Prophylatic treatment of migraine and migraine clinical variants with topiramate: an update

The Treatment of Vestibular Migraine: A Narrative Review

Vestibular migraine (VM) is one of the most debilitating chronic diseases that is currently underdiagnosed and undertreated. The treatment of VM is a dynamic and rapidly advancing area of research. New developments in this field have the potential to improve the diagnosis and provide more individualized treatments for this condition. In this review, we discussed the progress of evidence-based treatment of VM, including pharmacotherapy and nonmedical methods. A search of the literature was conducted up to September 2019. In order to control or cure VM, patients should follow three steps. First, patients should comply with diet and behavioral medication; Second, during the attack of VM, patients should take medicine to control the symptoms. These acute attack treatment of VM consists of antiemetic medications (e.g., dimenhydrinate and benzodiazepines), anti-vertigo medicine, and analgesics (e.g. triptans). Third, prophylactic medicine (e.g., propranolol, topiramate, valproic aid, lamotrigine, and flunarizine) can be used to reduce the frequency and severity of VM attack. Also, vestibular rehabilitation (VR) treatment should be considered for all VM. Meanwhile, we also propose to establish a culture of prevention which is essential for reducing the personal, social and economic burden of VM.

The impact of self-administered acupressure on sleep quality and fatigue among patients with migraine: A randomized controlled trial

BACKGROUND AND AIM

Poor sleep and fatigue are among the most common complaints of patients with migraine. These problems can lead to different negative consequences such as headaches. This study aimed to examine the impacts of self-administered acupressure on sleep quality and fatigue among patients with migraine.

METHODS

This double-blind randomized controlled trial was conducted in 2016 on 76 patients who suffered from migraine without aura. Patients were conveniently selected from the neurology clinic of Valiasr (PBUH) teaching hospital and randomly allocated to either an acupressure (n = 38) or a sham acupressure group (n = 38) group. Data collection instruments were a demographic questionnaire, Pittsburg Sleep Quality Index, and Fatigue Severity Scale. Patients in the acupressure and the sham acupressure groups were trained to apply acupressure on respectively acupoints and sham points thrice weekly at bedtime for four consecutive weeks. The data were analyzed through the Chi-square, the independent-sample t, the paired-sample t, and the ANCOVA tests at the significance level of less than 0.05.

RESULTS

After controlling sleep quality mean scores at baseline, no significant difference was found between the sleep quality of the two groups after intervention (P > 0.05). The mean scores of fatigue significantly decreased in both acupressure and sham acupressure groups (P < 0.05). However, the decrease in the acupressure group was significantly greater than in the sham acupressure group (P < 0.05).

CONCLUSION

As a noninvasive non-pharmacological therapy, acupressure can significantly reduce fatigue among patients with migraine.

Is There An Association between Migraine and Allergic Rhinitis?

We conducted a prospective study to evaluate nasal signs and symptoms and to perform allergen-specific immunoglobulin E (IgE) testing to investigate the relationship between migraine and allergic rhinitis. Our study group consisted of 40 patients diagnosed with migraine—22 men and 18 women, aged 21 to 38 years (mean: 25.7). We compared their findings with a control group of 40 healthy adults—15 men and 25 women, aged 19 to 36 years (mean: 25.1). Allergen-specific IgE measurements were obtained with six groups of allergens: fungi, grass pollens, tree pollens, wild herbs, house dust mite 1, and house dust mite 2. We found no significant difference between the migraine patients and the controls in the incidence of nasal signs and symptoms (i.e., discharge, congestion, itching, and sneezing) or inferior turbinate signs (i.e., color and edema). According to the IgE assays, 14 migraine patients (35.0%) were sensitized to one or more allergens, compared with 11 of the controls (27.5%); the difference was not statistically significant. Sensitization was highest for the grass pollens panel in both groups. Even though we did not find an association between migraine and allergic rhinitis, the recent literature supports a correlation between migraine and atopy. The two conditions share common neural pathways and common mediators, and they can be linked statistically in patients and their families. A pathophysiologic association between the two conditions seems more likely than an etiologic association. In this regard, future efforts could be focused on the determination of atopy in migraine patients and the therapeutic implications of this diagnosis.

Balance disorders in childhood: Main etiologies according to age. Usefulness of the video head impulse test

Balance disorders are common in adult patients but less usual in the pediatric population. When this symptomatology appears in children it is a cause for concern, both for parents and health-care professionals.

OBJECTIVES

To explain the balance disorders in children describing a case series and to discuss the main etiologies found according to age.

STUDY DESIGN

A retrospective, observational, descriptive, and cross-sectional study was conducted.

POPULATION

Patients aged 1-18 years who consulted because of balance disorders at the otolaryngology department of a pediatric tertiary-care hospital between March 2012 and July 2015.

RESULTS

Two hundred and six patients were included in the study. Median age was 10 years. The most common diagnoses were vestibular migraine in 21.8% of the children, ataxia in 9.22%, benign paroxysmal vertigo of childhood in 7.77%, and post-traumatic vertigo in 6.31%.Overall, 61 videonystagmographies- of which 46 were normal - and 55 video head impulse tests - which were normal in 45 and showed abnormalities in the vestibulo-ocular reflex gain in 10 - were performed.

CONCLUSIONS

In a child with balance disorders, the medical history and neurotological examination are essential. Vestibular migraine is the most commonly found disorder in every age group, and most of the patients have a family history of migraine. Ancillary studies, especially the video head-impulse test, provide important data to confirm the diagnosis.

Migraine headache prophylaxis in adolescents

Migraine headache is estimated to affect up to 28 percent of adolescents, most of whom are female. Chronic migraine in this population has been associated with reduced quality of life and academic disruption due to missed school days. Historically, migraine headache was treated episodically as it occurred. In March 2014 the U.S. Food and Drug Administration approved an existing medication, topiramate (Topamax®), for migraine prophylaxis in adolescents between the ages of 12 and 17. This is the first FDA approval of a drug for migraine prevention in this population. There are several possible adverse effects of taking topiramate, some potentially serious, so adequate education for adolescents and their families on all the potential benefits and risks is imperative.

Evaluation and management of vestibular migraine in children: Experience from a pediatric vestibular clinic

OBJECTIVE

Epidemiologic studies have shown Vestibular migraine (VM) to be the most common cause of vertigo in children, but little is known about the typical presentation and response to treatment of this disorder in the pediatric population. The aim of this study was to evaluate the diagnostic features and response to therapy of VM in children managed at a pediatric vestibular clinic.

METHODS

Twenty-eight patients ≤18 years old with a diagnosis of VM were identified from 208 patients seen at the Balance and Vestibular Program at Boston Children's Hospital from July 2012-July 2014, after excluding 12 patients with a history of major otologic or neurologic surgery, recent concussion, or additional vestibular disorders. Patients' electronic medical records and testing results were retrospectively reviewed.

RESULTS

Patients ranged in age from 9 to 18 years old (mean 14.48). All included patients met criteria for definite (n = 25) or probable (n = 3) VM as defined by the International Classification of Headache Disorders. Rotary chair (n = 17), caloric (n = 8), cervical vestibular evoked myogenic potential (n = 16), and video head impulse (n = 3) tests were normal. Medications effectively reduced reported vestibular symptoms in 88% of those treated with tricyclics (n = 8), 86% of those treated with cyprohepatadine (n = 7), 80% of those treated with topiramate (n = 5), 80% of those treated with triptans (n = 10), and 25% of those treated with gabapentin (n = 4).

CONCLUSIONS

Vestibular migraine is a common cause of vertigo in the pediatric population that is frequently responsive to medical therapy.

Functioning of women with migraine headaches

BACKGROUND

Migraines are one of the most commonly occurring ailments affecting the nervous system. The aim of this research paper was to evaluate the effect migraines have on the everyday functioning of women.

METHOD

The study involved women with diagnosed migraine headaches (IHS-2004) undergoing treatment at a neurological clinic. In order to evaluate the influence of headaches on the everyday functioning of women, a MSQ v.2 questionnaire was used, whereas pain severity was assessed on a linear VAS scale.

RESULTS

Among the clinical factors, the most influential was the frequency of headaches. Headache duration was particularly significant for women below the age of 40. Pain severity cited at 8-10 pts on the VAS significantly disrupted and limited everyday functioning. On the emotional function subscale, the most influential factors were age, education, and the frequency of headaches.

CONCLUSIONS

On account of headache frequency emerging as the most significant influencing factor, it is of the utmost importance to inform patients of the value of taking prophylactic measures. Central to this is the identification of factors that trigger the onset of migraines. This approach would greatly aid the individual in choosing the appropriate treatment, either pharmacological or others.

Zonisamide versus topiramate in migraine prophylaxis: a double-blind randomized clinical trial

BACKGROUND

Topiramate is an antiepileptic drug that has been approved for migraine prophylaxis. Despite appropriate efficacy for migraine prophylaxis, some patients cannot tolerate its adverse effects. The aim of this study was to compare the efficacy of zonisamide, another antiepileptic drug, with topiramate in decreasing the frequency and severity of migraine attacks to determine whether it could be used as an alternative for noncompliant patients to topiramate.

METHODS

Eighty patients, recruited from referred migraineurs to our neurology clinic, who met the diagnosis and inclusion criteria were allocated randomly to group A (50-mg/d zonisamide, gradually titrated up to 200 mg/d) and group B (25-mg/d topiramate, gradually titrated up to 100 mg/d). Each patient was followed for 12 weeks and was assessed at entrance, in the fourth week and twelfth week for frequency of attacks, headache severity, need for acute medication, migraine disability assessment score, and adverse effects. A P < 0.05 was considered as the level of significant difference in all tests.

RESULTS

Both drugs caused a significant decrease in frequency, severity, need for acute medication in migraine attacks, and migraine disability assessment score (P < 0.05). Except headache severity that was reduced significantly better by zonisamide (P < 0.008), there were no significant difference between the 2 groups in other items. Except for 2 cases of intolerable paresthesia, both drugs were tolerated well during the study.

CONCLUSION

Our results indicated that zonisamide is as effective as topiramate in migraine prophylaxis and can be considered as an alternative treatment when topiramate is not tolerated well.