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Du K, Li A, Zhang CY, Li SM, Chen P. Repurposing antihypertensive drugs for pain disorders: a drug-target mendelian randomization study. Front Pharmacol 2024; 15:1448319. [PMID: 39268473 PMCID: PMC11390634 DOI: 10.3389/fphar.2024.1448319] [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: 06/13/2024] [Accepted: 08/16/2024] [Indexed: 09/15/2024] Open
Abstract
Objective Addressing the rising prevalence of pain disorders and limitations of current analgesics, our study explores repurposing antihypertensive drugs for pain management, inspired by the link between hypertension and pain. We leverage a drug-target Mendelian Randomization (MR) approach to explore their dual benefits and establish causal connections. Methods A comprehensive compilation of antihypertensive drug classes was undertaken through British National Formulary, with their target genes identified using the DrugBank database. Relevant single nucleotide polymorphisms (SNPs) associated with these targets were selected from published genomic studies on systolic blood pressure (SBP) as genetic instruments. These SNPs were validated through MR against acute coronary artery disease (CAD) to ensure genes not linked to CAD were excluded from acting as proxies for antihypertensive drugs. An MR analysis of 29 pain-related outcomes was conducted using the FinnGen R10 database employing the selected and validated genetic instruments. We utilized the Inverse Variance Weighted (IVW) method for primary analysis, applying Bonferroni correction to control type I error. IVW's multiplicative random effects (MRE) addressed heterogeneity, and MR-PRESSO managed pleiotropy, ensuring accurate causal inference. Results Our analysis differentiates strong and suggestive evidence in linking antihypertensive drugs to pain disorder risks. Strong evidence was found for adrenergic neuron blockers increasing migraine without aura risk, loop diuretics reducing panniculitis, and vasodilator antihypertensives lowering limb pain risk. Suggestive evidence suggests alpha-adrenoceptor blockers might increase migraine risk, while beta-adrenoceptor blockers could lower radiculopathy risk. Adrenergic neuron blockers also show a potential protective effect against coxarthrosis (hip osteoarthritis) and increased femgenpain risk (pain and other conditions related to female genital organs and menstrual cycle). Additionally, suggestive links were found between vasodilator antihypertensives and reduced radiculopathy risk, and both alpha-adrenoceptor blockers and renin inhibitors possibly decreasing dorsalgianas risk (unspecified dorsalgia). These findings highlight the intricate effects of antihypertensive drugs on pain disorders, underlining the need for further research. Conclusion The findings indicate that antihypertensive medications may exert varied effects on pain management, suggesting a repurposing potential for treating specific pain disorders. The results advocate for further research to confirm these associations and to explore underlying mechanisms, to optimize pain management practices.
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Affiliation(s)
- Kai Du
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Ao Li
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Chen-Yu Zhang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Shu-Ming Li
- Department of Pain Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Ping Chen
- Department of Pain Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
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Mosarrezaii A, Tahazadeh D, Soleimantabar H, Panahi P. Comparison of the Efficacy of Propranolol Versus Valsartan in the Prevention of Migraine: A Randomized Controlled Trial. Pain Manag Nurs 2024:S1524-9042(24)00201-7. [PMID: 39142916 DOI: 10.1016/j.pmn.2024.07.001] [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: 12/17/2023] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Migraine is a prevalent episodic headache that affects approximately 14%-15% of the global population. Since valsartan is an antihypertensive drug, it is hypothesized that taking valsartan can prevent migraine attacks in patients with the condition. This study aimed to determine the efficacy of propranolol versus valsartan in preventing migraine attacks. MATERIAL AND METHODS This randomized controlled trial was conducted on 56 patients with migraine from a neurology clinic. Patients were divided into two equal groups of 28 individuals, after providing informed consent. The patients then received either propranolol or valsartan treatment. The intensity and frequency of migraines were compared before and after treatment in both study groups. RESULTS The patients' mean age was 32.78 years old (±6.9 SD), and 64% of the patients were female. After a 1-month treatment period, the results showed that valsartan patients experienced significantly fewer severe migraine attacks compared to propranolol patients. CONCLUSION According to the results of the present study, valsartan may be at least as effective as propranolol and perhaps more effective on some measures.
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Affiliation(s)
- Arash Mosarrezaii
- Department of Neurology, School of Medicine, Neurophysiology Research Center, Cellular and Molecular Medicine Research Institute, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Danial Tahazadeh
- Department of Radiology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hussein Soleimantabar
- Department of Radiology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Pegah Panahi
- School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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3
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Chichorro JG, Gambeta E, Baggio DF, Zamponi GW. Voltage-gated Calcium Channels as Potential Therapeutic Targets in Migraine. THE JOURNAL OF PAIN 2024; 25:104514. [PMID: 38522594 DOI: 10.1016/j.jpain.2024.03.010] [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: 11/22/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
Migraine is a complex and highly incapacitating neurological disorder that affects around 15% of the general population with greater incidence in women, often at the most productive age of life. Migraine physiopathology is still not fully understood, but it involves multiple mediators and events in the trigeminovascular system and the central nervous system. The identification of calcitonin gene-related peptide as a key mediator in migraine physiopathology has led to the development of effective and highly selective antimigraine therapies. However, this treatment is neither accessible nor effective for all migraine sufferers. Thus, a better understanding of migraine mechanisms and the identification of potential targets are still clearly warranted. Voltage-gated calcium channels (VGCCs) are widely distributed in the trigeminovascular system, and there is accumulating evidence of their contribution to the mechanisms associated with headache pain. Several drugs used in migraine abortive or prophylactic treatment target VGCCs, which probably contributes to their analgesic effect. This review aims to summarize the current evidence of VGGC contribution to migraine physiopathology and to discuss how current pharmacological options for migraine treatment interfere with VGGC function. PERSPECTIVE: Calcitonin gene-related peptide (CGRP) represents a major migraine mediator, but few studies have investigated the relationship between CGRP and VGCCs. CGRP release is calcium channel-dependent and VGGCs are key players in familial migraine. Further studies are needed to determine whether VGCCs are suitable molecular targets for treating migraine.
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Affiliation(s)
- Juliana G Chichorro
- Biological Sciences Sector, Department of Pharmacology, Federal University of Parana, Curitiba, Parana, Brazil.
| | - Eder Gambeta
- Cumming School of Medicine, Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Darciane F Baggio
- Biological Sciences Sector, Department of Pharmacology, Federal University of Parana, Curitiba, Parana, Brazil
| | - Gerald W Zamponi
- Cumming School of Medicine, Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Versijpt J, Deligianni C, Hussain M, Amin F, Reuter U, Sanchez-Del-Rio M, Uluduz D, Boucherie D, Zeraatkar D, MaassenVanDenBrink A, Sacco S, Lampl C, Gil-Gouveia R. European Headache Federation (EHF) critical re-appraisal and meta-analysis of oral drugs in migraine prevention - part 4: propranolol. J Headache Pain 2024; 25:119. [PMID: 39044170 PMCID: PMC11267726 DOI: 10.1186/s10194-024-01826-y] [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: 03/09/2024] [Accepted: 07/11/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVE The aim of this paper is to critically re-appraise the published trials assessing propranolol for migraine prophylaxis. METHODS We report methods and results following the Preferred Reporting Items for Systematic Reviews (PRISMA), by searching MEDLINE, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov for randomized trials of pharmacologic treatments for migraine prophylaxis. We included randomized trials that compared propranolol with placebo for migraine prophylaxis in adults. The outcomes of interest were informed by the Core outcome set for preventive intervention trials in chronic and episodic migraine (COSMIG) and include the proportion of patients who experience a 50% or more reduction in monthly migraine days, the reduction of monthly migraine days, and the number of adverse events leading to discontinuation. We assessed risk of bias by using a modified Cochrane RoB (risk of bias) 2.0 tool and the certainty of evidence by using the GRADE approach. RESULTS Our search yielded twenty trials (n = 1291 patients) eligible for data synthesis and analysis. The analysis revealed a moderate certainty evidence that propranolol leads to a reduction in monthly migraine days versus placebo (-1.27; 95% CI: -2.25 to -0.3). We found moderate certainty evidence that propranolol increases the proportion of patients who experience a 50% or more reduction in monthly migraine days, compared to placebo with a relative risk of 1.65 (95% CI 1.41 to 1.93); absolute risk difference: 179 more per 1,000 (95% CI 113 to 256). We found high certainty evidence that propranolol increases the proportion of patients who discontinue due to adverse events compared to placebo with a risk difference of 0.02 (95% CI 0.00 to 0.03); absolute risk difference: 20 more per 1,000 (95% CI 0 to 30). CONCLUSIONS The present meta-analysis shows that propranolol has a prophylactic role in migraine, with an overall acceptable tolerability profile. Combining these results with its long-standing use and its global availability at a low cost confirms its role as a first line agent in the prophylaxis of migraine.
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Affiliation(s)
- Jan Versijpt
- Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
| | | | - Muizz Hussain
- Department of Anesthesia and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Faisal Amin
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Derya Uluduz
- Department of Neurology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Deirdre Boucherie
- Department of Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus MC Medical Center, Rotterdam, the Netherlands
| | - Dena Zeraatkar
- Department of Anesthesia and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Antoinette MaassenVanDenBrink
- Department of Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus MC Medical Center, Rotterdam, the Netherlands
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L´Aquila, Rome, Italy
| | - Christian Lampl
- Department of Neurology and Stroke Unit Konventhospital Barmherzige Brüder Linz, Linz, Austria
| | - Raquel Gil-Gouveia
- Neurology Department, Hospital da Luz Headache Center, Hospital da Luz Lisboa, Lisbon, Portugal
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5
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Gościniak A, Stasiłowicz-Krzemień A, Michniak-Kohn B, Fiedor P, Cielecka-Piontek J. One Molecule, Many Faces: Repositioning Cardiovascular Agents for Advanced Wound Healing. Molecules 2024; 29:2938. [PMID: 38931002 PMCID: PMC11206936 DOI: 10.3390/molecules29122938] [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: 05/15/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
Chronic wound treatments pose a challenge for healthcare worldwide, particularly for the people in developed countries. Chronic wounds significantly impair quality of life, especially among the elderly. Current research is devoted to novel approaches to wound care by repositioning cardiovascular agents for topical wound treatment. The emerging field of medicinal products' repurposing, which involves redirecting existing pharmaceuticals to new therapeutic uses, is a promising strategy. Recent studies suggest that medicinal products such as sartans, beta-blockers, and statins have unexplored potential, exhibiting multifaceted pharmacological properties that extend beyond their primary indications. The purpose of this review is to analyze the current state of knowledge on the repositioning of cardiovascular agents' use and their molecular mechanisms in the context of wound healing.
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Affiliation(s)
- Anna Gościniak
- Department of Pharmacognosy and Biomaterials, Poznan University of Medical Sciences, Rokietnicka 3 Str., 60-806 Poznań, Poland; (A.G.); (A.S.-K.)
| | - Anna Stasiłowicz-Krzemień
- Department of Pharmacognosy and Biomaterials, Poznan University of Medical Sciences, Rokietnicka 3 Str., 60-806 Poznań, Poland; (A.G.); (A.S.-K.)
| | - Bożena Michniak-Kohn
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers-The State University of New Jersey, Piscataway, NJ 08854, USA;
- Center for Dermal Research, Rutgers-The State University of New Jersey, Piscataway, NJ 08854, USA
| | - Piotr Fiedor
- Department of General and Transplantation Surgery, Medical University of Warsaw, 02-008 Warsaw, Poland;
| | - Judyta Cielecka-Piontek
- Department of Pharmacognosy and Biomaterials, Poznan University of Medical Sciences, Rokietnicka 3 Str., 60-806 Poznań, Poland; (A.G.); (A.S.-K.)
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Mehramiri A, Shalilahmadi D, Mohamadianinejad SE, Kouti L, Hosseinpour Y. The Effect of Melatonin on Reducing the Frequency and Severity of Migraine Attacks: A Double-Blind, Randomized Clinical Trial. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:313-321. [PMID: 38751874 PMCID: PMC11091273 DOI: 10.30476/ijms.2023.97782.2965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/27/2023] [Accepted: 08/12/2023] [Indexed: 05/18/2024]
Abstract
Background There is no definite recommendation for melatonin supplementation in episodic migraine. This study aimed to evaluate the effect of melatonin on reducing the frequency and severity of migraine attacks. Methods This randomized, double-blind clinical trial was conducted at Golestan Hospital of Ahvaz, Iran, in 2021. A total of 60 patients with episodic migraine were randomly assigned into 2 groups of receiving 3 mg melatonin (intervention group; n=30) or the same dose of placebo (control group; n=30) along with baseline therapy (propranolol 20 mg, BID) for two months. The attack frequency, attack duration, attack severity (based on VAS), the number of analgesic intakes, drug complications, Migraine Disability Assessment score (MIDAS), and Pittsburgh sleep quality index (PSQI) were evaluated at baseline and in the first, second, third, and fourth months of follow-up. The independent t test, chi-square, and analysis of variance (ANOVA) with repeated measures were used to compare variables between the two groups. Results In both groups, the frequency, duration, and severity of attacks, taking analgesics, MIDAS, and PSQI scores during follow-up decreased significantly (P<0.001). After treatment, the mean frequency (P=0.032) and duration of attacks (P=0.001), taking analgesic (P<0.001), and MIDAS (P<0.001) and PSQI scores (P<0.001) in the melatonin group were lower than placebo. Only the attack severity was not significantly different between the two groups (P=0.126). Side effects were observed in two patients (6.7%) in the melatonin group and one patient (3.3%) in the placebo group (P>0.999). Conclusion Our study shows that melatonin was more efficacious than the placebo in the reduction of frequency and duration of migraine attacks. It was equally safe as the placebo and might be effective in the preventive treatment of episodic migraine in adults.Trial Registration Number: IRCT20190107042264N5.
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Affiliation(s)
- Asieh Mehramiri
- Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Davood Shalilahmadi
- Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Leila Kouti
- Department of Clinical Pharmacy, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Yazdan Hosseinpour
- Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Chowdhury D, Datta D, Mundra A, Duggal A, Krishnan A. Interictal Dysfunctions of Attention, Vigilance, and Executive Functions in Migraine and Their Reversal by Preventive Treatment: A longitudinal Controlled Study. Ann Indian Acad Neurol 2024; 27:254-263. [PMID: 38819434 PMCID: PMC11232828 DOI: 10.4103/aian.aian_40_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/31/2024] [Accepted: 04/11/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE To assess attention, vigilance, and executive functions in migraine patients during headache-free (interictal) periods and in healthy controls without migraine and to study the impact of migraine preventive treatment on these cognitive functions. METHODS Preventive drug-naive migraine patients, aged ≥18 years, without a history of medication overuse were studied and compared to non-migraine controls. Psychiatric comorbidity was screened by Patient Health Questionnaire-9, and those who screened positive were evaluated further by specific scales. The Epworth Sleepiness Scale assessed subjective complaints of sleep quality. Cognitive functions were assessed by Mini-Mental State Examination (MMSE), digit span forward and backward (DS-F, DS-B), trail-making tests (TMT-A and B) and Stroop word (SW), Stroop color (SC), and Stroop interference (SI) tests. Cognitive test scores at the end of 6 months following treatment were compared to baseline scores. RESULTS One hundred and fifty migraine patients and controls each were studied. Compared to controls, migraine patients performed significantly worse in DS-B ( P < 0.0001), TMT-A ( P = 0.00004), TMT-B ( P < 0.0001), SW ( P < 0.0001), SC ( P < 0.0001), and SI ( P = 0.0221). MMSE scores did not differ between patients and the controls ( P = 0.3224). Compared to the patients without psychiatric comorbidity, migraine patients with psychiatric comorbidity showed no significant differences in the cognitive test scores. Significant improvement in all cognitive test scores ( P < 0.001) was observed after 6 months of treatment. CONCLUSION Migraine patients, compared to non-migraine controls, showed deficits in attention, vigilance, and executive functions during the interictal period, which improved with successful preventive treatment. Psychiatric comorbidities did not have a significant impact on cognitive dysfunctions.
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Affiliation(s)
- Debashish Chowdhury
- Department of Neurology, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi
| | - Debabrata Datta
- Department of Neurology, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi
| | - Ankit Mundra
- Department of Neurology, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi
| | - Ashish Duggal
- Department of Neurology, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi
| | - Anand Krishnan
- Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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8
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Pavelić AR, Zebenholzer K, Wöber C. Reconceptualizing autonomic function testing in migraine: a systematic review and meta-analysis. J Headache Pain 2024; 25:54. [PMID: 38600467 PMCID: PMC11005222 DOI: 10.1186/s10194-024-01758-7] [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: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Autonomic nervous system (ANS) testing has aided in our ability to evaluate autonomic dysfunction in migraine patients. We reviewed the literature in multiple databases which investigate ANS function in migraine patients and healthy subjects. METHODS This systematic review and meta-analysis examined the respective deep breathing, Valsalva manoeuvre, orthostatic and isometric challenge results, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analyses of Observational Studies in Epidemiology (MOOSE) statements. RESULTS Seven articles met all inclusion criteria. Fixed-effects meta-analysis showed migraine patients (n = 424), collectively, had lower interictal autonomic test results compared with healthy controls (n = 268). In detail, this was true for the standardized mean difference (g) of deep breathing (g= -0.32; 95% confidence interval (CI) -0.48, -0.16), orthostatic challenge (g= -0.28; 95% CI -0.44, -0.13) and isometric challenge (g= -0.55; 95% CI -0.71, -0.39) and for the difference of means (MD) of the Valsalva ratio (MD = -0.17; 95% CI -0.23, -0.10). CONCLUSIONS Interictal ANS dysfunction can be identified in migraine patients when compared to healthy controls. These findings indicate the importance to evaluate ANS function in migraine patients - especially, as migraine-specific prophylactic therapies (such as anti-calcitonin gene-related peptide (CGRP) antibodies) may affect the function of the ANS.
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Affiliation(s)
- Antun R Pavelić
- Department of Neurology, University Hospital Tulln, Alter Ziegelweg 10, Tulln, 3430, Austria
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Karin Zebenholzer
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria.
- Medical University of Vienna Comprehensive Center for Clinical Neurosciences & Mental Health, Vienna, 1090, Austria.
| | - Christian Wöber
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
- Medical University of Vienna Comprehensive Center for Clinical Neurosciences & Mental Health, Vienna, 1090, Austria
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Diener HC, May A. New migraine drugs: A critical appraisal of the reason why the majority of migraine patients do not receive an adequate medication. Cephalalgia 2024; 44:3331024241228605. [PMID: 38520255 DOI: 10.1177/03331024241228605] [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: 03/25/2024]
Abstract
The last three decades have produced several novel and efficient medications to treat migraine attacks and reduce attack frequency. Additionally, promising approaches for the development of acute therapy and migraine prophylaxis continue to be pursued. At the same time as we witness the development of better and more efficient medications with continuously fewer side effects, we also realise that the high cost of such therapies means that only a minority of migraine patients who could benefit from these medications can afford them. Furthermore, information on cost-effectiveness is still lacking. Here, we compare availiable data, highlight open questions and suggest trials to close knowledge gaps. With good reason, our medicine is evidence-based. However, if this evidence is not collected, our decisions will continue to be based on marketing and assumptions. At the moment, we are not doing justice to our patients.
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Affiliation(s)
- Hans Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Arne May
- Department of Systems Neuroscience, University Hamburg, Hamburg, Germany
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10
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Dzator JSA, Smith RA, Coupland KG, Howe PRC, Griffiths LR. Associations between Cerebrovascular Function and the Expression of Genes Related to Endothelial Function in Hormonal Migraine. Int J Mol Sci 2024; 25:1694. [PMID: 38338971 PMCID: PMC10855027 DOI: 10.3390/ijms25031694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
There is evidence to suggest that hormonal migraine is associated with altered cerebrovascular function. We aimed to investigate whether the expression of genes related to endothelial function in venous blood (1) might influence cerebrovascular function, (2) differs between hormonal migraineur and non-migraineur women, and (3) changes following resveratrol supplementation. This study utilised data obtained from 87 women (59 hormonal migraineurs and 28 controls) where RNA from venous blood was used to quantify gene expression and transcranial Doppler ultrasound was used to evaluate cerebrovascular function. Spearman's correlation analyses were performed between gene expression, cerebrovascular function, and migraine-related disability. We compared the expression of genes associated with endothelial function between migraineurs and non-migraineurs, and between resveratrol and placebo. The expression of several genes related to endothelial function was associated with alterations in cerebrovascular function. Notably, the expression of CALCA was associated with increased neurovascular coupling capacity (p = 0.013), and both CALCA (p = 0.035) and VEGF (p = 0.014) expression were associated with increased cerebral blood flow velocity in the overall study population. Additionally, VCAM1 expression correlated with decreased pulsatility index (a measure of cerebral arterial stiffness) (p = 0.009) and headache impact test-6 scores (p = 0.007) in the migraineurs. No significant differences in gene expression were observed between migraineurs and controls, or between placebo and resveratrol treatments in migraineurs. Thus, altering the expression of genes related to endothelial function may improve cerebrovascular function and decrease migraine-related disability.
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Affiliation(s)
- Jemima S. A. Dzator
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW 2308, Australia (P.R.C.H.)
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
| | - Robert A. Smith
- Genomics Research Centre, Centre for Genomics and Personalised Health, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Kirsten G. Coupland
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW 2308, Australia (P.R.C.H.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Peter R. C. Howe
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW 2308, Australia (P.R.C.H.)
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
- Centre for Health Research, University of Southern Queensland, Raceview, QLD 4350, Australia
| | - Lyn R. Griffiths
- Genomics Research Centre, Centre for Genomics and Personalised Health, Queensland University of Technology, Brisbane, QLD 4059, Australia
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Kalala SS, Schumacher LM, Thomas JG, Lipton RB, Pavlovic J, Bond DS. Association of Migraine and Blood Pressure-Does Obesity Severity Have a Moderating Role? Int J Behav Med 2023:10.1007/s12529-023-10241-7. [PMID: 37973767 DOI: 10.1007/s12529-023-10241-7] [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] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The relationship between migraine and blood pressure (BP) is equivocal, warranting exploration of potential moderators. Obesity associates with both migraine and BP in a dose-dependent fashion, although its role as a moderator has not been evaluated. We examined the relation between migraine and BP in women with comorbid migraine and obesity, and whether this relation was influenced by obesity severity. METHODS Women with migraine and obesity (n = 134) completed a 28-day headache diary before randomization to lifestyle intervention or migraine education. BP (systolic (SBP)/diastolic (DBP)), body mass index (BMI), and waist circumference (WC) were measured before diary completion. Hierarchical linear regression assessed associations between BP and migraine characteristics (headache frequency, duration, and pain intensity), and obesity severity (both total (BMI) and abdominal (WC)) as moderators of these associations. RESULTS Participants (BMI = 35.4 ± 6.5 kg/m2; WC = 105.4 ± 15.6 cm, SBP = 113.1 ± 12.1/DPB = 68.1 ± 8.0 mmHg) reported 8.4 ± 4.5 migraine days that lasted 20.2 ± 15.9 h with mean pain intensity of 5.9 ± 1.6 on a 10-point scale. DBP inversely related to migraine days in both total (β = - 0.226, p = .010) and abdominal (β = 0.214, p = .015) obesity severity models. SBP and obesity severity did not relate to migraine characteristics. Obesity severity did not moderate relations between migraine characteristics and BP (p's > .05). CONCLUSION Among women with comorbid migraine and obesity, DBP inversely related to migraine frequency; however, obesity severity did not affect the strength of this or other examined associations. Future studies including healthy weight controls and men and women with continuous BP measures are needed to confirm these findings and identify mechanisms and moderators.
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Affiliation(s)
| | - Leah M Schumacher
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1801 N. Broad St, Philadelphia, PA, 19129, USA.
| | - J Graham Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Richard B Lipton
- Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Jelena Pavlovic
- Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Dale S Bond
- Departments of Surgery and Research, Hartford Hospital/Hartford HealthCare, Hartford, CT, USA
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12
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Suri P, Elgaeva EE, Williams FMK, Freidin MB, Verzun DA, Tsepilov YA. Repurposing Antihypertensive and Statin Medications for Spinal Pain: A Mendelian Randomization Study. Spine (Phila Pa 1976) 2023; 48:1568-1574. [PMID: 37539717 DOI: 10.1097/brs.0000000000004790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023]
Abstract
STUDY DESIGN Mendelian randomization (MR) study. OBJECTIVE To examine whether antihypertensive medications (beta-blockers, calcium channel blockers, and angiotensin-converting enzyme inhibitors) and statins can be repurposed to prevent or treat spinal pain (back or neck pain). SUMMARY OF BACKGROUND DATA Observational studies and a recent MR study have found associations between elevated blood pressure and a greater risk of back pain. Observational studies have found associations between hyperlipidemia and statin use and greater risk of back pain. No prior MR studies have examined the effects of antihypertensives or statins on spinal pain. MATERIALS AND METHODS This was a two-sample MR study using publicly available summary statistics from large-scale genome-wide association studies (GWAS). Sample sizes in exposure GWASs were n=757,601 (systolic blood pressure) and n=173,082 (low-density lipoprotein cholesterol), and n=1,028,947 for the outcome GWAS of spinal pain defined as health care seeking for any spinal pain-related diagnosis. Genes and cis-acting variants were identified as proxies for the drug targets of interest. MR analyses used inverse-variance weighted meta-analysis. The threshold for statistical significance after correction for multiple testing was P <0.0125. RESULTS No statistically significant associations of these medications with spinal pain were found. However, findings were suggestive of a protective effect of beta-blockers on spinal pain risk (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.72-0.98; P =0.03), and calcium channel blockers on greater spinal pain risk (OR 1.12, 95% CI 1.02-1.24; P =0.02). CONCLUSIONS A protective effect of beta-blockers on spinal pain was suggested in the current study, consistent with findings from observational studies of various other pain phenotypes. The detrimental effect of calcium channel blockers on spinal pain suggested in the current study must be interpreted in the context of conflicting directions of effect on nonspinal pain phenotypes in other observational studies.This Mendelian randomization study examined whether antihypertensive medications (beta-blockers, calcium channel blockers, and angiotensin-converting enzyme inhibitors) and statins can be repurposed to prevent or treat spinal.This was a two-sample MR study using publicly available summary statistics from large-scale genome-wide association studies ranging size from 173,082 to 1,028,947 adults.While no statistically significant associations were found, a protective effect of beta-blockers on spinal pain was suggested (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.72 to 0.98; p= 0.03), as was a detrimental effect of calcium channel blockers on spinal pain (OR 1.12, 95% CI 1.02 to 1.24; p= 0.02).
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Affiliation(s)
- Pradeep Suri
- Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, WA
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA
- Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, WA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Elizaveta E Elgaeva
- Department of Natural Sciences, Novosibirsk State University, Novosibirsk, Russia
- Laboratory of Recombination and Segregation Analysis, Institute of Cytology and Genetics, Novosibirsk, Russia
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - Maxim B Freidin
- Department of Biology, School of Biological and Behavioural Sciences, Queen Mary University of London, UK
| | - Dmitrii A Verzun
- Department of Natural Sciences, Novosibirsk State University, Novosibirsk, Russia
- Laboratory of Recombination and Segregation Analysis, Institute of Cytology and Genetics, Novosibirsk, Russia
| | - Yakov A Tsepilov
- Laboratory of Recombination and Segregation Analysis, Institute of Cytology and Genetics, Novosibirsk, Russia
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13
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Juhasz G, Gecse K, Baksa D. Towards precision medicine in migraine: Recent therapeutic advances and potential biomarkers to understand heterogeneity and treatment response. Pharmacol Ther 2023; 250:108523. [PMID: 37657674 DOI: 10.1016/j.pharmthera.2023.108523] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/11/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023]
Abstract
After 35 years since the introduction of the International Classification of Headache Disorders (ICHD), we are living in the era of the second great revolution in migraine therapies. First, discoveries of triptans provided a breakthrough in acute migraine treatment utilizing bench-to-bedside research results on the role of serotonin in migraine. Next, the discovery of the role of neuropeptides, more specifically calcitonin gene-related peptide (CGRP) in migraine attack led to the development of anti-CGRP therapies that are effective both in acute and preventive treatment, and are also able to reduce migraine-related burden. Here, we reviewed the most recent clinical studies and real-world data on available migraine-specific medications, including triptans, ditants, gepants and anti-CGRP monoclonal antibodies. Novel drug targets, such as PACAP and amylins were also discussed. To address the main challenges of migraine therapy, the high heterogeneity of people with migraine, the prevalent presence of various comorbid disorders, and the insufficient medical care of migraine patients were covered. Promising novel approaches from the fields of omics, blood and saliva biomarker, imaging and provocation studies might bring solutions for these challenges with the potential to identify further drug targets, distinguish more homogeneous patient subgroups, contribute to more optimal drug selection strategies, and detect biomarkers in association with headache features or predicting treatment efficacy. In the future, the combined analysis of data of different biomarker modalities with machine learning algorithms may serve precision medicine in migraine treatment.
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Affiliation(s)
- Gabriella Juhasz
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary; NAP3.0 Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.
| | - Kinga Gecse
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary; NAP3.0 Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
| | - Daniel Baksa
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary; NAP3.0 Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary; Department of Personality and Clinical Psychology, Institute of Psychology, Faculty of Humanities and Social Sciences, Pazmany Peter Catholic University, Budapest, Hungary
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14
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Ingram EE, Bocklud BE, Corley SC, Granier MA, Neuchat EE, Ahmadzadeh S, Shekoohi S, Kaye AD. Non-CGRP Antagonist/Non-Triptan Options for Migraine Disease Treatment: Clinical Considerations. Curr Pain Headache Rep 2023; 27:497-502. [PMID: 37584847 DOI: 10.1007/s11916-023-01151-0] [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] [Accepted: 07/17/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE OF REVIEW Although the association between CGRP and migraine disease is well-known and studied, therapies can target other pathways to minimize migraine symptoms. It is important to understand the role of these medications as options for migraine treatment and the varied mechanisms by which symptoms can be addressed. In the present investigation, the role of non-CGRP antagonist/non-triptan options for migraine disease therapy is reviewed, including NSAIDs, ß-blockers, calcium channel blockers, antidepressants, and antiepileptics. Pharmacologic therapies for both acute symptoms and prophylaxis are evaluated, and their adverse effects are compared. RECENT FINDINGS At present, the Food and Drug Association has approved the beta-blockers propranolol and timolol and the anti-epileptic drugs topiramate and divalproex sodium for migraine prevention. Clinicians have other options for evidence-based treatment of episodic migraine attacks. Treatment decisions should consider contraindications, the effectiveness of alternatives, and potential side effects. NSAIDs are effective for the acute treatment of migraine exacerbations with caution for adverse effects such as gastrointestinal upset and renal symptoms. Beta-blockers are effective for migraine attack prophylaxis but are associated with dizziness and fatigue and are contraindicated in patients with certain co-morbidities, including asthma, congestive heart failure, and abnormal cardiac rhythms. Calcium channel blockers do not show enough evidence to be recommended as migraine attack prophylactic therapy. The anti-epileptic drugs topiramate and divalproex sodium and antidepressants venlafaxine and amitriptyline are effective for migraine exacerbation prophylaxis but have associated side effects. The decision for pharmacologic management should ultimately be made following consideration of risk vs. benefit and discussion between patient and physician.
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Affiliation(s)
- Ellen E Ingram
- School of Medicine, Louisiana State University Health Sciences Center at New Orleans, New Orleans, LA, 70112, USA
| | - Brooke E Bocklud
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Sarah C Corley
- School of Medicine, Louisiana State University Health Sciences Center at New Orleans, New Orleans, LA, 70112, USA
| | - Mallory A Granier
- School of Medicine, Louisiana State University Health Sciences Center at New Orleans, New Orleans, LA, 70112, USA
| | - Elisa E Neuchat
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Alan D Kaye
- Department of Anesthesiology, Department of Pharmacology, Louisiana State University Health Sciences Center at Shreveport, Toxicology, and Neurosciences1501 Kings Highway, Shreveport, LA, 71103, USA
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15
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George E, Straube A, Kamm K. [Migraine - diagnosis and prophylaxis]. MMW Fortschr Med 2023; 165:52-58. [PMID: 37759020 DOI: 10.1007/s15006-023-2884-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Affiliation(s)
- Elizabeth George
- Neurologische Klinik und -Poliklinik, LMU Klinikum Campus Großhadern, München, Deutschland
| | - Andreas Straube
- Neurologische Klinik / Oberbayer. Kopfschmerzzentrum, Klinikum Großhadern der LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - Katharina Kamm
- - Neurolog. Klinik und Poliklinik -, Klinikum Großhadern d. LMU München, Marchioninistraße 15, 81377, München, Deutschland.
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16
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Pinheiro-Araujo CF, Rocha MR, Carvalho GF, Moraes R, Silva DC, Dach F, Bevilaqua-Grossi D. One-year changes in clinical and balance parameters in individuals of different subtypes of migraine. Musculoskelet Sci Pract 2023; 66:102806. [PMID: 37400347 DOI: 10.1016/j.msksp.2023.102806] [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: 05/03/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Migraine has been associated with balance dysfunction, more pronounced in patients with aura and chronic migraine. Also, it has been suggested that balance deficits are progressive through the migraineurs lifetime. OBJECTIVE To analyze the one-year progression of balance parameters and clinical parameters associated with balance in female patients with and without migraine. DESIGN Prospective cohort study. METHODS The participants were distributed in four groups: control (CG; n = 27) migraine with aura (MA; n = 25), migraine without aura (MwA; n = 26), and chronic migraine (CM; n = 27). They performed the Sensory Organization Test, Motor Control Test and Adaptation Test protocols of dynamic posturography tests. Questionnaires about fear of falls, dizziness disability, and kinesiophobia were administered. These assessments were performed twice: baseline and after 1-year (follow-up). No intervention was performed for balance improvement, and the participants maintained their usual migraine treatment prescribed. RESULTS None of the groups differed in balance tests between baseline and follow-up. We observed a reduction in migraine frequency in MA (-2.2 days, p = 0.01) and CM (-10.8 days, p < 0.001) groups, and in the migraine intensity (-2.3 points, p = 0.001) in CM group. Significant decreases in the scores of fear of falling, dizziness disability, and kinesiophobia were observed in the migraine groups (p < 0.05), but the differences did not exceed the minimal detectable change of the questionaries scores. CONCLUSION Women with different migraine subtypes did not present balance changes in a one-year interval. The improvements in migraine's clinical features were not accompanied by improvements in balance parameters.
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Affiliation(s)
- Carina F Pinheiro-Araujo
- Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil.
| | - Michely R Rocha
- Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil.
| | - Gabriela F Carvalho
- Institute of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
| | - Renato Moraes
- Biomechanics and Motor Control Lab, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Bandeirantes Avenue, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil.
| | - Daiane C Silva
- Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil.
| | - Fabiola Dach
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil.
| | - Debora Bevilaqua-Grossi
- Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil.
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Lampl C, MaassenVanDenBrink A, Deligianni CI, Gil-Gouveia R, Jassal T, Sanchez-Del-Rio M, Reuter U, Uluduz D, Versijpt J, Zeraatkar D, Sacco S. The comparative effectiveness of migraine preventive drugs: a systematic review and network meta-analysis. J Headache Pain 2023; 24:56. [PMID: 37208596 DOI: 10.1186/s10194-023-01594-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVE While there are several trials that support the efficacy of various drugs for migraine prophylaxis against placebo, there is limited evidence addressing the comparative safety and efficacy of these drugs. We conducted a systematic review and network meta-analysis to facilitate comparison between drugs for migraine prophylaxis. METHODS We searched MEDLINE, EMBASE, CENTRAL, and clinicaltrials.gov from inception to August 13, 2022, for randomized trials of pharmacological treatments for migraine prophylaxis in adults. Reviewers worked independently and in duplicate to screen references, extract data, and assess risk of bias. We performed a frequentist random-effects network meta-analysis and rated the certainty (quality) of evidence as either high, moderate, low, or very low using the GRADE approach. RESULTS We identified 74 eligible trials, reporting on 32,990 patients. We found high certainty evidence that monoclonal antibodies acting on the calcitonin gene related peptide or its receptor (CGRP(r)mAbs), gepants, and topiramate increase the proportion of patients who experience a 50% or more reduction in monthly migraine days, compared to placebo. We found moderate certainty evidence that beta-blockers, valproate, and amitriptyline increase the proportion of patients who experience a 50% or more reduction in monthly migraine days, and low certainty evidence that gabapentin may not be different from placebo. We found high certainty evidence that, compared to placebo, valproate and amitriptyline lead to substantial adverse events leading to discontinuation, moderate certainty evidence that topiramate, beta-blockers, and gabapentin increase adverse events leading to discontinuation, and moderate to high certainty evidence that (CGRP(r)mAbs) and gepants do not increase adverse events. CONCLUSIONS (CGRP(r)mAbs) have the best safety and efficacy profile of all drugs for migraine prophylaxis, followed closely by gepants.
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Affiliation(s)
- Christian Lampl
- Department of Neurology, Konventhospital Barmherzige Brüder Linz, Linz, Austria.
- Headache Medical Center Linz, Linz, Austria.
| | | | | | - Raquel Gil-Gouveia
- Neurology Department, Hospital da Luz Headache Center, Hospital da Luz Lisboa, Lisbon, Portugal
- Center for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Tanvir Jassal
- Department of Anesthesia and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | | | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Derya Uluduz
- Department of Neurology Istanbul Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Jan Versijpt
- Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Dena Zeraatkar
- Department of Anesthesia and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L´Aquila, L'Aquila, Italy
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Silvestro M, Orologio I, Siciliano M, Trojsi F, Tessitore A, Tedeschi G, Russo A. Emerging drugs for the preventive treatment of migraine: a review of CGRP monoclonal antibodies and gepants trials. Expert Opin Emerg Drugs 2023. [PMID: 37185047 DOI: 10.1080/14728214.2023.2207819] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Migraine is a leading cause of years lived with disability and preventive strategies represent a mainstay to reduce health-related disability and improve quality of life of migraine patients. Until a few years ago, migraine prevention was based on drugs developed for other clinical indications and relocated in the migraine therapeutic armamentarium, characterized by unfavourable tolerability profiles. The advent of monoclonal antibodies against Calcitonin Gene-Related Peptide (CGRP) and gepants, CGRP receptor antagonists, has been a turning point in migraine prevention owing to advantageous efficacy, safety and tolerability profiles.Nevertheless, while in an ideal scenario a drug characterized by significant greater efficacy and tolerability compared to existing therapeutic strategies should be adopted as a first-line treatment, cost-effectiveness analyses available for monoclonal antibodies against CGRP pathway tend to limit their administration to more severe migraine phenotypes. AREAS COVERED The present narrative review aim to provide a critical appraisal of phase II and III CGRP-mAbs and gepants trials to analyse their use in clinical practice. EXPERT OPINION Despite monoclonal antibodies against CGRP pathway and gepants can be undoubtedly considered top-of-the-range treatments, there are still issues deserving to be addressed in the coming years as the risk of off-target effects as well as their economic sustainability based on the considerable migraine burden.
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Affiliation(s)
- Marcello Silvestro
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Ilaria Orologio
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Mattia Siciliano
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Francesca Trojsi
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Alessandro Tessitore
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Gioacchino Tedeschi
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Antonio Russo
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
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[Consensus statement of the migraine and headache societies (DMKG, ÖKSG, and SKG) on the duration of pharmacological migraine prophylaxis]. Schmerz 2023; 37:5-16. [PMID: 36287263 PMCID: PMC9607711 DOI: 10.1007/s00482-022-00671-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 02/03/2023]
Abstract
Migraine is the most common neurological disorder and can be associated with a high degree of disability. In addition to non-pharmacological approaches to reduce migraine frequency, pharmacological migraine preventatives are available. Evidence-based guidelines from the German Migraine and Headache Society (DMKG), and German Society for Neurology (DGN), Austrian Headache Society (ÖKSG), and Swiss Headache Society (SKG) are available for indication and application. For therapy-relevant questions such as the duration of a pharmacological migraine prevention, no conclusions can be drawn from currently available study data. The aim of this review is to present a therapy consensus statement that integrates the current data situation and, where data are lacking, expert opinions. The resulting current recommendations on the duration of therapy for pharmacological migraine prophylaxis are shown here.
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Tabet P, Elblidi A, Saliba I. Vestibular Migraine versus Méniere's Disease: Diagnostic Utility of Electrocochleography. Audiol Res 2022; 13:12-22. [PMID: 36648923 PMCID: PMC9844276 DOI: 10.3390/audiolres13010002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Objectives: The diagnostic criteria for vestibular migraine (VM) and Méniere’s disease (MD) present an important overlap, which leads to a difficult diagnosis in patients presenting with headache, vertigo, hearing loss, ear fullness, and tinnitus. The objective of our study is to determine whether the area-under-the-curve ratio of the summating potentials (SP) and action potentials (AP) curves on electrocochleography (ECoG) helps differentiate VM from MD with or without the use of the well-established clinical criteria. Method: A retrospective review of patients filling either VM or MD criteria was undertaken between September 2015 and December 2018. All patients underwent ECoG before the introduction of anti-migraine therapy. The prediction of symptom improvement between the clinical criteria and ECoG results was compared by using the Vertigo Symptom Scale. Results: In total, 119 patients were included. An overlap of 36% exists between patients filling VM and MD criteria. Clinical criteria alone did not demonstrate a significant prediction of symptom response to anti-migraine therapy (VM 83%, MD 51%; p = 0.10). However, ECoG results alone did demonstrate adequate prediction (VM 94%, MD 32%; p < 0.001). A negative ECoG result combined with the clinical criteria of VM (100% symptom improvement) was shown to be more predictive of treatment response when compared to clinical criteria alone (83% symptom improvement) (p = 0.017). Finally, when used in patients filling both the VM and MD criteria (VMMD), ECoG was able to predict symptom improvement, thus better differentiating both diseases (normal ECoG: 95%, abnormal ECoG 29%; p < 0.001). Conclusion: Combining VM criteria with normal ECoG using the AUC ratio seems superior in predicting adequate symptom improvement than VM criteria alone.
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Affiliation(s)
- Paul Tabet
- Division of Otolaryngology Head & Neck Surgery, University of Montreal Hospital Center (CHUM), Montreal, QC H2X 3E4, Canada
| | - Ahlem Elblidi
- Division of Otolaryngology Head & Neck Surgery, University of Montreal Hospital Center (CHUM), Montreal, QC H2X 3E4, Canada
| | - Issam Saliba
- Division of Otolaryngology Head & Neck Surgery, University of Montreal Hospital Center (CHUM), Montreal, QC H2X 3E4, Canada
- University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, QC H2X 3E4, Canada
- Correspondence:
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Goßrau G, Förderreuther S, Ruscheweyh R, Ruschil V, Sprenger T, Lewis D, Kamm K, Freilinger T, Neeb L, Malzacher V, Meier U, Gehring K, Kraya T, Dresler T, Schankin CJ, Gantenbein AR, Brössner G, Zebenholzer K, Diener HC, Gaul C, Jürgens TP. [Consensus statement of the migraine and headache societies (DMKG, ÖKSG, and SKG) on the duration of pharmacological migraine prophylaxis]. DER NERVENARZT 2022; 94:306-317. [PMID: 36287216 PMCID: PMC9607745 DOI: 10.1007/s00115-022-01403-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/07/2022]
Abstract
Migraine is the most common neurological disorder and can be associated with a high degree of disability. In addition to non-pharmacological approaches to reduce migraine frequency, pharmacological migraine preventatives are available. Evidence-based guidelines from the German Migraine and Headache Society (DMKG), and German Society for Neurology (DGN), Austrian Headache Society (ÖKSG), and Swiss Headache Society (SKG) are available for indication and application. For therapy-relevant questions such as the duration of a pharmacological migraine prevention, no conclusions can be drawn from currently available study data. The aim of this review is to present a therapy consensus statement that integrates the current data situation and, where data are lacking, expert opinions. The resulting current recommendations on the duration of therapy for pharmacological migraine prophylaxis are shown here.
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Affiliation(s)
- Gudrun Goßrau
- Kopfschmerzambulanz, Universitätsschmerzcentrum, Medizinische Fakultät der TU Dresden, Universitätsklinikum Dresden, Fetscherstr. 74, 01307 Dresden, Deutschland
| | - Stefanie Förderreuther
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Ruth Ruscheweyh
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Deutschland ,Deutsche Migräne- und Kopfschmerzgesellschaft, Frankfurt, Deutschland ,Klinik für Psychosomatik und Psychotherapie, Technische Universität München, München, Deutschland
| | - Victoria Ruschil
- Abteilung Neurologie mit Schwerpunkt Epileptologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Till Sprenger
- Deutsche Klinik für Diagnostik, DKD Helios Klinik Wiesbaden, Wiesbaden, Deutschland
| | | | - Katharina Kamm
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Deutschland
| | | | - Lars Neeb
- Helios Global Health, Berlin, Deutschland ,Neurologische Klinik und Poliklinik, Institut für Public Health, Charité-Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt Universität zu Berlin, Berlin, Deutschland
| | | | - Uwe Meier
- Berufsverband Deutscher Neurologen, Wulffstr. 8, 12165 Berlin, Deutschland
| | - Klaus Gehring
- Berufsverband Deutscher Nervenärzte, Wulffstr. 8, 12165 Berlin, Deutschland
| | - Torsten Kraya
- Neurologische Klinik, Krankenhaus Sankt Georg Leipzig, Leipzig, Deutschland ,Neurologische Klinik, Universitätsklinikum Halle-Saale, Halle-Saale, Deutschland
| | - Thomas Dresler
- Klinik für Psychiatrie und Psychotherapie, Tübingen Zentrum für seelische Gesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland ,LEAD Graduiertenschule & Forschungsnetzwerk, Tübingen, Tübingen, Deutschland
| | - Christoph J. Schankin
- Neurologische Klinik, Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz ,Universitätsspital Bern, Universität Bern, Bern, Schweiz
| | - Andreas R. Gantenbein
- Neurologie & Schmerz, ZURZACH Care, Bad Zurzach, Schweiz ,Praxis Neurologie am Untertor, Bülach, Schweiz
| | - Gregor Brössner
- Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Karin Zebenholzer
- Universitätsklinik für Neurologie, Medizinische Universität Wien, Wien, Österreich
| | - Hans-Christoph Diener
- Institut für Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland
| | - Charly Gaul
- Kopfschmerzzentrum Frankfurt, Frankfurt, Deutschland
| | - Tim P. Jürgens
- Kopfschmerzzentrum Nordost, Neurologische Klinik und Poliklinik, Universitätsklinik Rostock, Rostock, Deutschland ,Neurologische Klinik, KMG Krankenhaus Güstrow, Güstrow, Deutschland
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22
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Ferrillo M, Giudice A, Marotta N, Fortunato F, Di Venere D, Ammendolia A, Fiore P, de Sire A. Pain Management and Rehabilitation for Central Sensitization in Temporomandibular Disorders: A Comprehensive Review. Int J Mol Sci 2022; 23:12164. [PMID: 36293017 PMCID: PMC9602546 DOI: 10.3390/ijms232012164] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022] Open
Abstract
Temporomandibular disorders (TMD) are a group of musculoskeletal diseases affecting masticatory muscles and temporomandibular joints (TMJ). In this context, the chronic TMD could be considered as a condition with chronic primary orofacial pain, presenting as myofascial TMD pain or TMJ arthralgia. In this context, myogenous TMD may present overlapping features with other disorders, such as fibromyalgia and primary headaches, characterized by chronic primary pain related to dysfunction of the central nervous system (CNS), probably through the central sensitization. This phenomenon could be defined as an amplified response of the CNS to sensory stimuli and peripheral nociceptive, characterized by hyperexcitability in the dorsal horn neurons in the spinal cord, which ascend through the spinothalamic tract. The main objectives of the management of TMD patients are: decreasing pain, increasing TMJ function, and reducing the reflex masticatory muscle spasm/pain. The first-line treatments are physical therapy, pharmacological drugs, occlusal splints, laser therapy, extracorporeal shockwave therapy, transcutaneous electrical nerve stimulation, and oxygen-ozone therapy. Although all these therapeutic approaches were shown to have a positive impact on the central sensitization of TMD pain, there is still no agreement on this topic in the scientific literature. Thus, in this comprehensive review, we aimed at evaluating the evidence on pain management and rehabilitation for the central sensitization in TMD patients.
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Affiliation(s)
- Martina Ferrillo
- Dentistry Unit, Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Amerigo Giudice
- Dentistry Unit, Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Daniela Di Venere
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Pietro Fiore
- Neurological Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS Institute of Bari, 70124 Bari, Italy
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
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23
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Abstract
In light of the multiple pharmacologic alternatives for migraine management, the adverse effects associated with different treatment regimens, and their varying efficacy, it is vital to undertake ongoing evaluations and seek a tailored therapeutic strategy. This case report describes two patients who presented with classic migraine headaches, with the first responding to both abortive and prophylactic migraine medications and the second, with status migrainosus-like presentation, responding to the newer antimigraine agents. We also examined current pharmacological therapeutic options and existing recommendations, analyzing their strengths and weaknesses. This case review exemplifies how treatment in the last 10 years and success in medications used for abortive and prophylactic therapy are evolving from the older agents to newer agents like the recently approved calcitonin gene receptor protein monoclonal antibody inhibitors.
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24
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Kung D, Rodriguez G, Evans R. Chronic Migraine. Neurol Clin 2022; 41:141-159. [DOI: 10.1016/j.ncl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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25
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Holdridge A, Buczyner J, Aymat CC, Le A. Prevention of Migraine. Semin Neurol 2022; 42:558-570. [PMID: 36513096 DOI: 10.1055/s-0042-1758781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Migraine, a primary headache disorder is a chronic and complex neurological disease that affects millions of people worldwide, impacting their quality of life. It is one of the most common reasons why individuals seek the advice of their physician, and is one of the most common referrals seen in the offices of general neurologists and headache specialists. In the past decade, there has been robust research on not only the pathophysiology of migraine but in the efforts to treat and, importantly, prevent. The introduction of calcitonin gene related peptide antagonists (CGRP-A) have opened new doors for preventive treatment options. OnabotulinumtoxinA (BoNTA) has remained a staple in the treatment of chronic migraine with data emerging with combination therapy. Neurostimulation has offered additional nonpharmacologic approaches to migraine treatment. In addition to lifestyle and behavioral modifications, these have changed the landscape of migraine prevention.
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Affiliation(s)
- Ashley Holdridge
- Department of Neurology and Headache, Advocate Aurora HealthCare, Whitefish Bay, Wisconsin
| | - Jennifer Buczyner
- Department of Neurology, First Choice Neurology, Palm Beach Gardens, Florida
| | - Cristina Cabret Aymat
- Department of Neurology and Headache, Ochsner Health Center - Covington, Covington, Louisiana
| | - Ariel Le
- Department of Neurology, First Choice Neurology, Palm Beach Gardens, Florida
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26
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Melhado EM, Santos PSF, Kaup AO, da Costa ATNM, Roesler CADP, Piovesan ÉJ, Sarmento EM, Theotonio GOM, de Campos HC, Fortini I, de Souza JA, Maciel JA, Segundo JBA, de Carvalho JJF, Speziali JG, Calia LC, Barea LM, Queiroz LP, Souza MNP, Figueiredo MRCF, Costa MENDM, Peres MFP, Jurno ME, Peixoto PM, Kowacs PA, Rocha-Filho PAS, Moreira PF, Silva-Neto RP, Fragoso YD. Consensus of the Brazilian Headache Society (SBCe) for the Prophylactic Treatment of Episodic Migraine: part I. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:845-861. [PMID: 36252594 PMCID: PMC9703891 DOI: 10.1055/s-0042-1756441] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The Brazilian Headache Society (Sociedade Brasileira de Cefaleia, SBCe, in Portuguese) nominated a Committee of Authors with the aim of establishing a consensus with recommendations regarding prophylactic treatment for episodic migraine based on articles published in the worldwide literature, as well as personal experience. Migraine affects 1 billion people around the world and more than 30 million Brazilians. In addition, it is an underdiagnosed and undertreated disorder. It is well known within the medical community of neurologists, and especially among headache specialists, that there is a need to disseminate knowledge about prophylactic treatment for migraine. For this purpose, together with the need for drug updates and to expand knowledge of the disease itself (frequency, intensity, duration, impact and perhaps the progression of migraine), this Consensus was developed, following a full online methodology, by 12 groups who reviewed and wrote about the pharmacological categories of the drugs used and, at the end of the process, met to read and establish conclusions for this document. The drug classes studied were: anticonvulsants, tricyclic antidepressants, monoclonal anti-calcitonin gene-related peptide (anti-CGRP) antibodies, beta-blockers, antihypertensives, calcium channel inhibitors, other antidepressants (selective serotonin reuptake inhibitors, SSRIs, and dual-action antidepressants), other drugs, and polytherapy. Hormonal treatment and anti-inflammatories and triptans in minimum prophylaxis schemes (miniprophylaxis) will be covered in a specific chapter. The drug classes studied for part I of the Consensus were: anticonvulsants, tricyclic antidepressants, monoclonal anti-CGRP antibodies, and beta-blockers.
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Affiliation(s)
- Eliana Meire Melhado
- Centro Universitário Padre Albino, Faculdade de Medicina, Departamento de Neurologia, Catanduva SP, Brazil
| | - Paulo Sergio Faro Santos
- Instituto de Neurologia de Curitiba, Departamento de Neurologia, Setor de Cefaleia e Dor Orofacial, Curitiba PR, Brazil
| | - Alexandre Ottoni Kaup
- Houston Headache Clinic, Houston TX, United States,Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil,Universidade de Santo Amaro, São Paulo SP, Brazil
| | | | | | - Élcio Juliato Piovesan
- Universidade Federal do Paraná, Departamento de Clínica Médica, Disciplina de Neurologia, Curitiba PR, Brazil
| | | | | | | | - Ida Fortini
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Jano Alves de Souza
- Universidade Federal Fluminense, Departamento de Medicina Clínica, Disciplina de Neurologia, Niterói RJ, Brazil
| | - Jayme Antunes Maciel
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brazil
| | | | - João José Freitas de Carvalho
- Unichristus, Curso de Medicina, Disciplina de Neurologia, Fortaleza CE, Brazil,Hospital Geral de Fortaleza, Serviço de Neurologia, Núcleo de Cefaleias, Fortaleza CE, Brazil
| | - José Geraldo Speziali
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurologia, Ribeirão Preto SP, Brazil
| | - Leandro Cortoni Calia
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo SP, Brazil
| | - Liselotte Menke Barea
- Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Disciplina de Neurologia, Porto Alegre RS, Brazil
| | - Luiz Paulo Queiroz
- Universidade Federal de Santa Catarina, Hospital Universitário, Serviço de Neurologia, Florianópolis SC, Brazil
| | | | | | | | | | - Mauro Eduardo Jurno
- Fundação José Bonifácio Lafayette de Andrada, Faculdade de Medicina de Barbacena, Barbacena MG, Brazil,Fundação Hospitalar do Estado de Minas Gerais, Hospital Regional de Barbacena Dr. José Américo, Barbacena MG, Brazil
| | | | - Pedro André Kowacs
- Instituto de Neurologia de Curitiba, Serviço de Neurologia, Curitiba PR, Brazil,Universidade Federal do Paraná, Complexo Hospital de Clínicas, Serviço de Neurologia, Curitiba PR, Brazil
| | - Pedro Augusto Sampaio Rocha-Filho
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Área de Neuropsquiatria, Recife PE, Brazil,Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Ambulatório de Cefaleias, Recife PR, Brazil
| | - Pedro Ferreira Moreira
- Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Departamento de Medicina Clínica, Niterói RJ, Brazil
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27
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Çirakli S. Can flunarizine be used routinely as the first option for childhood headache treatment?: Flunarizine and childhood headache. Medicine (Baltimore) 2022; 101:e29265. [PMID: 35839040 PMCID: PMC11132379 DOI: 10.1097/md.0000000000029265] [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: 12/18/2020] [Accepted: 03/16/2022] [Indexed: 11/26/2022] Open
Abstract
The prevalence of headache in childhood increases due to environmental factors. Various risk factors in children whose playgrounds are restricted outside and therefore remain inactive. So diagnosis and treatment can be challenging. The aim of this study was to evaluate the experience of flunarizine in childhood headache with a focus on efficacy and success. We conducted a retrospective observational study of 185 pediatric patients at the tertiary pediatric emergency and pediatric neurology unit between May 2018 and May 2020. Patients with headache for >15 days of a month for at least 3 months were included in the study, whether or not receiving treatment. Also, all patients who had an adequate follow-up period were included in the study. All patients were evaluated by history, physical-neurological examination, blood tests, blood pressure, eye examination, and cranial magnetic resonance imaging. All data were evaluated statistically. Ninety-eight (53%) of 185 cases were female and 87 (47%) were male. Average age was 11.4 years (min-max, 4-17). There was family history in 51.3% of the cases. The most frequent applicants were in the autumn season (43%), when schools were opened. Organic causes were hypertension in 1 case, brain tumor in 1 case, and papilledema due to idiopathic intracranial hypertension in 2 cases. The other cases were asked to make a 1-month pain chart and grading according to the visual analog scale. In this process, it was stated that painkillers could be used if needed. At the end of the first month, these patients were reevaluated. Flunarizine treatment was initiated in 95 patients who had to use painkillers for >4 times and who described ≥6 pain score according to the visual analog scale. The treatment was discontinued due to sleepiness and weakness in 2 patients. At the end of the third month, a 50% reduction in headache was observed in 82 cases (86.3%). We used flunarizine as the first choice in all patients and we achieved a high rate of treatment success. Flunarizine can be considered as an alternative option for headache management in terms of low side effects, easy accessibility, and compliance with treatment.
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Affiliation(s)
- Sevgi Çirakli
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Ordu University, Ordu, Turkey
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28
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Lee W, Cho S, Hwang H, Lee M, Kim EH, Kim KM, Heo K, Chu MK. Crystal‐clear days and unclear days in migraine: A population‐based study. Headache 2022; 62:818-827. [DOI: 10.1111/head.14359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/01/2022] [Accepted: 06/03/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Wonwoo Lee
- Department of Neurology Yonsei University College of Medicine Seoul South Korea
- Department of Neurology Yongin Severance Hospital, Yonsei University Health System Yongin South Korea
| | - Soo‐Jin Cho
- Department of Neurology Dongtan Sacred Heart Hospital, Hallym University College of Medicine Hwaseong South Korea
| | - Heewon Hwang
- Department of Neurology Yonsei University College of Medicine Seoul South Korea
- Department of Neurology Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine Wonju South Korea
| | - Myeongjee Lee
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics Yonsei University College of Medicine Seoul South Korea
| | - Eun Hwa Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics Yonsei University College of Medicine Seoul South Korea
| | - Kyung Min Kim
- Department of Neurology Yonsei University College of Medicine Seoul South Korea
| | - Kyoung Heo
- Department of Neurology Yonsei University College of Medicine Seoul South Korea
| | - Min Kyung Chu
- Department of Neurology Yonsei University College of Medicine Seoul South Korea
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29
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Wang Y, Benavides R, Diatchenko L, Grant AV, Li Y. A graph-embedded topic model enables characterization of diverse pain phenotypes among UK biobank individuals. iScience 2022; 25:104390. [PMID: 35637735 PMCID: PMC9142639 DOI: 10.1016/j.isci.2022.104390] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/08/2022] [Accepted: 05/06/2022] [Indexed: 11/05/2022] Open
Abstract
Large biobank repositories of clinical conditions and medications data open opportunities to investigate the phenotypic disease network. We present a graph embedded topic model (GETM). We integrate existing biomedical knowledge graph information in the form of pre-trained graph embedding into the embedded topic model. Via a variational autoencoder framework, we infer patient phenotypic mixture by modeling multi-modal discrete patient medical records. We applied GETM to UK Biobank (UKB) self-reported clinical phenotype data, which contains 443 self-reported medical conditions and 802 medications for 457,461 individuals. Compared to existing methods, GETM demonstrates good imputation performance. With a more focused application on characterizing pain phenotypes, we observe that GETM-inferred phenotypes not only accurately predict the status of chronic musculoskeletal (CMK) pain but also reveal known pain-related topics. Intriguingly, medications and conditions in the cardiovascular category are enriched among the most predictive topics of chronic pain. Interpretable deep learning to integrate knowledge graphs and patient data Modeling phenotypes from self-reports of 457,461 individuals from the UK Biobank Predicting and characterizing chronic pain phenotypes using latent phenotypes Potential link between cardiovascular conditions or medications and chronic pain
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Affiliation(s)
- Yuening Wang
- School of Computer Science, McGill University, Canada
| | - Rodrigo Benavides
- Department of Anesthesiology, Centro Nacional de Rehabilitación, San Jose, Costa Rica
| | - Luda Diatchenko
- Department of Anesthesia, McGill University, Canada.,Faculty of Dentistry, McGill University, Canada.,Alan Edwards Centre for Research on Pain, McGill University, Canada
| | - Audrey V Grant
- Department of Anesthesia, McGill University, Canada.,Faculty of Dentistry, McGill University, Canada.,Alan Edwards Centre for Research on Pain, McGill University, Canada
| | - Yue Li
- School of Computer Science, McGill University, Canada
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30
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Chowdhury D, Bansal L, Duggal A, Datta D, Mundra A, Krishnan A, Koul A, Gupta A. TOP-PRO study: A randomized double-blind controlled trial of topiramate versus propranolol for prevention of chronic migraine. Cephalalgia 2022; 42:396-408. [PMID: 34579560 DOI: 10.1177/03331024211047454] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of the TOP-PRO-study, a double-blind randomized controlled trial, was to assess the efficacy (non-inferiority) and tolerability of propranolol compared to topiramate for the prevention of chronic migraine. BACKGROUND Except for topiramate, oral preventive treatment for chronic migraine lacks credible evidence. METHODS Chronic migraine patients aged above 18 years and less than 65 years of age, not on any preventive treatment were randomly allocated to receive topiramate (100 mg/day) or propranolol (160 mg/day). The primary efficacy outcome was the mean change in migraine days per 28 days at the end of 24 weeks from baseline. A mean difference of 1.5 days per four weeks was chosen as the cut-off delta value. Multiple secondary efficacy outcomes and treatment emergent adverse events were also assessed. RESULTS As against the planned sample size of 244, only 175 patients could be enrolled before the spread of the corona virus disease-2019 pandemic and enforcement of lockdown in India. Of the 175 randomized patients, 95 (topiramate 46 and propranolol 49) completed the trial. The mean change in migraine days was -5.3 ± 1.2 vs -7.3 ± 1.1 days (p = 0.226) for topiramate and propranolol groups respectively. Propranolol was found to be non-inferior and not superior to topiramate (point estimate of -1.99 with a 95% confidence interval of -5.23 to 1.25 days). Multiple secondary outcomes also did not differ between the two groups. Intention to treat analysis of 175 patients and per-protocol analysis of 95 patients yielded concordant results. There was no significant difference in the incidence of adverse events between the two groups. CONCLUSION Propranolol (160mg/day) was non-inferior, non-superior to topiramate (100mg/day) for the preventive treatment of chronic migraine and had a comparable tolerability profile.Trial Registration: Clinical Trials Registry-India CTRI/2019/05/018997).
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Affiliation(s)
- Debashish Chowdhury
- Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Luv Bansal
- Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Ashish Duggal
- Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Debabrata Datta
- Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Ankit Mundra
- Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Anand Krishnan
- All India Institute of Medical Sciences, New Delhi, India
| | - Arun Koul
- Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Anu Gupta
- All India Institute of Medical Sciences, New Delhi, India
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31
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Approaches to Assessing and Adjusting for Selective Outcome Reporting in Meta-analysis. J Gen Intern Med 2022; 37:1247-1253. [PMID: 34669145 PMCID: PMC8971211 DOI: 10.1007/s11606-021-07135-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Selective or non-reporting of study outcomes results in outcome reporting bias. OBJECTIVE We sought to develop and assess tools for detecting and adjusting for outcome reporting bias. DESIGN Using data from a previously published systematic review, we abstracted whether outcomes were reported as collected, whether outcomes were statistically significant, and whether statistically significant outcomes were more likely to be reported. We proposed and tested a model to adjust for unreported outcomes and compared our model to three other methods (Copas, Frosi, trim and fill). Our approach assumes that unreported outcomes had a null intervention effect with variance imputed based on the published outcomes. We further compared our approach to these models using simulation, and by varying levels of missing data and study sizes. RESULTS There were 286 outcomes reported as collected from 47 included trials: 142 (48%) had the data provided and 144 (52%) did not. Reported outcomes were more likely to be statistically significant than those collected but for which data were unreported and for which non-significance was reported (RR, 2.4; 95% CI, 1.9 to 3.0). Our model and the Copas model provided similar decreases in the pooled effect sizes in both the meta-analytic data and simulation studies. The Frosi and trim and fill methods performed poorly. LIMITATIONS Single intervention of a single disease with only randomized controlled trials; approach may overestimate outcome reporting bias impact. CONCLUSION There was evidence of selective outcome reporting. Statistically significant outcomes were more likely to be published than non-significant ones. Our simple approach provided a quick estimate of the impact of unreported outcomes on the estimated effect. This approach could be used as a quick assessment of the potential impact of unreported outcomes.
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32
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Paczkowska-Walendowska M, Sip S, Staszewski R, Cielecka-Piontek J. Single-Pill Combination to Improve Hypertension Treatment: Pharmaceutical Industry Development. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4156. [PMID: 35409840 PMCID: PMC8999086 DOI: 10.3390/ijerph19074156] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 12/10/2022]
Abstract
Multiple illness is an increasingly common phenomenon. Its consequence is the need for polytherapy, which is particularly common among people suffering from arterial hypertension. The development of combined preparations (containing at least two API-active pharmaceutical ingredients) dedicated to the treatment of hypertension is a response to increased compliance, especially in elderly patients. In our work, we describe in particular the possibilities of using β-adrenergic receptors blockers and angiotensin-converting enzyme inhibitors in combinations. The combinations of APIs are used as single pills in patients with arterial hypertension with concomitant diseases such as hyperlipidemia; blood coagulation problems and diabetes mellitus were also discussed successively. Pharmacoeconomic analysis for the API combinations shown is also presented. As a final conclusion, numerous benefits of using the combined preparations should be indicated, especially by the elderly and/or in patients with coexistence of other diseases.
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Affiliation(s)
| | - Szymon Sip
- Department of Pharmacognosy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (M.P.-W.); (S.S.)
| | - Rafał Staszewski
- Department of Hypertension, Angiology and Internal Medicine, Poznan University of Medical Sciences, Długa 1/2, 61-848 Poznań, Poland;
| | - Judyta Cielecka-Piontek
- Department of Pharmacognosy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (M.P.-W.); (S.S.)
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Tran JP, Horine SV. Title: Novel Analgesic Potential of ß2-Agonists for Neuropathic Pain via ß2-Agonist Action. Curr Pain Headache Rep 2022; 26:73-77. [PMID: 35129823 DOI: 10.1007/s11916-022-01006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Multimodal therapies are often employed to treat chronic pain, and ß2-agonists are a potential drug class that shows promise. The primary aim of this paper is to discuss the role of ß2-agonists as an adjunctive therapy for chronic pain based on the current literature. RECENT FINDINGS Recent studies in mouse models have shown that the ß2-adrenergic system plays an essential role in the analgesic properties of antidepressant drugs used to treat neuropathic pain and that the adrenergic relies on an intact endogenous opioid system to be effective. Studies also show that ß2-agonism alone is adequate to exert anti-allodynic effects in a mouse model. This paper summarized the basic physiology and pharmacology of the sympathetic nervous system and specifically the ß2-adrenergic system and summarized current literature in its involvement in the treatment of chronic neuropathic pain.
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Affiliation(s)
- Johnny P Tran
- NewYork-Presbyterian Hospital/Weill Cornell Medicine, Department of Anesthesiology, New York, NY, USA
| | - Storm V Horine
- Department of Anesthesiology, Memorial-Sloan Kettering Cancer Center, New York, NY, USA.
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Abstract
Globally, headache disorders are an important cause of disability in adults. As many types of headache (eg, migraine, tension-type and medication-overuse) are more common in women and have peak incidence in reproductive years, chronic headache disorders are highly prevalent in pregnant women. Some women with a history of migraine may find that it improves during pregnancy while others may find that their migraines become more unpredictable. Ideally, women with migraine and problematic headache disorder should be offered preconception counselling to address pregnancy-related concerns and advice on the use of medicines, which should be supported by high-quality information. For women with history of headache, the use of effective non-pharmacological options should be maximised, and the smallest number of the safest medicines at the lowest effective doses should be used while preparing for pregnancy and during pregnancy. This article forms part of the series of prescribing for pregnancy and discusses the impact of headache and migraine on pregnancy, the impact of pregnancy on headache and migraine and options for prophylaxis and treatment.
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Affiliation(s)
- Caroline Ovadia
- Department of Women and Children's Health, King's College London, London, UK
- Obstetrics and Gynaecology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Metoprolol decreases retention of fear memory and facilitates long-term depression in lateral amygdala. Behav Pharmacol 2021; 31:535-543. [PMID: 31860562 DOI: 10.1097/fbp.0000000000000533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Posttraumatic stress disorder is a mental disorder with a known cause, yet effective behavioral and pharmacotherapies remain elusive for many afflicted patients. Propranolol is suggested to be effective as a fear-reducing agent when paired with behavioral therapy soon after trauma when psychological stress is high, possibly dampening or preventing the later development of posttraumatic stress disorder. In our previous study, we found propranolol efficaciously reduced fear retention induced by reactivation via β-adrenergic receptors in lateral amygdala. However, it is unclear which subtypes of β-adrenergic receptors dominate the function of adrenergic activation in lateral amygdala. In this study, we investigated the action of β1-adrenergic receptor antagonist-metoprolol and β2-adrenergic receptor antagonist-butoxamine on the retention of conditioned fear memory and synaptic adaptation in the lateral amygdala of rats. We found metoprolol not butoxamine attenuated the reactivation-induced strengthening of fear retention and restored the impaired long-term depression in lateral amygdala. Intra-amygdala infusion of metoprolol not butoxamine attenuated reactivation-induced enhancement of fear retention. Our results suggest that β1-adrenergic receptor antagonist-metoprolol may be more suitable for the treatment of posttraumatic stress disorder.
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Eigenbrodt AK, Ashina H, Khan S, Diener HC, Mitsikostas DD, Sinclair AJ, Pozo-Rosich P, Martelletti P, Ducros A, Lantéri-Minet M, Braschinsky M, Del Rio MS, Daniel O, Özge A, Mammadbayli A, Arons M, Skorobogatykh K, Romanenko V, Terwindt GM, Paemeleire K, Sacco S, Reuter U, Lampl C, Schytz HW, Katsarava Z, Steiner TJ, Ashina M. Diagnosis and management of migraine in ten steps. Nat Rev Neurol 2021; 17:501-514. [PMID: 34145431 PMCID: PMC8321897 DOI: 10.1038/s41582-021-00509-5] [Citation(s) in RCA: 202] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 02/05/2023]
Abstract
Migraine is a disabling primary headache disorder that directly affects more than one billion people worldwide. Despite its widespread prevalence, migraine remains under-diagnosed and under-treated. To support clinical decision-making, we convened a European panel of experts to develop a ten-step approach to the diagnosis and management of migraine. Each step was established by expert consensus and supported by a review of current literature, and the Consensus Statement is endorsed by the European Headache Federation and the European Academy of Neurology. In this Consensus Statement, we introduce typical clinical features, diagnostic criteria and differential diagnoses of migraine. We then emphasize the value of patient centricity and patient education to ensure treatment adherence and satisfaction with care provision. Further, we outline best practices for acute and preventive treatment of migraine in various patient populations, including adults, children and adolescents, pregnant and breastfeeding women, and older people. In addition, we provide recommendations for evaluating treatment response and managing treatment failure. Lastly, we discuss the management of complications and comorbidities as well as the importance of planning long-term follow-up.
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Affiliation(s)
- Anna K Eigenbrodt
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Håkan Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sabrina Khan
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hans-Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Dimos D Mitsikostas
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra J Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
- Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Anne Ducros
- Neurology Department, Montpellier University Hospital, Montpellier, France
| | - Michel Lantéri-Minet
- Departement d'Evaluation et Traitement de la Douleur, Centre Hospitalo-Universitaire de Nice, Nice, France
| | | | | | - Oved Daniel
- Headache & Facial Pain Clinic, Laniado Medical Center, Netanya, Israel
| | - Aynur Özge
- Department of Neurology, Mersin University Medical Faculty, Mersin, Turkey
| | - Ayten Mammadbayli
- Department of Neurology, Azerbaijan State Medical University, Baku, Azerbaijan
| | - Mihails Arons
- Department of Anesthesiology and Intensive Care, P. Stradins University, Riga, Latvia
| | | | | | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Lampl
- Headache Medical Center, Seilerstaette Linz, Linz, Austria
- Department of Geriatric Medicine, Ordensklinikum Linz, Linz, Austria
| | - Henrik W Schytz
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Zaza Katsarava
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany
- EVEX Medical Corporation, Tbilisi, Georgia
- Department of Nervous Diseases of the Institute of Professional Education, IM Sechenov First Moscow State Medical University, Moscow, Russia
| | - Timothy J Steiner
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Division of Brain Sciences, Imperial College London, London, UK
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Nervous Diseases of the Institute of Professional Education, IM Sechenov First Moscow State Medical University, Moscow, Russia.
- Danish Knowledge Center on Headache Disorders, Glostrup, Denmark.
- Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan.
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Ducros A, de Gaalon S, Roos C, Donnet A, Giraud P, Guégan-Massardier E, Lantéri-Minet M, Lucas C, Mawet J, Moisset X, Valade D, Demarquay G. Revised guidelines of the French headache society for the diagnosis and management of migraine in adults. Part 2: Pharmacological treatment. Rev Neurol (Paris) 2021; 177:734-752. [PMID: 34340810 DOI: 10.1016/j.neurol.2021.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/21/2022]
Abstract
The French Headache Society proposes updated French guidelines for the management of migraine. This article presents the second part of the guidelines, which is focused on the pharmacological treatment of migraine, including both the acute treatment of attacks and the prophylaxis of episodic migraine as well as chronic migraine with and without medication overuse. The specific situations that can be encountered in women with migraine are also discussed, including pregnancy, menstrual migraine, contraception and hormonal replacement therapy.
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Affiliation(s)
- A Ducros
- Department of neurology, Gui-de-Chauliac hospital, CHU Montpellier, university of Montpellier, 34000 Montpellier, France
| | - S de Gaalon
- Department of neurology, Laënnec hospital, CHU de Nantes, Nantes, France
| | - C Roos
- Emergency headache center (centre d'urgences céphalées), department of neurology, Lariboisière hospital, Assistance publique-Hôpitaux de Paris, Paris, France
| | - A Donnet
- Centre d'évaluation et de traitement de la douleur, FHU INOVPAIN, hôpital de La Timone, Marseille, France
| | - P Giraud
- Department of neurology, Annecy Genevois hospital, Annecy, France
| | | | - M Lantéri-Minet
- Pain department, FHU InovPain, CHU Nice Côte Azur université, Nice, France
| | - C Lucas
- Centre d'évaluation et de traitement de la douleur, service de neurochirurgie, hôpital Salengro, CHRU de Lille, Lille, France
| | - J Mawet
- Emergency headache center (centre d'urgences céphalées), department of neurology, Lariboisière hospital, Assistance publique-Hôpitaux de Paris, Paris, France
| | - X Moisset
- Neuro-Dol, université Clermont Auvergne, CHU de Clermont-Ferrand, INSERM, Clermont-Ferrand, France
| | - D Valade
- Department of neurosurgery, hôpital Pitié-Sapêtrière, Paris, France
| | - G Demarquay
- Neurological hospital, Lyon, neuroscience research center (CRNL), INSERM U1028, CNRS UMR5292, Lyon, France.
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Mirzoyan RS, Gan’shina TS, Kurdyumov IN, Maslennikov DV, Gnezdilova AV, Gorbunov AA, Kursa EV, Turilova AI, Kostochka LM, Mirzoyan NR. Migraine pharmacology and brain ischemia. RESEARCH RESULTS IN PHARMACOLOGY 2021. [DOI: 10.3897/rrpharmacology.7.67463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Introduction: The aim of this review article was to analyze in details the mechanism of drugs’ effects in the treatment and prevention of a migraine attack, as well as to discuss the hypotheses of migraine pathogenesis.
Migraine attack treatment agents: The main agents for migraine attack treatment have an anti-nociceptive activity.
Agents for migraine preventive treatment: β-blocker propranolol also has anti-serotonin and analgesic activities, and most drugs used for the prophylactic treatment of migraine have a vasodilating activity.
Vascular hypothesis of migraine pathogenesis: Despite numerous studies that have expanded our understanding of migraine pathogenesis, the importance of the vascular component in the pathogenesis of this disease has not questioned yet.
Neurogenic hypotheses of cortical spreading depression: It is necessary to take into account the points of this hypothesis in the context of the pathophysiology of migraine.
Neurochemical serotonin hypotheses of migraine pathogenesis: Serotonin plays an important role in the pathogenesis of migraine.
Trigemino-vascular hypotheses of migraine pathogenesis: The trigemino-vascular hypothesis claims to solve the problem of migraine pain.
Migraine and ischemic brain damage: Migraine is a risk factor for ischemic stroke and cognitive disorders.
Search for the new anti-ischemic anti-migraine preparations: A methodology for the search for new anti-ischemic anti-serotonin drugs for the treatment of migraine is proposed.
Conclusion: Belonging of a drug to one or another pharmacological group does not always correspond to its therapeutic effect on the pathogenetic processes of migraine. Migraine with its variety of forms cannot fit only one of the proposed hypotheses on the pathogenesis of this disease.
Graphical abstract:
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Donnet A, Ducros A, Radat F, Allaf B, Chouette I, Lanteri-Minet M. Severe migraine and its control: A proposal for definitions and consequences for care. Rev Neurol (Paris) 2021; 177:924-934. [PMID: 33810839 DOI: 10.1016/j.neurol.2020.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/19/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022]
Abstract
Currently many patients with severe migraine do not receive appropriate treatment and are never referred to specialist headache centres. On the other hand, specialist headache centres are frequently attended by patients whose migraines could be managed adequately in the community. One reason for this may be the absence of standardised definitions of migraine severity and control and of a treatment algorithm for orientating difficult-to-treat patients to specialist headache centres. Based on a review of the relevant literature and consensus meetings, proposals have been made for these items. We propose that migraine should be considered severe if headache frequency is at least eight migraine days per month or, if headaches are less frequent, the HIT-6 score is ≥60 or ≥50% of headaches require complete interruption of activity. The proposed definition of migraine control is defined on the basis of appropriate response to acute headache therapy and to preventative therapy. A treatment algorithm is proposed to assess migraine control regularly and to adapt therapy accordingly. These proposals may contribute to developing and testing strategies for management of severe disease with appropriate and effective preventive treatment strategies. With the anticipated introduction of new possibilities for migraine prevention in the near future, the time is ripe for a holistic approach to migraine management.
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Affiliation(s)
- Anne Donnet
- Centre d'évaluation et de traitement de la douleur, CHU de la Timone, Marseille, France; Neuro-Dol Inserm U1107, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Anne Ducros
- Service de Neurologie, CHU Gui de Chauliac, Montpellier, France
| | - Françoise Radat
- Unité de traitement de la douleur chronique, CHU de Bordeaux, Bordeaux, France
| | | | | | - Michel Lanteri-Minet
- Neuro-Dol Inserm U1107, Université Clermont Auvergne, Clermont-Ferrand, France; Département d'évaluation et de traitement de la douleur CHU de Nice, FHU InovPain Université Côte Azur, Nice, France.
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40
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Rist PM, Bernstein C, Kowalski M, Osypiuk K, Connor JP, Vining R, Long CR, Macklin EA, Wayne PM. Multimodal chiropractic care for migraine: A pilot randomized controlled trial. Cephalalgia 2021; 41:318-328. [PMID: 33050719 PMCID: PMC9670157 DOI: 10.1177/0333102420963844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Spinal manipulation may reduce migraine frequency, but effects of multimodal chiropractic care on migraine frequency have not been evaluated. METHODS We conducted a pilot randomized controlled trial comparing multimodal chiropractic care + enhanced usual care (MCC+) versus enhanced usual care alone (EUC) among adult women with episodic migraine. EUC was comprised of usual medical care and migraine education literature. MCC+ participants received 10 sessions of chiropractic care over 14 weeks. Primary aims evaluated feasibility of recruitment, retention, protocol adherence, and safety. Change in migraine days was a secondary aim. RESULTS Of 422 patients screened, 61 were randomized over 20 months. Fifty-seven (93%) completed daily migraine logs during the intervention, 51 (84%) completed final follow-up, and 45 (74%) completed all assessments. Twenty-four of 29 MCC+ participants (83%) attended > 75% of the chiropractic sessions. Ninety-eight non-serious adverse events were reported by 26 participants (43%) with 39 events among 11 EUC participants and 59 events among 15 MCC+ participants. MCC+ participants experienced greater reductions in migraine days (-2.9 days for MCC+ vs. -1.0 days for EUC, difference = -1.9; 95% confidence interval: -3.5, -0.4). CONCLUSIONS Pre-specified feasibility criteria were not met, but deficits were remediable. Preliminary data support a definitive trial of MCC+ for migraine. TRIAL REGISTRATION This study is registered at Clinicaltrials.gov (NCT03177616).
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Affiliation(s)
- Pamela M. Rist
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA
| | - Carolyn Bernstein
- John Graham Headache Center, Department of Neurology, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA
- Osher Clinical Center, Brigham and Women’s Hospital, Boston, MA
| | | | - Kamila Osypiuk
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA
| | - Julie P. Connor
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA
| | | | | | - Eric A. Macklin
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Peter M. Wayne
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA
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Jin B, Liu H, Qiao L. Unveiling the comparative efficacy and tolerability of comprehensive treatments for migraine: A protocol of systematic review and Bayesian network meta-analysis. Medicine (Baltimore) 2021; 100:e24083. [PMID: 33530202 PMCID: PMC7850759 DOI: 10.1097/md.0000000000024083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Migraine is a chronic paroxysmal incapacitating neurological disorder, which endangers the health of human worldwide ranking as the third most prevalent medical condition. There are no comprehensive estimates of treatments for migraine. We will conduct this systematic review and Bayesian network meta-analysis (NMA) to synthesis quantitative and comparative evidence on the efficacy and tolerability of all the known pharmacological and non-pharmacological interventions for migraine. METHOD We will perform the systematic electronic search of the literature utilizing MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing & Allied Health (CINAHL), and PsycINFO. We will only include randomized controlled trials (RCTs) of high quality which appraise the efficacy or safety of any potential pharmacological or non-pharmacological interventions in the treatment of patients with migraine. The traditional pairwise meta-analyses will be performed to anticipate the heterogeneities and publication bias and the NMA will be conducted within a Bayesian hierarchical model framework to obtain estimates for all valuable treatments for migraine. The entire heterogeneity will be quantified by Q statistic and I2 index. Other analyses included sensitivity analyses, meta-regression, and subgroup analyses will also be conducted. The whole process will be conducted using in R-3.6.0 software. RESULTS This study will obtain the efficacy and tolerability of all potential treatments for migraine, aiming at providing consolidated evidence to help make the best choice of interventions. The results will be published in a peer-reviewed journal. DISCUSSION This Bayesian network meta-analysis may be the first attempt to quantitatively synthesize the efficacy and tolerability of all potential treatments for migraine. And this method can ensure us to fully utilize both the direct and indirect evidence as well as gain the comparative estimates displayed in the derived hierarchies. Besides, we have registered this protocol on the international prospective register of systematic review (PROSPERO) (CRD42020157278).
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Affiliation(s)
- Boru Jin
- Department of Neurology, First Affiliated Hospital, China Medical University
| | - Huayan Liu
- Department of Neurology, First Affiliated Hospital, China Medical University
| | - Lei Qiao
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
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AMINI L, YAGHINI O, GHAZAVI M, ASLANI N. L-carnitine versus Propranolol for pediatric migraine prophylaxis. IRANIAN JOURNAL OF CHILD NEUROLOGY 2021; 15:77-86. [PMID: 36213159 PMCID: PMC9376025 DOI: 10.22037/ijcn.v15i2.25558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 06/16/2020] [Indexed: 11/21/2022]
Abstract
Objective Carnitine plays a significant role in fatty acid transportation in mitochondria and has been shown to have a prophylactic effect on adult migraine. The aim of this randomized controlled trial was to compare and evaluate the effects of L-carnitine supplementation versus propranolol in the prevention of pediatric migraine. Materials & Methods A total of 60 pediatric patients with episodic migraine were randomly allocated to 2 independent groups to receive either 50 mg/kg/day L-carnitine or 1 mg/kg/day propranolol as a prophylactic drug. Frequency, severity, and duration of migraine attacks and headache disability based on the Pediatric Migraine Disability Assessment Score (PedMIDAS) were studied at the baseline and after 2, 4, and 12 weeks. Results A total of 56 patients were evaluated in the study: 23 girls (41%) and 33 boys (59%) with a mean age of 9.7 ± 2.1 years. Frequency of migraine headaches per month reduced from 11.4 ± 7.1 to 5.34 ± 2.4 in the L-carnitine group and from 10.7 ± 6.2 to 4.96 ± 3.9 in the propranolol group by the end of the study. Headache severity score was also reduced from 19.38 ± 14 to 2.88 ± 7.4 and from 12.92 ± 13 to 0.82 ± 1.3 in the L-carnitine and propranolol groups, respectively. We found a significant decrease in frequency, severity, and duration of headache attacks in both groups (P < 0.01). No significant difference was observed between the efficacies of the 2 drugs.This study concluded that L-carnitine supplementation can play a prophylactic role in the management of pediatric migraine.
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Affiliation(s)
- Laya AMINI
- Department of Pediatrics, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid YAGHINI
- Pediatric Neurology, Child Growth and Development Research center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza GHAZAVI
- Pediatric Neurology, Child Growth and Development Research center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahid ASLANI
- Department of Pediatrics, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Barcia E, Sandoval V, Fernandez-Carballido A, Negro S. Flunarizine-loaded microparticles for the prophylaxis of migraine. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.102012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dolezil D, Markova J, Klimes J, Pocikova Z, Dostal F, Stepanova R, Svobodnik A. An Investigation into the Prevalence of Migraine and Its Prophylactic Treatment Patterns in the Czech Republic: An Observational Study. J Pain Res 2020; 13:2895-2906. [PMID: 33209057 PMCID: PMC7669514 DOI: 10.2147/jpr.s273119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/16/2020] [Indexed: 01/23/2023] Open
Abstract
Purpose A national primary and secondary healthcare-level study in the Czech Republic has not yet been conducted to evaluate the prevalence of migraine. We analyzed the current treatment patterns (acute and prophylactic) in migraine patients and the number of migraine patients potentially eligible for treatment with recent calcitonin gene-related peptide (CGRP) pathway-targeted therapies. Methods This retrospective study utilized the Ministry of the Interior Health Insurance Fund claims database of the Czech Republic wherein every citizen is insured. Migraine patients with or without aura, and potentially on triptan therapy were included in this study (index years 2012–2016). The prevalence approach included all patients (new and old) present in each index year. Prophylactic therapies were followed f0or three and seven years prior to the index year, including the index year, until 2010. The incidence approach included all patients first diagnosed in each index year. Prophylactic therapies were followed for the next three years, including the index year, until 2017 following incidence approach. The primary endpoint of this study was to determine the rate of migraine prevalence and diagnosis for each index year during the period 2012–2016. The study also evaluated prophylactic and acute treatment patterns and comorbidities among patients in 2016. Results The rate of migraine prevalence was 1% and the rate of diagnosis was 0.2–0.4%. By prevalence approach, approximately 39% of the patients were on prophylactics, and 11.2% and 21.6% of the patient population had two prior treatment failures (three- and seven-year recall period, respectively). Antiepileptics (26%) and beta blockers (15.8%) were the most prescribed prophylactics, and sumatriptan was the predominant triptan used (12%) for acute treatment. Conclusion Taking into account the number of inhabitants in the Czech Republic (10.7 million), there could be up to 23,000 adult patients eligible for novel CGRP therapies.
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Affiliation(s)
- David Dolezil
- Prague Headache Center, DADO MEDICAL s.r.o., Prague, Czech Republic
| | | | - Jiri Klimes
- Novartis, s.r.o., Prague, Czech Republic.,Faculty of Pharmacy, Department of Social and Clinical Pharmacy, Charles University in Prague, Prague, Czech Republic
| | - Zuzana Pocikova
- Novartis, s.r.o., Prague, Czech Republic.,Faculty of Pharmacy, Department of Social and Clinical Pharmacy, Charles University in Prague, Prague, Czech Republic
| | - Filip Dostal
- Novartis, s.r.o., Prague, Czech Republic.,Faculty of Pharmacy, Department of Social and Clinical Pharmacy, Charles University in Prague, Prague, Czech Republic
| | - Radka Stepanova
- Aixial, s.r.o., Brno, Czech Republic.,Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Adam Svobodnik
- Aixial, s.r.o., Brno, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
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Anderson CC, Ray CA, Butler MR, Darken RS. Effects of Procedural Discomfort and Expectation of Benefit on Therapy Continuation in Chronic Migraine Patients Treated With OnabotulinumtoxinA. Headache 2020; 60:2357-2363. [DOI: 10.1111/head.14008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Christopher A. Ray
- Department of Neurology Washington University School of Medicine St. Louis MO USA
| | - Michael R. Butler
- Department of Neurology Washington University School of Medicine St. Louis MO USA
| | - Rachel S. Darken
- Department of Neurology Washington University School of Medicine St. Louis MO USA
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Urits I, Gress K, Charipova K, Zamarripa AM, Patel PM, Lassiter G, Jung JW, Kaye AD, Viswanath O. Pharmacological options for the treatment of chronic migraine pain. Best Pract Res Clin Anaesthesiol 2020; 34:383-407. [PMID: 33004155 DOI: 10.1016/j.bpa.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 12/29/2022]
Abstract
Migraine is a debilitating neurological condition with symptoms typically consisting of unilateral and pulsating headache, sensitivity to sensory stimuli, nausea, and vomiting. The World Health Organization (WHO) reports that migraine is the third most prevalent medical disorder and second most disabling neurological condition in the world. There are several options for preventive migraine treatments that include, but are not limited to, anticonvulsants, antidepressants, beta blockers, calcium channel blockers, botulinum toxins, NSAIDs, riboflavin, and magnesium. Patients may also benefit from adjunct nonpharmacological options in the comprehensive prevention of migraines, such as cognitive behavior therapy, relaxation therapies, biofeedback, lifestyle guidance, and education. Preventative therapies are an essential component of the overall approach to the pharmacological treatment of migraine. Comparative studies of newer therapies are needed to help patients receive the best treatment option for chronic migraine pain.
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Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
| | - Kyle Gress
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Alec M Zamarripa
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Parth M Patel
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Grace Lassiter
- Georgetown University School of Medicine, Washington, DC, USA
| | - Jai Won Jung
- Georgetown University School of Medicine, Washington, DC, USA
| | - Alan D Kaye
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Omar Viswanath
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA; Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA
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A genome-wide cross-phenotype meta-analysis of the association of blood pressure with migraine. Nat Commun 2020; 11:3368. [PMID: 32632093 PMCID: PMC7338361 DOI: 10.1038/s41467-020-17002-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/02/2020] [Indexed: 11/29/2022] Open
Abstract
Blood pressure (BP) was inconsistently associated with migraine and the mechanisms of BP-lowering medications in migraine prophylaxis are unknown. Leveraging large-scale summary statistics for migraine (Ncases/Ncontrols = 59,674/316,078) and BP (N = 757,601), we find positive genetic correlations of migraine with diastolic BP (DBP, rg = 0.11, P = 3.56 × 10−06) and systolic BP (SBP, rg = 0.06, P = 0.01), but not pulse pressure (PP, rg = −0.01, P = 0.75). Cross-trait meta-analysis reveals 14 shared loci (P ≤ 5 × 10−08), nine of which replicate (P < 0.05) in the UK Biobank. Five shared loci (ITGB5, SMG6, ADRA2B, ANKDD1B, and KIAA0040) are reinforced in gene-level analysis and highlight potential mechanisms involving vascular development, endothelial function and calcium homeostasis. Mendelian randomization reveals stronger instrumental estimates of DBP (OR [95% CI] = 1.20 [1.15–1.25]/10 mmHg; P = 5.57 × 10−25) on migraine than SBP (1.05 [1.03–1.07]/10 mmHg; P = 2.60 × 10−07) and a corresponding opposite effect for PP (0.92 [0.88–0.95]/10 mmHg; P = 3.65 × 10−07). These findings support a critical role of DBP in migraine susceptibility and shared biology underlying BP and migraine. The association between blood pressure (BP) and migraine is poorly understood. Here, the authors explore this relationship using summary-level GWAS data for BP and migraine. Cross-trait meta-analysis reveals shared loci between BP and migraine, while Mendelian randomization suggests that diastolic BP specifically plays a key role in migraine susceptibility.
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Togha M, Martami F, Abdollahi M, Mozafari M, Cheraghali H, Rafiee P, Shafaei M. Cinnarizine as an alternative recommendation for migraine prophylaxis: a narrative review. Expert Rev Neurother 2020; 20:943-951. [PMID: 32597267 DOI: 10.1080/14737175.2020.1787834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Despite the available prophylactic and acute drugs for migraine management, this disabling disorder remains undertreated especially among pediatrics. In this review, the authors aim at assessing the preventive role cinnarizine plays in treating migraine based on previously published studies. AREAS COVERED Randomized clinical trials, randomized controlled trials, non-randomized open-label trials, and retrospective studies concerning cinnarizine in migraine prevention in children and adults were reviewed. Especial attention was given to the response rate, migraine characteristics, and tolerability. EXPERT OPINION The majority of reviewed trials demonstrated that cinnarizine is comparable to the conventional drugs used in migraine prophylaxis. However, most of the reviewed studies were limited by a non-controlled open-label design. Due to poor planning and possibility of high placebo responses, particularly in children and adolescents, the interpretation of open-label studies' results should be done cautiously. The evidence shows that cinnarizine's effectiveness was more promising in pediatric migraineurs and adults with migraine-associated vertigo such as vestibular migraine. Therefore, while the efficacy of cinnarizine cannot be dismissed, before reaching a definite conclusion on its effectiveness, it is necessary to do further high-quality RCTs among both children and adults.
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Affiliation(s)
- Mansoureh Togha
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences , Tehran, Iran.,Department of Neurology, Sina Hospital, Tehran University of Medical Sciences , Tehran, Iran
| | - Fahime Martami
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences , Tehran, Iran
| | - Mohammad Abdollahi
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences , Tehran, Iran
| | - Mohammad Mozafari
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences , Tehran, Iran
| | - Hamed Cheraghali
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences , Tehran, Iran
| | - Pegah Rafiee
- Student Research Committee, (Department and Faculty of Nutrition Sciences and Food Technology), Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Maryam Shafaei
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences , Tehran, Iran
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Visser EJ, Drummond PD, Lee-Visser JLA. Reduction in Migraine and Headache Frequency and Intensity With Combined Antioxidant Prophylaxis (N-acetylcysteine, Vitamin E, and Vitamin C): A Randomized Sham-Controlled Pilot Study. Pain Pract 2020; 20:737-747. [PMID: 32306462 DOI: 10.1111/papr.12902] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/02/2020] [Accepted: 04/14/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the preventive effects of a combined antioxidant drug (N-acetylcysteine, vitamin E, and vitamin C [NEC]) on migraine outcomes. Migraine is characterized by increased oxidative stress and neurogenic inflammation in the brain; therefore, antioxidants may have a migraine preventive effect. DESIGN Randomized, double-blind, sham-controlled pilot study. SETTING Australian community. SUBJECTS Adults reporting 2 to 8 migraines per month for at least a year. METHODS After a 1-month baseline period, 35 subjects completed 3 months of treatment with NEC (n = 19) or sham (n = 16) capsules. The primary outcome was the difference in mean number of headaches per month between baseline and final month of the trial for NEC and sham groups; secondary outcomes are listed below. RESULTS For NEC there was a significant decrease in mean number of headaches by 3.0 per month (P = 0.004) compared with 1.4 for sham (P = 0.073); there was no significant difference in these changes between the 2 groups (P = 0.052). Average monthly headache (P = 0.041) and migraine frequency (P = 0.018) were significantly less for NEC vs. sham. In NEC subjects, there was a significant decrease in average monthly migraine days (-3.1), moderate/severe headache days (-3.2), migraine duration, headache pain scores, and acute headache medication use. CONCLUSIONS This is the first randomized controlled trial to find that combined antioxidant therapy with NEC reduces headaches and migraines in adult migraineurs. Given the limitations of this pilot study, an adequately powered randomized controlled trial is planned to further investigate antioxidant prophylaxis in migraine.
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Affiliation(s)
- Eric John Visser
- School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | | | - Julia L A Lee-Visser
- School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Mazdeh M, Mahmudian R, Vafaei SY, Taheri M, Ghafouri-Fard S. Effect of propranolol with and without rosuvastatin on migraine attacks: a triple blind randomized clinical trial. FUTURE NEUROLOGY 2020. [DOI: 10.2217/fnl-2019-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aim: To investigate the effect of rosuvastatin in combination with propranolol in reducing migraine attacks. Patients & methods: In a clinical trial study with census method, 120 patients with migraine headache were included. Patients were randomly assigned (using block randomization) to either propranolol (10 mg twice a day) with rosuvastatin (10 mg daily; intervention group [n = 60]) or propranolol (10 mg twice a day) with placebo (control [n = 60]). Results: The numbers of attacks were significantly decreased in the intervention group at the end of second, third and fourth weeks from the beginning of the intervention (p < 0.05). Conclusion: In patients with migraine, concomitant administration of propranolol (10 mg twice a day) and rosuvastatin (10 mg daily) is effective in reducing migraine attacks.
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Affiliation(s)
- Mehrdokht Mazdeh
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rihane Mahmudian
- Department of Neurology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Y Vafaei
- Department of Pharmaceutics & Pharmaceutical Biotechnology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Taheri
- Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soudeh Ghafouri-Fard
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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