beginning to end of sham treatments on average.
Collapse
Affiliation(s)
- Michael A. Fishman
- Center for Pain Control PC, Lancaster, PA 19610, USA; (M.A.F.); (A.M.S.)
| | - Ahish Chitneni
- Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital—Columbia and Cornell, New York, NY 10065, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA;
| | | | - Ashley M. Scherer
- Center for Pain Control PC, Lancaster, PA 19610, USA; (M.A.F.); (A.M.S.)
| | - Brendan Schetzner
- Department of Anesthesiology, St Elizabeths Medical Center, Brighton, MA 02135, USA;
| | - Malvina Klusek
- Peconic Bay Medical Center/Northwell Health, New York, NY 10065, USA;
| | | | - Stephen Meloni
- Thermaquil, Inc., Philadelphia, PA 19610, USA; (S.R.P.); (S.M.)
| | - Steven Falowski
- Neurosurgical Associates of Lancaster, Lancaster, PA 19610, USA;
| | - Philip Kim
- Center for Interventional Pain Spine, LLC, Wilmington, DE 19803, USA;
| | - Konstantin V. Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60607, USA;
- Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, IL 60612, USA
| | | |
Collapse
|
43
|
Corasaniti MT, Lawrence GW, Bagetta G, Iannacchero R, Tarsitano A, Monteleone A, Pagliaro M, Tonin P, Sandrini G, Nicotera P, Scuteri D. Combination of anti-CGRP/CGRP-R mAbs with onabotulinumtoxin A as a novel therapeutic approach for refractory chronic migraine: a retrospective study of real-world clinical evidence and a protocol for a double-blind, randomized clinical trial to establish the efficacy and safety. Front Pharmacol 2023; 14:1296577. [PMID: 38152694 PMCID: PMC10751376 DOI: 10.3389/fphar.2023.1296577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/22/2023] [Indexed: 12/29/2023] Open
Abstract
Chronic migraine is a disabling neurovascular disorder that ranks amongst the top causes of years lived with disability worldwide. The duration and the frequency of migraine affect cognitive and affective domains, inducing worsening of memory, executive functions, orientation and causing anxiety. Population-based studies report a worrying level of resistance to treatments. Therefore, this study aims: 1) to assess efficacy of monoclonal antibodies (mAbs) directed towards the calcitonin gene-related peptide (CGRP) or its receptor (CGRP-R) for chronic migraine resistant to current preventatives; 2) to design a clinical trial protocol to evaluate the efficacy and safety of combination therapy utilizing anti-CGRP/CGRP-R together with onabotulinumtoxin A in patients suffering from resistant chronic migraine; 3) to provide a molecular rationale for combination therapy. A controlled trial is warranted as pooled analysis of real-world data from our group highlighted that combined treatment provides ≥50% reduction vs. baseline (onabotulinumtoxin A) of monthly headache days (MHDs) in up to 58.8% of patients, but there has been only sparse application of this combined therapy to date. The mAbs chosen are: erenumab, because its combination effect with onabotulinumtoxin A improved symptoms in 65% of patients; eptinezumab, due to its faster action. The results highlight that early diagnosis of migraine improves therapeutic outcomes with mAbs alone, confirming their effectiveness and the need for an adequately powered clinical trial evaluating the safety and potential superior effectiveness of eptinezumab/erenumab and onabotulinumtoxin A together.
Collapse
Affiliation(s)
- M. T. Corasaniti
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - G. W. Lawrence
- Department of Biotechnology, Dublin City University, Dublin, Ireland
| | - G. Bagetta
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - R. Iannacchero
- Department of Neurology, Headache Center, Regional Hospital “Pugliese-Ciaccio”, Catanzaro, Italy
| | - A. Tarsitano
- Pain Therapy Center, Provincial Health Authority (ASP), Cosenza, Italy
| | - A. Monteleone
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - M. Pagliaro
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - P. Tonin
- Regional Center for Serious Brain Injuries, S. Anna Institute, Crotone, Italy
| | - G. Sandrini
- Department of Brain and Behavioral Sciences, IRCCS C. Mondino Foundation Neurologic Institute, University of Pavia, Pavia, Italy
| | - P. Nicotera
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - D. Scuteri
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
- Regional Center for Serious Brain Injuries, S. Anna Institute, Crotone, Italy
| |
Collapse
|
44
|
Sun Z, Kleine-Borgmann J, Suh J, McDermott GC, Vishnevetsky A, Rist PM. Migraine and the risk of cervical artery dissection: A systematic review and meta-analysis. Eur Stroke J 2023; 8:904-914. [PMID: 37555306 PMCID: PMC10683742 DOI: 10.1177/23969873231191860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/18/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Migraine is a common, disabling chronic pain condition possibly related to changes in endothelial and vascular structure and function. Several observational studies have suggested an elevated risk of cervical artery dissection (CeAD) in patients with a history of migraine. We aimed to investigate this potential association using systematic review and meta-analytic methods. PATIENTS AND METHODS We utilized a pre-defined search protocol to identify and screen studies related to migraine and CeAD in PubMed, Embase, and the Web of Science Core Collection. We assessed the risk of bias and performed a meta-analysis of selected studies to assess the association between migraine and CeAD. We also performed subgroup analyses by migraine subtype, biological sex, and the use of stroke versus non-stroke controls. RESULTS We identified 11 studies (N = 9857 patients) for inclusion in the meta-analysis. Meta-analysis showed an association between migraine and CeAD with an odds ratio of 1.74 (95%CI 1.38-2.19). There was high heterogeneity among the included studies (I2 = 61%). Publication bias was present but the Trim-Fill imputation suggested that the impact on results was likely minimal. Subgroup analyses revealed an association between migraine without aura and CeAD (OR 1.86, 95%CI 1.55-2.24) but not migraine with aura and CeAD (OR 1.15, 95%CI 0.71-1.88). There was no difference in the association between migraine and CeAD in men compared to women. DISCUSSION AND CONCLUSION A history of migraine is associated with an increased risk of CeAD. Further studies are needed to elucidate the potential pathophysiologic mechanisms underlying this association.
Collapse
Affiliation(s)
- Zihan Sun
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Julian Kleine-Borgmann
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Center for Translational Neuro- and Behavioral Sciences, Department of Neurology, University Medicine Essen, Essen, Germany
| | - Joome Suh
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Neurology, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Gregory C McDermott
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Anastasia Vishnevetsky
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pamela M Rist
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
45
|
Altamura C, Brunelli N, Marcosano M, Alesina A, Fofi L, Vernieri F. Eptinezumab for the Prevention of Migraine: Clinical Utility, Patient Preferences and Selection - A Narrative Review. Ther Clin Risk Manag 2023; 19:959-971. [PMID: 38023625 PMCID: PMC10680459 DOI: 10.2147/tcrm.s263824] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/18/2023] [Indexed: 12/01/2023] Open
Abstract
The new Calcitonin Gene-Related Peptide (CGRP)-targeted therapies have proven high efficacy and tolerability in episodic and chronic migraine. Eptinezumab is a humanized monoclonal antibody that selectively binds CGRP with high affinity. Eptinezumab was approved by the Food and Drug Administration on February 21st, 2020, for the preventive treatment of migraine in adults. It is administered intravenously over 30 minutes with a standard dose of 100 mg and has a T-max of 30 minutes-1 hour and a half-life of 27 days. These pharmacological properties allow for a very rapid onset of effect and a quarterly administration. It is the first time that a preventive treatment for migraine can be offered as an intravenous administration. As the range of therapeutic possibilities in migraine is expanding, the treatment process must include common decision-making, where physicians should explain in detail to patients the different characteristics of treatment options beyond efficacy and side effects. Patients can now express a preference on a range of opportunities: pharmacological versus non-pharmacological approaches, route of administration, frequency of administration, efficacy, rapidity, side effects, costs, the possibility of titration or dosing, and durability of effectiveness at suspension. Also, patient preferences can be influenced by age, country, migraine severity, and earlier experience with CGRP-targeted therapies. Besides, adherence may be influenced by several factors, including route and the schedule of administration. This narrative review describes a new perspective from the patient's point of view. Clinicians should ally with patients to select treatments that meet each patient's needs and thus apply a tailored approach, addressing not only headaches. In this way, physicians would care for the patients globally and stand out their preferences on different aspects of treatment. Besides, healthcare professionals shall be aware that patients' beliefs about therapies are subject to change with increasing experience with new therapeutic approaches.
Collapse
Affiliation(s)
- Claudia Altamura
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, 00128, Italy
- Unit of Headache and Neurosonology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Nicoletta Brunelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, 00128, Italy
- Unit of Headache and Neurosonology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Marilena Marcosano
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, 00128, Italy
- Unit of Headache and Neurosonology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Alessandro Alesina
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, 00128, Italy
- Unit of Headache and Neurosonology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Luisa Fofi
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, 00128, Italy
- Unit of Headache and Neurosonology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Fabrizio Vernieri
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, 00128, Italy
- Unit of Headache and Neurosonology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| |
Collapse
|
46
|
Fu C, Chen Y, Xu W, Zhang Y. Exploring the causal relationship between inflammatory cytokines and migraine: a bidirectional, two-sample Mendelian randomization study. Sci Rep 2023; 13:19394. [PMID: 37938611 PMCID: PMC10632361 DOI: 10.1038/s41598-023-46797-3] [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: 09/10/2023] [Accepted: 11/05/2023] [Indexed: 11/09/2023] Open
Abstract
To further evaluate the causal relationships between inflammatory cytokines and migraine, we conducted a bidirectional, two-sample Mendelian randomization (MR) analysis using genetic data from publicly available genome-wide association studies (GWAS). We used several MR methods, including random-effect inverse-variance weighting (IVW), weighted median, MR-Egger, to test the causal relationships. Sensitivity analyses were also conducted to evaluate the robustness of the results. The results showed that hepatocyte growth factor (HGF) was positively associated with the risk of migraine (odds ratio [OR], 1.004; 95% confidence interval [CI], 1.001-1.008; P = 0.022). In addition, Interleukin-2 (IL-2) was considered a downstream consequence of migraine (OR, 0.012; 95% CI, 0.000-0.0929; P = 0.046). These findings suggest that HGF may be a factor associated with the etiology of migraine, while IL-2 is more likely to be involved in the downstream development of migraine.
Collapse
Affiliation(s)
- Chong Fu
- Department of Gastroenterology, Anqing Municipal Hospital, 352#, Renmin Road, Anqing, Anhui, 246000, People's Republic of China
| | - Yan Chen
- Department of Gastroenterology, Anqing Municipal Hospital, 352#, Renmin Road, Anqing, Anhui, 246000, People's Republic of China
| | - Wei Xu
- Department of Gastroenterology, Anqing Municipal Hospital, 352#, Renmin Road, Anqing, Anhui, 246000, People's Republic of China
| | - Yanping Zhang
- Department of Gastroenterology, Anqing Municipal Hospital, 352#, Renmin Road, Anqing, Anhui, 246000, People's Republic of China.
| |
Collapse
|
47
|
Al-Hassany L, Linstra KM, Meun C, van den Berg J, Boersma E, Danser AHJ, Fauser BCJM, Laven JSE, Wermer MJH, Terwindt GM, Maassen Van Den Brink A. Decreased role of neuropeptides in the microvascular function in migraine patients with polycystic ovary syndrome. Atherosclerosis 2023; 384:117172. [PMID: 37400308 DOI: 10.1016/j.atherosclerosis.2023.06.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND AND AIMS To understand pathophysiological mechanisms underlying migraine as a cardiovascular risk factor, we studied neuropeptide action and endothelial function as measures of peripheral microvascular function in middle-aged women with or without migraine. METHODS We included women with the endocrine disorder polycystic ovary syndrome (PCOS), a population with supposed elevated cardiovascular risk, with and without comorbid migraine. In 26 women without and 23 women with migraine in the interictal phase (mean age 50.8 ± 2.9 years) local thermal hyperemia (LTH) of the skin of the volar forearm was measured cross-sectionally under control conditions, after inhibition of neuropeptide release by 5% lidocaine/prilocaine (EMLA) cream application, and after inhibition of nitric oxide formation by iontophoresis of NG-monomethyl-l-arginine (L-NMMA). Hereafter, changes in the natural logarithm of the reactive hyperemia index (lnRHI) and augmentation index (AI) during reperfusion after occlusion-derived ischemia were measured. RESULTS While mean values under control conditions and L-NMMA conditions were similar, migraine patients had a significantly higher mean area of the curve (AUC) of the total LTH response after EMLA application than those without (86.7 ± 26.5% versus 67.9 ± 24.2%; p = 0.014). This was also reflected by a higher median AUC of the plateau phase under similar conditions in women with migraine compared to those without (83.2% (IQR[73.2-109.5]) versus 73.2% (IQR[54.3-92.0]); p = 0.039). Mean changes in lnRHI and AI scores were similar in both groups. CONCLUSIONS In PCOS patients with migraine, neuropeptide action was lower compared with those without migraine. While larger studies are warranted, these findings provide a potential mechanism supporting previous findings that migraine may be independent from traditional risk factors, including atherosclerosis.
Collapse
Affiliation(s)
- Linda Al-Hassany
- Erasmus MC University Medical Center, Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Rotterdam, the Netherlands
| | - Katie M Linstra
- Erasmus MC University Medical Center, Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Rotterdam, the Netherlands; Leiden University Medical Center, Department of Neurology, Leiden, the Netherlands
| | - Cindy Meun
- Erasmus MC University Medical Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Rotterdam, the Netherlands
| | - Jeffrey van den Berg
- Erasmus MC University Medical Center, Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Rotterdam, the Netherlands
| | - Eric Boersma
- Erasmus MC University Medical Center Rotterdam, Department of Cardiology, the Netherlands
| | - A H Jan Danser
- Erasmus MC University Medical Center, Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Rotterdam, the Netherlands
| | - Bart C J M Fauser
- University Medical Center Utrecht, Department of Reproductive Medicine & Gynaecology, Utrecht, the Netherlands
| | - Joop S E Laven
- Erasmus MC University Medical Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Rotterdam, the Netherlands
| | - Marieke J H Wermer
- Leiden University Medical Center, Department of Neurology, Leiden, the Netherlands
| | - Gisela M Terwindt
- Leiden University Medical Center, Department of Neurology, Leiden, the Netherlands
| | - Antoinette Maassen Van Den Brink
- Erasmus MC University Medical Center, Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Rotterdam, the Netherlands.
| |
Collapse
|
48
|
Sgro M, Ray J, Foster E, Mychasiuk R. Making migraine easier to stomach: the role of the gut-brain-immune axis in headache disorders. Eur J Neurol 2023; 30:3605-3621. [PMID: 37329292 DOI: 10.1111/ene.15934] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND PURPOSE Headache disorders place a significant burden on the healthcare system, being the leading cause of disability in those under 50 years. Novel studies have interrogated the relationship between headache disorders and gastrointestinal dysfunction, suggesting a link between the gut-brain-immune (GBI) axis and headache pathogenesis. Although the exact mechanisms driving the complex relationship between the GBI axis and headache disorders remain unclear, there is a growing appreciation that a healthy and diverse microbiome is necessary for optimal brain health. METHODS A literature search was performed through multiple reputable databases in search of Q1 journals within the field of headache disorders and gut microbiome research and were critically and appropriately evaluated to investigate and explore the following; the role of the GBI axis in dietary triggers of headache disorders and the evidence indicating that diet can be used to alleviate headache severity and frequency. The relationship between the GBI axis and post-traumatic headache is then synthesized. Finally, the scarcity of literature regarding paediatric headache disorders and the role that the GBI axis plays in mediating the relationship between sex hormones and headache disorders are highlighted. CONCLUSIONS There is potential for novel therapeutic targets for headache disorders if understanding of the GBI axis in their aetiology, pathogenesis and recovery is increased.
Collapse
Affiliation(s)
- Marissa Sgro
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jason Ray
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, Austin Health, Melbourne, Victoria, Australia
| | - Emma Foster
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
49
|
Di Antonio S, Arendt-Nielsen L, Ponzano M, Bovis F, Torelli P, Finocchi C, Castaldo M. Trigeminocervical pain sensitivity during the migraine cycle depends on headache frequency. Neurol Sci 2023; 44:4021-4032. [PMID: 37308781 PMCID: PMC10260380 DOI: 10.1007/s10072-023-06858-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/13/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This experimental study aimed to assess pain sensitivity in low-frequency episodic migraine (LFEM), high-frequency episodic migraine (HFEM), and chronic migraine (CM) patients across the different phases of the migraine cycle. METHOD In this observational, experimental study, clinical characteristics (diary and time from the last/next headache attack), and quantitative sensory testing (QST) (wind-up pain ratio (WUR) and pressure pain threshold (PPT) from the trigeminal area and PPT from the cervical spine) was performed. LFEM, HFEM, and CM were assessed in each of the 4 migraine phases (HFEM and LFEM: interictal, preictal, ictal, and postictal; CM: interictal and ictal) and compared vs. each other's (matched for the phase) and controls. RESULTS A total of 56 controls, 105 LFEM, 74 HFEM, and 32 CM were included. No differences in QST parameters were observed between LFEM, HFEM, and CM in any of the phases. During the interictal phase and when comparing with controls the following were found: 1) LFEM had lower trigeminal PPT (p = 0.001) and 2) lower cervical PPT (p = 0.001). No differences were observed between HFEM or CM and healthy controls. During the ictal phase and when comparing with controls the following were found: HFEM and CM had 1) lower trigeminal PPTs (HFEM p = 0.001; CM = p < 0.001), 2) lower cervical PPT s (HFEM p = 0.007; CM p < 0.001), and 3) higher trigeminal WUR (HFEM p = 0.001, CM p = 0.006). No differences were observed between LFEM and healthy controls. During the preictal phase and when comparing with controls the following were found: 1) LFEM had lower cervical PPT (p = 0.007), 2) HFEM had lower trigeminal (p = 0.013) and 3) HFEM had lower cervical (p = .006) PPTs. During the postictal phase and when comparing with controls the following were found: 1) LFEM had lower cervical PPT (p = 0.003), 2) HFEM had lower trigeminal PPT (p = 0.005), and 3) and HFEM had lower cervical (p = 0.007) PPTs. CONCLUSION This study suggested that HFEM patients have a sensory profile matching CM better than LFEM. When assessing pain sensitivity in migraine populations, the phase with respects to headache attacks is of utmost importance and can explain the inconsistency in pain sensitivity data reported in the literature.
Collapse
Affiliation(s)
- Stefano Di Antonio
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), SMI, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, Genoa, Italy
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), SMI, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, 9000, Aalborg, DK, Denmark
| | - Marta Ponzano
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Francesca Bovis
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Paola Torelli
- Headache Centre, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Matteo Castaldo
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), SMI, School of Medicine, Aalborg University, Aalborg, Denmark.
| |
Collapse
|
50
|
Lipton RB, Pozo-Rosich P, Orr SL, Reed ML, Fanning KM, Dabruzzo B, Buse DC. Impact of monthly headache days on migraine-related quality of life: Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Headache 2023; 63:1448-1457. [PMID: 37795746 DOI: 10.1111/head.14629] [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: 04/07/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To characterize the direct impact of monthly headache days (MHDs) on health-related quality of life (HRQoL) in people with migraine and the potential mediating effects of anxiety, depression, and allodynia. BACKGROUND Although the general relationship between increased migraine frequency (i.e., MHDs) and reduced HRQoL is well established, the degree to which reduced HRQoL is due to a direct effect of increased MHDs or attributable to mediating factors remains uncertain. METHODS Cross-sectional baseline data from participants with migraine who completed the Core and Comorbidities/Endophenotypes modules in the 2012-2013 US Chronic Migraine Epidemiology and Outcomes (CaMEO) study, a longitudinal web-based survey study, were analyzed. The potential contribution of depression, anxiety, and/or allodynia to the observed effects of MHDs on HRQoL as measured by the Migraine-Specific Quality-of-Life Questionnaire version 2.1 (MSQ) was evaluated. RESULTS A total of 12,715 respondents were included in the analyses. The MSQ domain scores demonstrated progressive declines with increasing MHD categories (B = -1.23 to -0.60; p < 0.001). The observed HRQoL decrements associated with increasing MHDs were partially mediated by the presence of depression, anxiety, and allodynia. The MHD values predicted 24.0%-32.4% of the observed variation in the MSQ domains. Depression mediated 15.2%-24.3%, allodynia mediated 9.6%-16.1%, and anxiety mediated 2.3%-6.0% of the observed MHD effects on the MSQ. CONCLUSIONS Increased MHD values were associated with lower MSQ scores; the impact of MHDs on the MSQ domain scores was partially mediated by the presence of depression, anxiety, and allodynia. MHDs remain the predominant driver of the MSQ variation; moreover, most of the variation in the MSQ remains unexplained by the variables we analyzed. Future longitudinal analyses and studies may help clarify the contribution of MHDs, comorbidities, and other factors to changes in HRQoL.
Collapse
Affiliation(s)
- Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache Research Group, VHIR, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Serena L Orr
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Brett Dabruzzo
- Medical Affairs (Neurosciences - Migraine), AbbVie, Illinois, North Chicago, USA
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|