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Belvís R, Irimia P, González N, García-Ull J, Pozo-Rosich P, López-Bravo A, Morollón N, Quintas S, Plana A, Baz PG, Tentor A, Gallego Artiles N, León FJ, Pérez Martín M, Rivera I, Ramírez R, Colomina I, Lainez JM, Pascual J. Migraine treatment consensus document of the Spanish Society of Neurology (SEN), Spanish Society of Family and Community Medicine (SEMFYC), Society of Primary Care Medicine (SEMERGEN) and Spanish Association of Migraine and Headache (AEMICE) on migraine treatment. Med Clin (Barc) 2024:S0025-7753(24)00137-4. [PMID: 38643025 DOI: 10.1016/j.medcli.2024.02.006] [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: 09/28/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 04/22/2024]
Abstract
Migraine is a disease with a high prevalence and incidence, in addition to being highly disabling, causing a great impact on the patient's quality of life at a personal, family and work level, but also social, given its high expense due to its direct (care) and indirect (presenteeism and work absenteeism) costs. The multiple and recent developments in its pathophysiological knowledge and in its therapy require updating and, therefore, in this article the Spanish scientific societies most involved in its study and treatment (SEN, SEMFYC and SEMERGEN), together with the Association Spanish Association for Patients with Migraine and other Headaches (AEMICE), we have developed these updated care recommendations. We reviewed the treatment of migraine attacks, which consisted mainly of the use of NSAIDs and triptans, to which ditans and gepants have been added. We also discuss preventive treatment consisting of oral preventive drugs, botulinum toxin, and treatments that block the action of calcitonin-related peptide (CGRP). Finally, we emphasize that pharmacological treatments must be complementary to carrying out general measures consisting of identifying and managing/deletion the precipitating factors of the attacks and the chronicizing factors, controlling the comorbidities of migraine and eliminating analgesic overuse.
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Affiliation(s)
- Robert Belvís
- Unidad de Cefaleas y Neuralgias, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau. Grupo de Estudio de Cefaleas de la SEN, Barcelona, España.
| | - Pablo Irimia
- Servicio de Neurología, Clínica Universidad de Navarra. Grupo de Estudio de Cefaleas de la SEN, Pamplona, España
| | - Nuria González
- Servicio de Neurología, Hospital Universitario San Carlos. Grupo de Estudio de Cefaleas de la SEN, Madrid, España
| | - Jésica García-Ull
- Servicio de Neurología, Hospital Clínico. Grupo de Estudio de Cefaleas de la SEN, Valencia, España
| | - Patricia Pozo-Rosich
- Unidad de Cefalea y Grupo de Investigación en Cefalea, Servicio de Neurología, Hospital Vall d'Hebron y Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona. Grupo de Estudio de Cefaleas de la SEN, Barcelona, España
| | - Alba López-Bravo
- Unidad de Cefaleas, Sección de Neurología, Hospital Reina Sofía. Instituto de Investigación Sanitaria de Aragón (IIS-A). Grupo de Estudio de Cefaleas de la SEN, Tudela, Navarra, España
| | - Noemí Morollón
- Unidad de Cefaleas y Neuralgias, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau. Grupo de Estudio de Cefaleas de la SEN, Barcelona, España
| | - Sonia Quintas
- Servicio de Neurología, Hospital de La Princesa. Grupo de Estudio de Cefaleas de la SEN, Madrid, España
| | - Antoni Plana
- ABS Balàfia-Pardinyes-Secà de Sant Pere de Lleida, Àmbit Lleida. Institut Català de la Salut (ICS). Grupo de Trabajo de Neurología SEMFYC, Lleida, España
| | | | | | | | - Francisco Javier León
- Centro de Salut Dúrcal, Distrito Sanitario Granada Metropolitano. Grupo de Trabajo de Neurología SEMFYC, Granada, España
| | | | - Inés Rivera
- C.S. Barranco Grande, Santa Cruz de Tenerife, España
| | - Raquel Ramírez
- Servicio de Medicina de Familia, Clínica Universitaria de Navarra, Madrid, España
| | | | - José Miguel Lainez
- Servicio de Neurología, Hospital Clínico. Grupo de Estudio de Cefaleas de la SEN, Valencia, España
| | - Julio Pascual
- Servicio de Neurología, Hospital Marqués de Valdecilla, Universidad de Cantabria e IDIVAL. Grupo de Estudio de Cefaleas de la SEN, Santander, España
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Mazzacane F, Vaghi G, Cotta Ramusino M, Perini G, Costa A. Arterial hypertension in the chronic evolution of migraine: bystander or risk factor? An overview. J Headache Pain 2024; 25:13. [PMID: 38311745 PMCID: PMC10840219 DOI: 10.1186/s10194-024-01720-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/17/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Several risk factors are associated with the chronic evolution of migraine. Clinical and preclinical studies have provided data about the role of hypertension (HT) as one of the potential modifiable risk factors of chronic migraine (CM). This review is focused on the biological and clinical evidence supporting common mechanisms underlying HT and migraine and the potential role of HT in the transition from episodic to chronic migraine. METHODS We conducted a narrative review from a literature search covering the available evidence from studies investigating: i) the role of HT in the transition to CM in clinical practice; ii) the biological mechanisms potentially underpinning the association between HT and evolution to CM; iii) the role of antihypertensive medications in migraine prophylaxis. RESULTS HT proved to be at the base of multiple mechanisms underlying migraine and migraine chronicization. Endothelial dysfunction, blood-brain barrier alterations, calcitonin gene-related peptide signaling, and renin-angiotensin-aldosterone system dysregulation are involved in the worsening effect of HT on migraine frequency, and the role of HT in the transition to CM is supported by clinical observations. CONCLUSIONS The observed evidence supports HT contribution to CM evolution due to shared pathophysiologic mechanisms. While a bidirectional influence appears to be ascertained, data are still lacking about the one-way role of HT as direct risk factor for CM transition. Further research is needed to confirm a causal role of HT in this process.
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Affiliation(s)
- Federico Mazzacane
- Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy
- Unit of Behavioral Neurology, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Gloria Vaghi
- Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy.
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, 27100, Pavia, Italy.
| | - Matteo Cotta Ramusino
- Unit of Behavioral Neurology, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Giulia Perini
- Unit of Behavioral Neurology, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Alfredo Costa
- Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy
- Unit of Behavioral Neurology, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
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Di Lauro M, Guerriero C, Cornali K, Albanese M, Costacurta M, Mercuri NB, Di Daniele N, Noce A. Linking Migraine to Gut Dysbiosis and Chronic Non-Communicable Diseases. Nutrients 2023; 15:4327. [PMID: 37892403 PMCID: PMC10609600 DOI: 10.3390/nu15204327] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
In the world, migraine is one of the most common causes of disability in adults. To date, there is no a single cause for this disorder, but rather a set of physio-pathogenic triggers in combination with a genetic predisposition. Among the factors related to migraine onset, a crucial role seems to be played by gut dysbiosis. In fact, it has been demonstrated how the intestine is able to modulate the central nervous system activities, through the gut-brain axis, and how gut dysbiosis can influence neurological pathologies, including migraine attacks. In this context, in addition to conventional pharmacological treatments for migraine, attention has been paid to an adjuvant therapeutic strategy based on different nutritional approaches and lifestyle changes able to positively modulate the gut microbiota composition. In fact, the restoration of the balance between the different gut bacterial species, the reconstruction of the gut barrier integrity, and the control of the release of gut-derived inflammatory neuropeptides, obtained through specific nutritional patterns and lifestyle changes, represent a possible beneficial additive therapy for many migraine subtypes. Herein, this review explores the bi-directional correlation between migraine and the main chronic non-communicable diseases, such as diabetes mellitus, arterial hypertension, obesity, cancer, and chronic kidney diseases, whose link is represented by gut dysbiosis.
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Affiliation(s)
- Manuela Di Lauro
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, RM, Italy; (M.D.L.); (C.G.); (K.C.); (M.A.); (N.B.M.); (N.D.D.)
| | - Cristina Guerriero
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, RM, Italy; (M.D.L.); (C.G.); (K.C.); (M.A.); (N.B.M.); (N.D.D.)
| | - Kevin Cornali
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, RM, Italy; (M.D.L.); (C.G.); (K.C.); (M.A.); (N.B.M.); (N.D.D.)
| | - Maria Albanese
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, RM, Italy; (M.D.L.); (C.G.); (K.C.); (M.A.); (N.B.M.); (N.D.D.)
- Neurology Unit, Headache Center, Tor Vergata University Hospital, 00133 Rome, RM, Italy
| | - Micaela Costacurta
- Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, RM, Italy;
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, RM, Italy; (M.D.L.); (C.G.); (K.C.); (M.A.); (N.B.M.); (N.D.D.)
- Neurology Unit, Headache Center, Tor Vergata University Hospital, 00133 Rome, RM, Italy
| | - Nicola Di Daniele
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, RM, Italy; (M.D.L.); (C.G.); (K.C.); (M.A.); (N.B.M.); (N.D.D.)
- Fondazione Leonardo per le Scienze Mediche Onlus, Policlinico Abano, 35031 Abano Terme, PD, Italy
| | - Annalisa Noce
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, RM, Italy; (M.D.L.); (C.G.); (K.C.); (M.A.); (N.B.M.); (N.D.D.)
- UOSD Nephrology and Dialysis, Policlinico Tor Vergata, 00133 Rome, RM, Italy
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Fernández-de-Las-Peñas C, Cuadrado ML, Gómez-Mayordomo V, García-Azorín D, Arendt-Nielsen L. Headache as a COVID-19 onset symptom or Post-COVID symptom according to the SARS-CoV-2 Variant. Expert Rev Neurother 2023; 23:179-186. [PMID: 36857191 DOI: 10.1080/14737175.2023.2185138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
INTRODUCTION COVID19 associated headaches are highly common and there is currently an unmet need to better understand their association with SARSCoV2 variants. Headaches are a prevalent symptom in the acute phase of COVID19 and are associated with a better prognosis and better immune response. They are also a relevant post-COVID symptom. AREAS COVERED This article analyses the differences in the prevalence of headache as an onset symptom and in post-COVID headache among the different SARS-CoV-2 variants: the historical strain, Alpha, Delta and Omicron. The different pathophysiological mechanisms by which SARS-CoV-2 infection may cause headache are also discussed. EXPERT OPINION The presence of headache at the acute phase is a risk factor for post-COVID headache, whereas a history of primary headache does not appear to be associated with post-COVID headache. The prevalence of headache as an onset symptom appears to be variable for the different SARS-CoV-2 variants, but current data are inconclusive. However, the current evidence also suggests that headache represents a prevalent symptom in the acute and post-infection COVID-19 phase, regardless of SARS-CoV-2 variant.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid. Spain
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Maria L Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Victor Gómez-Mayordomo
- Department of Neurology, Institute of Neurosciences, Vithas Madrid La Milagrosa University Hospital. Madrid, Spain
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, AMech-Sense, alborg University Hospital, Aalborg, Denmark
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Davis L, Torphy B. Managing migraine on the frontline: Identifying disease, understanding burden, and incorporating CGRP pathway-targeting therapies in primary care. Br J Pain 2022; 16:560-573. [PMID: 36389011 PMCID: PMC9644104 DOI: 10.1177/20494637221104292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Migraine is a common neurologic disorder with clinical phenotypes encompassing a variety of symptoms which all contribute to the burden felt by patients. In addition to negative impacts on a patient's quality of life, migraine has both direct medical costs and indirect costs related to missed work and decreased productivity that affect individuals as well as society at large. Unfortunately, migraine diagnoses are often missed, and many patients do not receive appropriate treatment. Primary care providers are in a key position to provide timely diagnosis and effectively manage migraine for many patients. This review aims to be a guide for improving migraine management in the primary care setting by providing strategies to overcome common challenges in migraine diagnosis; summarizing current knowledge on the mechanism of action, efficacy, and safety of calcitonin gene-related peptide (CGRP) pathway-targeting therapies; and reviewing approaches to incorporate traditional and emerging treatment options into a patient-centric migraine management strategy.
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Affiliation(s)
- Linda Davis
- Kolvita Family Medical
Group, Mission Viejo, CA, USA
| | - Brad Torphy
- Chicago Headache Center and Research
Institute, Chicago, IL, USA
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Fernández-de-las-Peñas C, Gómez-Mayordomo V, García-Azorín D, Palacios-Ceña D, Florencio LL, Guerrero AL, Hernández-Barrera V, Cuadrado ML. Previous History of Migraine Is Associated With Fatigue, but Not Headache, as Long-Term Post-COVID Symptom After Severe Acute Respiratory SARS-CoV-2 Infection: A Case-Control Study. Front Hum Neurosci 2021; 15:678472. [PMID: 34295230 PMCID: PMC8290894 DOI: 10.3389/fnhum.2021.678472] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the association of pre-existing migraine in patients hospitalised and who recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with the presence of post-coronavirus disease (COVID) symptoms. BACKGROUND No study has investigated the role of migraine as a risk factor for development of post-COVID symptoms. METHODS A case-control study including individuals hospitalised during the first wave of the pandemic (from February 20 to May 31, 2020) was conducted. Patients with confirmed previous diagnosis of migraine were considered cases. Two age- and sex-matched individuals without a history of headache per case were also recruited as controls. Hospitalisation/clinical data were collected from hospital medical records. Patients were scheduled for a telephone interview. A list of post-COVID symptoms was systematically evaluated, but participants were invited to freely report any symptom. The Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index were used to assess anxiety/depressive symptoms and sleep quality. Multivariable conditional logistic regression models were constructed. RESULTS Overall, 57 patients with confirmed diagnosis of migraine and 144 non-migraine controls who had recovered from COVID-19 were assessed at 7.3 months (SD 0.6) after hospital discharge. The number of post-COVID symptoms in the migraine group was significantly greater (OR 1.70, 95% CI 1.29-2.25, P < 0.001) than in the non-migraine group. Fatigue was significantly more prevalent (OR 2.89, 95% CI 1.32-6.32, P = 0.008) in the migraine group. However, no between-groups difference in the prevalence of headache as a post-COVID symptom was detected. CONCLUSION Patients with a history of migraine who recovered from COVID-19 exhibited more long-term fatigue as post-COVID sequelae than those without migraine. Some of the pathophysiological changes associated with migraine could predispose to the occurrence of post-COVID symptoms.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | | | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Lidiane L. Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Angel L. Guerrero
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
- Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | | | - María L. Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Fernández-de-Las-Peñas C, Gómez-Mayordomo V, Cuadrado ML, Palacios-Ceña D, Florencio LL, Guerrero AL, García-Azorín D, Hernández-Barrera V, Arendt-Nielsen L. The presence of headache at onset in SARS-CoV-2 infection is associated with long-term post-COVID headache and fatigue: A case-control study. Cephalalgia 2021; 41:1332-1341. [PMID: 34134526 PMCID: PMC8212025 DOI: 10.1177/03331024211020404] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective To investigate the association of headache during the acute phase of SARS-CoV-2 infection with long-term post-COVID headache and other post-COVID symptoms in hospitalised survivors. Methods A case-control study including patients hospitalised during the first wave of the pandemic in Spain was conducted. Patients reporting headache as a symptom during the acute phase and age- and sex-matched patients without headache during the acute phase participated. Hospitalisation and clinical data were collected from medical records. Patients were scheduled for a telephone interview 7 months after hospital discharge. Participants were asked about a list of post-COVID symptoms and were also invited to report any additional symptom they might have. Anxiety/depressive symptoms and sleep quality were assessed with the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index. Results Overall, 205 patients reporting headache and 410 patients without headache at hospitalisation were assessed 7.3 months (Standard Deviation 0.6) after hospital discharge. Patients with headache at onset presented a higher number of post-COVID symptoms (Incident Rate Ratio: 1.16, 95% CI: 1.03–1.30). Headache at onset was associated with a previous history of migraine (Odd Ratio: 2.90, 95% Confidence Interval: 1.41–5.98) and with the development of persistent tension-type like headache as a new post-COVID symptom (Odd Ratio: 2.65, 95% CI: 1.66–4.24). Fatigue as a long-term symptom was also more prevalent in patients with headache at onset (Odd Ratio: 1.55, 95% CI: 1.07–2.24). No between-group differences in the prevalence of anxiety/depressive symptoms or sleep quality were seen. Conclusion Headache in the acute phase of SARS-CoV-2 infection was associated with higher prevalence of headache and fatigue as long-term post-COVID symptoms. Monitoring headache during the acute phase could help to identify patients at risk of developing long-term post-COVID symptoms, including post-COVID headache.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid. Spain
| | | | - María L Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid. Spain
| | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid. Spain
| | - Angel L Guerrero
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain.,Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | | | - Lars Arendt-Nielsen
- CNAP, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Real world effectiveness and tolerability of candesartan in the treatment of migraine: a retrospective cohort study. Sci Rep 2021; 11:3846. [PMID: 33589682 PMCID: PMC7884682 DOI: 10.1038/s41598-021-83508-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/03/2021] [Indexed: 12/29/2022] Open
Abstract
To date, two randomized, controlled studies support the use of candesartan for migraine prophylaxis but with limited external validity. We aim to evaluate the effectiveness and tolerability of candesartan in clinical practice and to explore predictors of patient response. Retrospective cohort study including all patients with migraine who received candesartan between April 2008-February 2019. The primary endpoint was the number of monthly headache days during weeks 8-12 of treatment compared to baseline. Additionally, we evaluated the frequency during weeks 20-24. We analysed the percentage of patients with 50% and 75% response rates and the retention rates after three and 6 months of treatment. 120/4121 patients were eligible, aged 45.9 [11.5]; 100 (83.3%) female. Eighty-four patients (70%) had chronic migraine and 53 (42.7%) had medication-overuse headache. The median number of prior prophylactics was 3 (Inter-quartile range 2-5). At baseline, patients had 20.5 ± 8.5 headache days per month, decreasing 4.3 ± 8.4 days by 3 months (weeks 12-16) and by 4.7 ± 8.7 days by 6 months (paired Student's t-test, p < 0.001). The percentage of patients with a 50% response was 32.5% at 3 months and 31.7% at 6 months, while the retention rate was 85.0% and 58.3%. The number of prior treatments (Odds ratio 0.79, 95% CI 0.64-0.97) and the presence of daily headache (Odds ratio 0.39, 95% CI 0.16-0.97) were associated with a lower probability of response. Candesartan showed beneficial effects in the preventive treatment of migraine in clinical practice, including patients with chronic migraine, medication-overuse headache and resistance to prior prophylactics.
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Yildirim E, Secen O, Keskin M. Should we be concerned about pain in hypertension treatment in young patients? GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2020. [DOI: 10.23736/s0393-3660.19.04047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Radenkovic M, Stojanović M, Nešić IM, Prostran M. Angiotensin receptor blockers & endothelial dysfunction: Possible correlation & therapeutic implications. Indian J Med Res 2017; 144:154-168. [PMID: 27934794 PMCID: PMC5206866 DOI: 10.4103/0971-5916.195022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The endothelium is one of the most important constituents of vascular homeostasis, which is achieved through continual and balanced production of different relaxing and contractile factors. When there is a pathological disturbance in release of these products, endothelial dysfunction (ED) will probably occur. ED is considered to be the initial step in the development of atherosclerosis. This pathological activation and inadequate functioning of endothelial cells was shown to be to some extent a reversible process, which all together resulted in increased interest in investigation of different beneficial treatment options. To this point, the pharmacological approach, including for example, the use of angiotensin-converting enzyme inhibitors or statins, was clearly shown to be effective in the improvement of ED. One of many critical issues underlying ED represents instability in the balance between nitric oxide and angiotensin II (Ang II) production. Considering that Ang II was confirmed to be important for the development of ED, the aim of this review article was to summarize the findings of up to date clinical studies associated with therapeutic application of angiotensin receptor blockers and improvement in ED. In addition, it was of interest to review the pleiotropic actions of angiotensin receptor blockers linked to the improvement of ED. The prospective, randomized, double-blind, placebo or active-controlled clinical trials were identified and selected for the final evaluation.
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Affiliation(s)
- Miroslav Radenkovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko Stojanović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Milićević Nešić
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Prostran
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Baena CP, D'Amico RC, Slongo H, Brunoni AR, Goulart AC, Benseñor I. The effectiveness of aspirin for migraine prophylaxis: a systematic review. SAO PAULO MED J 2017; 135:42-49. [PMID: 28380176 PMCID: PMC9969718 DOI: 10.1590/1516-3180.2016.0165050916] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/14/2016] [Indexed: 01/03/2023] Open
Abstract
CONTEXT AND OBJECTIVE: Many researchers have suggested that aspirin prevents migraines. However, the evidence is unclear. The aim of this study was to analyze the available evidence on the effect of aspirin as a migraine prophylactic. DESIGN AND SETTING: Systematic review, conducted at the Pontifícia Universidade Católica do Paraná, Brazil, and at the University of São Paulo, Brazil. METHODS: We performed electronic searches in the databases of MEDLINE/PubMed, Embase, WEB OF SCIENCE, the World Health Organization, CENTRAL and OpenGrey, and we also searched manually for interventional studies published before April 2016 that compared the effects of aspirin with a control, in adults. Two authors independently extracted data on the publication, population recruited, intervention (aspirin dosage, follow-up and combined treatment) and main outcomes (frequency, severity and duration of migraine). We evaluated the quality of the studies using the Cochrane risk-of-bias tool. RESULTS: Our search retrieved 1,098 references, of which 8 met the selection criteria for this systematic review. The total population was 28,326 participants (18-64 years old); most (96%) were men. The dosage varied from 50 to 650 mg/day across the studies. The risk of bias was generally low or unclear. The only outcome for which most of the studies included (6/8) reported a significant reduction was frequency of migraine, which was reduced at an aspirin dosage of at least 325 mg/day. CONCLUSION: Aspirin can reduce the frequency of migraines. However, the optimal dosage is unclear.
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Affiliation(s)
- Cristina Pellegrino Baena
- MD, PhD. Professor, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba (PR), Brazil
| | - Raíssa Campos D'Amico
- Medical Student, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba (PR), Brazil
| | - Helena Slongo
- Medical Student, Faculdade Evangélica do Paraná (FEPAR), Curitiba (PR), Brazil
| | - André Russowsky Brunoni
- MD. Professor, Hospital Universitário (HU), Universidade de São Paulo (USP), and Coordinator, Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Universidade de São Paulo (USP), São Paulo (SP), Brazil
| | | | - Isabela Benseñor
- MD, PhD. Professor, Hospital Universitário (HU), Universidade de São Paulo (USP), São Paulo (SP), Brazil
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12
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Patten GS, Abeywardena MY, Bennett LE. Inhibition of Angiotensin Converting Enzyme, Angiotensin II Receptor Blocking, and Blood Pressure Lowering Bioactivity across Plant Families. Crit Rev Food Sci Nutr 2016; 56:181-214. [PMID: 24915402 DOI: 10.1080/10408398.2011.651176] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Hypertension is a major risk factor for coronary heart disease, kidney disease, and stroke. Interest in medicinal or nutraceutical plant bioactives to reduce hypertension has increased dramatically. The main biological regulation of mammalian blood pressure is via the renin-angiotensin-aldosterone system. The key enzyme is angiotensin converting enzyme (ACE) that converts angiotensin I into the powerful vasoconstrictor, angiotensin II. Angiotensin II binds to its receptors (AT1) on smooth muscle cells of the arteriole vasculature causing vasoconstriction and elevation of blood pressure. This review focuses on the in vitro and in vivo reports of plant-derived extracts that inhibit ACE activity, block angiotensin II receptor binding and demonstrate hypotensive activity in animal or human studies. We describe 74 families of plants that exhibited significant ACE inhibitory activity and 16 plant families with potential AT1 receptor blocking activity, according to in vitro studies. From 43 plant families including some of those with in vitro bioactivity, the extracts from 73 plant species lowered blood pressure in various normotensive or hypertensive in vivo models by the oral route. Of these, 19 species from 15 families lowered human BP when administered orally. Some of the active plant extracts, isolated bioactives and BP-lowering mechanisms are discussed.
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Affiliation(s)
- Glen S Patten
- a CSIRO Preventative Health National Research Flagship, Animal, Food and Health Sciences , Adelaide , South Australia , Australia
| | - Mahinda Y Abeywardena
- a CSIRO Preventative Health National Research Flagship, Animal, Food and Health Sciences , Adelaide , South Australia , Australia
| | - Louise E Bennett
- b CSIRO Preventative Health National Research Flagship, Animal, Food and Health Sciences, Werribee , Victoria , British Columbia , Australia
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13
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ACE and ARB Agents in the Prophylactic Therapy of Migraine—How Effective Are They? Curr Treat Options Neurol 2016; 18:15. [DOI: 10.1007/s11940-016-0397-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Lipton RB, Silberstein SD. Episodic and chronic migraine headache: breaking down barriers to optimal treatment and prevention. Headache 2015; 55 Suppl 2:103-22; quiz 123-6. [PMID: 25662743 DOI: 10.1111/head.12505_2] [Citation(s) in RCA: 199] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2014] [Indexed: 02/03/2023]
Abstract
Migraine is a common disabling primary headache disorder that affects an estimated 36 million Americans. Migraine headaches often occur over many years or over an individual's lifetime. By definition, episodic migraine is characterized by headaches that occur on fewer than 15 days per month. According to the recent International Classification of Headache Disorders (third revision) beta diagnostic criteria, chronic migraine is defined as "headaches on at least 15 days per month for at least 3 months, with the features of migraine on at least 8 days per month." However, diagnostic criteria distinguishing episodic from chronic migraine continue to evolve. Persons with episodic migraine can remit, not change, or progress to high-frequency episodic or chronic migraine over time. Chronic migraine is associated with a substantially greater personal and societal burden, more frequent comorbidities, and possibly with persistent and progressive brain abnormalities. Many patients are poorly responsive to, or noncompliant with, conventional preventive therapies. The primary goals of migraine treatment include relieving pain, restoring function, and reducing headache frequency; an additional goal may be preventing progression to chronic migraine. Although all migraineurs require abortive treatment, and all patients with chronic migraine require preventive treatment, there are no definitive guidelines delineating which persons with episodic migraine would benefit from preventive therapy. Five US Food and Drug Association strategies are approved for preventing episodic migraine, but only injections with onabotulinumtoxinA are approved for preventing chronic migraine. Identifying persons who require migraine prophylaxis and selecting and initiating the most appropriate treatment strategy may prevent progression from episodic to chronic migraine and alleviate the pain and suffering associated with frequent migraine.
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Affiliation(s)
- Richard B Lipton
- Department of Psychiatry and Behavioral Sciences, Department of Epidemiology & Population Health, Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA
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15
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Wan D, Wang C, Zhang X, Tang W, Chen M, Dong Z, Yu S. Association between angiotensin-converting enzyme insertion/deletion polymorphism and migraine: a meta-analysis. Int J Neurosci 2015; 126:393-9. [DOI: 10.3109/00207454.2015.1025395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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16
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de Roos NM, Giezenaar CGT, Rovers JMP, Witteman BJM, Smits MG, van Hemert S. The effects of the multispecies probiotic mixture Ecologic®Barrier on migraine: results of an open-label pilot study. Benef Microbes 2015; 6:641-6. [PMID: 25869282 DOI: 10.3920/bm2015.0003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Migraine prevalence is associated with gastrointestinal disorders. Possible underlying mechanisms could be increased gut permeability and inflammation. Probiotics may decrease intestinal permeability as well as inflammation, and therefore may reduce the frequency and/or intensity of migraine attacks. Therefore we assessed feasibility, possible clinical efficacy, and adverse reactions of probiotic treatment in migraine patients. 29 migraine patients took 2 g/d of a probiotic food supplement (Ecologic(®)Barrier, 2.5×10(9) cfu/g) during 12 weeks. Participants recorded frequency and intensity of migraine in a headache diary and completed the Migraine Disability Assessment Scale (MIDAS) and Henry Ford Hospital Headache Disability Inventory (HDI) at baseline and after 12 weeks of treatment. Compliance was measured every 4 weeks by counting the remaining sachets with probiotics. The study was completed by 27/29 (93%) patients who took 95% of the supplements. Obstipation was reported by 4 patients during the first 2 weeks of treatment only. The mean±standard deviation (SD) number of migraine days/month decreased significantly from 6.7±2.4 at baseline to 5.1±2.2 (P=0.008) in week 5-8 and 5.2±2.4 in week 9-12 (P=0.001). The mean±SD intensity of migraine decreased significantly from 6.3±1.5 at baseline to 5.5±1.9 after treatment (P=0.005). The MIDAS score improved from 24.8±25.5 to 16.6±13.5 (P=0.031). However, the mean HDI did not change significantly. In conclusion, probiotics may decrease migraine supporting a possible role for the intestine in migraine management. Feasibility and lack of adverse reactions justify further placebo-controlled studies.
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Affiliation(s)
- N M de Roos
- 1 Wageningen UR, Division Human Nutrition, P.O. Box 8129, 6700 EV Wageningen, the Netherlands
| | - C G T Giezenaar
- 1 Wageningen UR, Division Human Nutrition, P.O. Box 8129, 6700 EV Wageningen, the Netherlands
| | - J M P Rovers
- 2 Hospital Gelderse Vallei, Department of Neurology, Willy Brandtlaan 10, 6716 RP Ede, the Netherlands
| | - B J M Witteman
- 3 Hospital Gelderse Vallei, Department of Gastroenterology and Hepatology, Willy Brandtlaan 10, 6716 RP Ede, the Netherlands
| | - M G Smits
- 2 Hospital Gelderse Vallei, Department of Neurology, Willy Brandtlaan 10, 6716 RP Ede, the Netherlands
| | - S van Hemert
- 4 Winclove b.v., R&D department, Hulstweg 11, 1032 LB Amsterdam, the Netherlands
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Bali A, Singh N, Jaggi AS. Renin–angiotensin system in pain: Existing in a double life? J Renin Angiotensin Aldosterone Syst 2014; 15:329-40. [DOI: 10.1177/1470320313503694] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Anjana Bali
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University Patiala, India
| | - Nirmal Singh
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University Patiala, India
| | - Amteshwar Singh Jaggi
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University Patiala, India
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18
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Ahad A, Al-Mohizea AM, Al-Jenoobi FI, Aqil M. Transdermal delivery of angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACEIs) and others for management of hypertension. Drug Deliv 2014; 23:579-90. [PMID: 25065883 DOI: 10.3109/10717544.2014.942444] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
CONTEXT Angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACEIs) are some of the most commonly prescribed medications for hypertension. OBJECTIVE Most of all conventional dosage forms of ARBs and ACEIs undergo extensive first-pass metabolism, which significantly reduces bioavailability. Majority of ARBs and ACEIs are inherently short acting due to a rapid elimination half-life. In addition, oral dosage forms of ARBs and ACEIs have many high incidences of adverse effects due to variable absorption profiles, higher frequency of administration and poor patient compliance. METHODS Many attempts have been made globally at the laboratory level to investigate the skin permeation and to develop transdermal therapeutic systems of various ARBs, ACEIs and other anti-hypertensives, to circumvent the drawbacks associated with their conventional dosage form. RESULTS This manuscript presents an outline of the transdermal research specifically in the area of ARBs, ACEIs and other anti-hypertensives reported in various pharmaceutical journals. CONCLUSION The transdermal delivery has gained a significant importance for systemic treatment as it is able to avoid first-pass metabolism and major fluctuations of plasma levels typical of repeated oral administration. As we can experience from this review article that transdermal delivery of different ARBs and ACEIs improves bioavailability as well as patient compliance by many folds. In fact, the rationale development of some newer ARBs, ACEIs and other anti-hypertensives transdermal systems will provide new ways of treatment, circumventing current limitations for conventional dosage forms.
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Affiliation(s)
- Abdul Ahad
- a Department of Pharmaceutics , College of Pharmacy, King Saud University , Riyadh , Saudi Arabia and
| | | | - Fahad Ibrahim Al-Jenoobi
- a Department of Pharmaceutics , College of Pharmacy, King Saud University , Riyadh , Saudi Arabia and
| | - Mohd Aqil
- b Department of Pharmaceutics, Faculty of Pharmacy , Jamia Hamdard (Hamdard University) , New Delhi , India
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Reddy DS. The pathophysiological and pharmacological basis of current drug treatment of migraine headache. Expert Rev Clin Pharmacol 2013; 6:271-88. [PMID: 23656340 DOI: 10.1586/ecp.13.14] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Migraine is a common neurological syndrome that affects approximately 10-20% of the population. The pathophysiology of migraine is unclear. 5-hydroxytriptamine is a key mediator in the pathogenesis of migraine and thus 5-HT1-receptor agonists are the principal drugs for acute migraine therapy. There are three classes of drugs for migraine: over-the-counter analgesics and nonsteroidal anti-inflammatory drugs for acute mild migraine, specific prescription drugs (triptans and ergot alkaloids) for acute severe migraine and pharmacological agents for prophylaxis of migraine. Sumatriptan, naratriptan and others, referred to as 'triptans', are the mainstay for acute treatment of migraine. Ergot alkaloids (ergotamine, dihydroergotamine) are used in patients with frequent, moderate migraine, but are less effective than triptans. There are several agents for prevention of migraine occurrence in patients with frequent or severe disabling migraine attacks. New drugs with improved efficacy and reduced side effects are needed for effective treatment and prevention of migraine.
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Affiliation(s)
- Doodipala Samba Reddy
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, 8447 State Highway 47, Medical Research & Education Building, Bryan, TX 77807, USA.
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Anti-nociceptive and anti-allodynic activity of aliskiren in various pain models. Eur J Pharmacol 2013; 708:80-7. [PMID: 23545357 DOI: 10.1016/j.ejphar.2013.03.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 02/28/2013] [Accepted: 03/24/2013] [Indexed: 11/21/2022]
Abstract
In the present study, we have investigated the anti-nociceptive and anti-allodynic activity of the renin inhibitor, aliskiren, in various pain models. The anti-nociceptive activity of aliskiren was investigated in chemically-induced pain, orofacial pain and centrally mediated pain models. Anti-allodynic activity was evaluated in post-operative and neuropathic pain models. The levels of TNF-α and IL-6 were measured in homogenates of hind paw as markers of inflammation in formalin injected mice. Intraperitoneal administration of aliskiren (1-50mg/kg) showed anti-nociceptive activity in the writhing test, formalin hind paw test, capsaicin induced pain, and orofacial pain tests in ICR mice in a dose dependent manner. Aliskiren (50mg/kg, i.p.) reduced levels of TNF-α and IL-6 in hind paw homogenates of formalin-injected mice. Aliskiren (50mg/kg, i.p.) did not show any analgesic activity in hot-plate and tail-flick tests, indicating the absence of centrally mediated anti-nociceptive effects. On the other hand, intra-plantar administration of aliskiren (0.1, 0.5 and 1mg) showed analgesic activity in rat formalin tests, indicating a locally mediated effect. Aliskiren (30-100mg/kg, i.p.) showed anti-allodynic activity in post-operative pain and chronic constriction injury-induced neuropathic pain in Sprague Dawley rats. This data suggests that aliskiren may have the potential to be used as an anti-nociceptive and anti-allodynic agent.
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Kukkar A, Singh N, Jaggi AS. Neuropathic pain-attenuating potential of aliskiren in chronic constriction injury model in rats. J Renin Angiotensin Aldosterone Syst 2012; 14:116-23. [PMID: 23087256 DOI: 10.1177/1470320312460899] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The present study was designed to investigate the potential of aliskiren, a direct renin inhibitor, in chronic constriction injury (CCI)-induced neuropathic pain in rats. Neuropathic pain was induced by placing four loose ligatures around the sciatic nerve. Acetone drop, von Frey hair, pin-prick and hot plate tests were performed to assess cold allodynia, mechanical allodynia, mechanical and heat hyperalgesia, respectively. The levels of Tumor necrosis factor-alpha (TNF-α) were measured in the sciatic nerve as an inflammatory marker. CCI was associated with the development of cold allodynia, mechanical allodynia, mechanical and heat hyperalgesia along with a rise in the levels of Tumor necrosis factor-alpha (TNF-α). Administration of aliskiren (25 or 50 mg/kg intraperitoneal (i.p.)) for 14 days in CCI-subjected rats significantly attenuated CCI-induced pain-related behavior and rise in TNF-α level. It may be concluded that aliskiren-mediated anti-inflammatory actions may be responsible for its beneficial effects in neuropathic pain in rats.
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Affiliation(s)
- Ankesh Kukkar
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, India
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22
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Sarchielli P, Granella F, Prudenzano MP, Pini LA, Guidetti V, Bono G, Pinessi L, Alessandri M, Antonaci F, Fanciullacci M, Ferrari A, Guazzelli M, Nappi G, Sances G, Sandrini G, Savi L, Tassorelli C, Zanchin G. Italian guidelines for primary headaches: 2012 revised version. J Headache Pain 2012; 13 Suppl 2:S31-70. [PMID: 22581120 PMCID: PMC3350623 DOI: 10.1007/s10194-012-0437-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The first edition of the Italian diagnostic and therapeutic guidelines for primary headaches in adults was published in J Headache Pain 2(Suppl. 1):105–190 (2001). Ten years later, the guideline committee of the Italian Society for the Study of Headaches (SISC) decided it was time to update therapeutic guidelines. A literature search was carried out on Medline database, and all articles on primary headache treatments in English, German, French and Italian published from February 2001 to December 2011 were taken into account. Only randomized controlled trials (RCT) and meta-analyses were analysed for each drug. If RCT were lacking, open studies and case series were also examined. According to the previous edition, four levels of recommendation were defined on the basis of levels of evidence, scientific strength of evidence and clinical effectiveness. Recommendations for symptomatic and prophylactic treatment of migraine and cluster headache were therefore revised with respect to previous 2001 guidelines and a section was dedicated to non-pharmacological treatment. This article reports a summary of the revised version published in extenso in an Italian version.
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Affiliation(s)
- Paola Sarchielli
- Headache Centre, Neurologic Clinic, University of Perugia, Perugia, Italy.
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Ho TW, Ho AP, Chaitman BR, Johnson C, Mathew NT, Kost J, Fan X, Aurora SK, Brandes JL, Fei K, Beebe L, Lines C, Krucoff MW. Randomized, controlled study of telcagepant in patients with migraine and coronary artery disease. Headache 2012; 52:224-35. [PMID: 22221076 DOI: 10.1111/j.1526-4610.2011.02052.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the efficacy of telcagepant in patients with migraine and coronary artery disease. BACKGROUND Calcitonin gene-related peptide receptor antagonists, such as telcagepant, may be useful for acute migraine treatment in patients with cardiovascular disease, a population for whom triptans are contraindicated. METHODS Randomized, double-blind, two-period (6 weeks per period) crossover study in patients with stable coronary artery disease and migraine. Patients were randomized 1:1 to either: (1) Period 1: telcagepant (280-mg tablet/300-mg capsule), Period 2: acetaminophen (1000-mg); or (2) Period 1: placebo for attack 1 then acetaminophen for subsequent attacks, Period 2: telcagepant. Patients could treat up to 12 migraine attacks per period to assess the tolerability of telcagepant. The primary efficacy analysis evaluated telcagepant vs placebo on 2-hour pain freedom during the first attack of Period 1. RESULTS One hundred and sixty-five of the planned 400 patients were enrolled, and 114 took at least one dose of treatment. Telcagepant was not statistically different from placebo for 2-hour pain freedom (25.0% vs 18.9%, odds ratio = 1.62 [95% confidence interval: 0.62, 4.25]). The median number of attacks treated per period was 3. No cardiovascular thrombotic adverse events occurred within 14 days of dosing. CONCLUSION The study was underpowered due to enrollment difficulties and did not demonstrate a significant efficacy difference between telcagepant and placebo for the treatment of a migraine attack in patients with stable coronary artery disease. Telcagepant was generally well tolerated for acute intermittent migraine treatment in these patients.
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Affiliation(s)
- Tony W Ho
- Merck Sharp & Dohme Corp., Whitehouse Station, NJ 19454-1099, USA.
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Jaggi AS, Singh N. Exploring the potential of telmisartan in chronic constriction injury-induced neuropathic pain in rats. Eur J Pharmacol 2011; 667:215-21. [DOI: 10.1016/j.ejphar.2011.06.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 04/05/2011] [Accepted: 06/14/2011] [Indexed: 12/16/2022]
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Abstract
Background: Medication repurposing, the practice of using old drugs in new ways, is becoming more common. Old drugs that had previously fallen out of favor due to safety concerns, lack of efficacy, or development of more desirable therapeutic alternatives have been resurfacing in the literature and on pharmacy shelves. Developing new uses for old drugs may provide patients with access to helpful therapies but may also present challenges and risks. Objective: To explore the rationale for, and historical context of, the developing trend of recycling existing drugs for new, innovative uses, and to provide pharmacy practitioners with information about how to find clinical evidence regarding these new uses. Data Synthesis: The process of obtaining marketing approval for new drugs can take an average of over 10 years and exceed $1 billion. Repurposing old drugs (both approved and unapproved) for new uses requires considerably fewer resources since information about production needs, pharmacology, and pharmacokinetics is already known. Other advantages of using old drugs include faster availability for patient use and known safety concerns for the original indication. Disadvantages of new uses for old drugs may include lack of clinical evidence, unknown safety for the new clinical context, limited availability of information about new uses, and liability or legal concerns. Several methods of identifying potential new uses exist, including the observance of previously unknown desirable pharmacologic effects during clinical use, new knowledge of a mechanism of action leading to exploration of innovative therapeutic areas, or screening compound libraries for targeted clinical activity. Conclusions: There are many examples of recycling existing medications for new purposes. Pharmacy practitioners should be aware of this developing trend and know how to find information about utilizing old drugs in new ways.
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Affiliation(s)
- Irene Seunghyun Hong
- IRENE SEUNGHYUN HONG PharmD, Clinical Assistant Professor, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY
| | - Heather J Ipema
- HEATHER J IPEMA PharmD, Clinical Assistant Professor, Drug Information Group, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Michael P Gabay
- MICHAEL P GABAY PharmD JD BCPS, Director, Drug Information Group, College of Pharmacy, University of Illinois at Chicago
| | - Amy E Lodolce
- AMY E LODOLCE PharmD BCPS, Assistant Director, Drug Information Group, College of Pharmacy, University of Illinois at Chicago
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Providencia RA. Headache and cardiovascular disease: old symptoms, new proposals. Future Cardiol 2010; 6:703-23. [DOI: 10.2217/fca.10.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Evidence of a link between headache symptoms and cardiovascular disease has rapidly grown in recent years and it is of utmost importance for the cardiologist and neurologist to be aware of this intimate connection. A brief overview of different cardiovascular diseases (namely hypertension, stroke, coronary heart disease, patent foramen ovale, atrial septal defects, atrial septal aneurisms, mitral valve prolapse, and aortic and carotid disease) that may be related to headache is presented in this article. Proposed pathophysiological mechanisms for this association and landmark studies are reviewed and discussed.
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Abstract
Progression of episodic migraine to chronic migraine may be related to comorbid medical conditions. In this study, we focused on the role played by arterial hypertension in migraine transformation. Several studies reveal that hypertension is associated with chronic migraine and may induce migraine chronification. Hypertension probably amplifies the effects of migraine on the vascular wall further enhancing the endothelial dysfunction in cerebral vasculature. Consequently, monitoring of blood pressure is recommended in migraineurs showing an otherwise unexplained increase in attack frequency. Studies are needed to verify if prophylactic treatment with drugs improving endothelial function (e.g. calcium channel blockers, beta blockers, calcium inhibitors, ACE inhibitors and sartans) may selectively ameliorate the course of migraine in these patients.
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