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Vitali-Silva A, Bello VA, Poli RC, de Oliveira CEC, Lopes MV, Silveira DN, Bossa BB, Espinosa BR, Ahrens TM, Reiche EMV, Simão ANC. IL18 rs360717 and rs187238 genetic variants are associated with migraine diagnosis. Eur J Pain 2024. [PMID: 38922725 DOI: 10.1002/ejp.2302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 05/06/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Migraine is a genetically determined disorder that predisposes to recurrent episodes of headache. Interleukin (IL)-18 is a pro-inflammatory cytokine that seems to play a role in migraine pathophysiology, and its genetic variants could potentially impact susceptibility to migraine. OBJECTIVE To investigate the association between IL18 rs360717 and rs187238 genetic variants with migraine diagnosis and its clinical characteristics. METHODS A case-control study was conducted with 152 people with migraine and 155 healthy controls, matched by sex, age, ethnicity, and body mass index. Clinical characteristics of migraine, as well as validated questionnaires regarding disability and impact of migraine, presence of allodynia, anxiety, depression, and hyperacusis were collected. Genotyping for IL18 rs360717 and rs187238 variants was performed using real-time polymerase chain reaction (qPCR) and TaqMan™ method. RESULTS The IL18 rs360717A and rs187238G alleles were associated with increased chance of being diagnosed with migraine (OR = 1.53, 95%CI 1.05-2.24, p = 0.028 and OR = 1.46, 95%CI 1.00-2.14, p = 0.049, respectively). In the dominant model, the rs360717GA + AA genotypes were also associated with a higher chance of migraine than the GG genotype (OR = 1.69, 95%CI 1.05-2.73, p = 0.030). In women, in addition to the previous associations, there was also an effect of the variants on the chance of migraine in the codominant models and dominant models. Furthermore, among women, there was an influence on the prevalence of postdrome perception with rs360717GA + AA (OR = 3.04, 95%CI 1.10-8.42, p = 0.032) and rs187238CG + GG (OR = 2.97, 95%CI 1.08-8.21, p = 0.035). CONCLUSION IL18 rs360717 and rs187238 variants were associated with migraine diagnosis and postdrome symptoms, especially in women. SIGNIFICANCE This study has demonstrated that IL18 rs360717 and rs187238 variants play a role in migraine, influencing the chance of being diagnosed with migraine, particularly among women. There are prospects that IL18 variants could be considered potential genetic biomarkers for migraine.
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Affiliation(s)
- Aline Vitali-Silva
- Escola de Medicina, Pontifícia Universidade Católica Do Paraná, Londrina, Brazil
- Universidade Estadual de Londrina, Londrina, Brazil
| | | | - Regina Célia Poli
- Escola de Medicina, Pontifícia Universidade Católica Do Paraná, Londrina, Brazil
- Universidade Norte Do Paraná, Londrina, Brazil
| | - Carlos Eduardo Coral de Oliveira
- Escola de Medicina, Pontifícia Universidade Católica Do Paraná, Londrina, Brazil
- Universidade Estadual de Londrina, Londrina, Brazil
| | - Milene Valéria Lopes
- Escola de Medicina, Pontifícia Universidade Católica Do Paraná, Londrina, Brazil
| | | | | | | | | | - Edna Maria Vissoci Reiche
- Escola de Medicina, Pontifícia Universidade Católica Do Paraná, Londrina, Brazil
- Universidade Estadual de Londrina, Londrina, Brazil
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Wei HL, Yu YS, Wang MY, Zhou GP, Li J, Zhang H, Zhou Z. Exploring potential neuroimaging biomarkers for the response to non-steroidal anti-inflammatory drugs in episodic migraine. J Headache Pain 2024; 25:104. [PMID: 38902598 PMCID: PMC11191194 DOI: 10.1186/s10194-024-01812-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are considered first-line medications for acute migraine attacks. However, the response exhibits considerable variability among individuals. Thus, this study aimed to explore a machine learning model based on the percentage of amplitude oscillations (PerAF) and gray matter volume (GMV) to predict the response to NSAIDs in migraine treatment. METHODS Propensity score matching was adopted to match patients having migraine with response and nonresponse to NSAIDs, ensuring consistency in clinical characteristics and migraine-related features. Multimodal magnetic resonance imaging was employed to extract PerAF and GMV, followed by feature selection using the least absolute shrinkage and selection operator regression and recursive feature elimination algorithms. Multiple predictive models were constructed and the final model with the smallest predictive residuals was chosen. The model performance was evaluated using the area under the receiver operating characteristic (ROCAUC) curve, area under the precision-recall curve (PRAUC), balance accuracy (BACC), sensitivity, F1 score, positive predictive value (PPV), and negative predictive value (NPV). External validation was performed using a public database. Then, correlation analysis was performed between the neuroimaging predictors and clinical features in migraine. RESULTS One hundred eighteen patients with migraine (59 responders and 59 non-responders) were enrolled. Six features (PerAF of left insula and left transverse temporal gyrus; and GMV of right superior frontal gyrus, left postcentral gyrus, right postcentral gyrus, and left precuneus) were observed. The random forest model with the lowest predictive residuals was selected and model metrics (ROCAUC, PRAUC, BACC, sensitivity, F1 score, PPV, and NPV) in the training and testing groups were 0.982, 0.983, 0.927, 0.976, 0.930, 0.889, and 0.973; and 0.711, 0.648, 0.639, 0.667,0.649, 0.632, and 0.647, respectively. The model metrics of external validation were 0.631, 0.651, 0.611, 0.808, 0.656, 0.553, and 0.706. Additionally, a significant positive correlation was found between the GMV of the left precuneus and attack time in non-responders. CONCLUSIONS Our findings suggest the potential of multimodal neuroimaging features in predicting the efficacy of NSAIDs in migraine treatment and provide novel insights into the neural mechanisms underlying migraine and its optimized treatment strategy.
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Affiliation(s)
- Heng-Le Wei
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, China
| | - Yu-Sheng Yu
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, China
| | - Meng-Yao Wang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, China
| | - Gang-Ping Zhou
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, China
| | - Junrong Li
- Department of Neurology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China.
| | - Hong Zhang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, China.
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
- Department of Radiology, Nanjing Drum Tower Hospital, Nanjing, China.
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Shimoda M, Hoshikawa K, Oda S, Imai M, Osada T, Aoki R, Sunaga A, Shinohara C. Cortical Hyperperfusion on MRI Arterial Spin-Labeling during the Interictal Period of Patients with Migraine Headache. AJNR Am J Neuroradiol 2024; 45:686-692. [PMID: 38663988 DOI: 10.3174/ajnr.a8208] [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: 11/07/2023] [Accepted: 01/25/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND AND PURPOSE Concentrations of calcitonin gene-related peptide, a neuropeptide and potent endogenous vasodilator, are reportedly higher in patients with migraine than in healthy subjects, both during and between migraine attacks, reflecting ongoing activation of the trigeminal nervous system. In this prospective study, we measured CBF during the interictal period of patients with migraine after considering insomnia and depression and examined the effects of ongoing activation of the trigeminal nervous system, including during the interictal period, on CBF. MATERIALS AND METHODS In a total of 242 patient with migraine (age range, 18-75 years), CBF was measured by MR imaging arterial spin-labeling during the interictal period and was compared with results from 26 healthy volunteers younger than 45 years of age as control subjects (age range, 22-45 years). Cortical hyperperfusion was defined as identification of ≥2 cerebral cortical regions with regional CBF values at least 2 SDs above the mean regional CBF in control subjects. RESULTS The overall frequency of cortical hyperperfusion was significantly higher in patients with migraine (115 of 242, 48%) than in control subjects (1 of 26, 4%). Multivariable analysis revealed the 18- to 40-year age group and patients with migraine without insomnia as significant positive clinical factors associated with cortical hyperperfusion. Among patients with migraine without insomnia, the frequency of cortical hyperperfusion was >92% (89 of 97). One-way ANOVA showed that in all ROIs of the cortex, regional CBF was significantly higher in patients with migraine without insomnia than in patients with migraine with insomnia or control subjects. In patients with migraine without insomnia, cortical hyperperfusion findings showed a sensitivity of 0.918 and a specificity of 0.962 for migraine in the interictal period, representing excellent accuracy. In contrast, among patients with migraine with insomnia, sensitivity was only 0.179 but specificity was 0.962. CONCLUSIONS Patients with migraine without insomnia may have cortical hyperperfusion during the interictal period; however, the findings of the present study need to be prospectively validated on a larger scale before clinical applicability can be considered.
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Affiliation(s)
- Masami Shimoda
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Kaori Hoshikawa
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Shinri Oda
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Masaaki Imai
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Takahiro Osada
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Rie Aoki
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Azusa Sunaga
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Chiaki Shinohara
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
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Conti M, Bovenzi R, Palmieri MG, Placidi F, Stefani A, Mercuri NB, Albanese M. Early effect of onabotulinumtoxinA on EEG-based functional connectivity in patients with chronic migraine: A pilot study. Headache 2024. [PMID: 38837259 DOI: 10.1111/head.14750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE In this pilot prospective cohort study, we aimed to evaluate, using high-density electroencephalography (HD-EEG), the longitudinal changes in functional connectivity (FC) in patients with chronic migraine (CM) treated with onabotulinumtoxinA (OBTA). BACKGROUND OBTA is a treatment for CM. Several studies have shown the modulatory action of OBTA on the central nervous system; however, research on migraine is limited. METHODS This study was conducted at the Neurology Unit of "Policlinico Tor Vergata," Rome, Italy, and included 12 adult patients with CM treated with OBTA and 15 healthy controls (HC). Patients underwent clinical scales at enrollment (T0) and 3 months (T1) from the start of treatment. HD-EEG was recorded using a 64-channel system in patients with CM at T0 and T1. A source reconstruction method was used to identify brain activity. FC in δ-θ-α-β-low-γ bands was analyzed using the weighted phase-lag index. FC changes between HCs and CM at T0 and T1 were assessed using cross-validation methods to estimate the results' reliability. RESULTS Compared to HCs at T0, patients with CM showed hyperconnected networks in δ (p = 0.046, area under the receiver operating characteristic curve [AUC: 0.76-0.98], Cohen's κ [0.65-0.93]) and β (p = 0.031, AUC [0.68-0.95], Cohen's κ [0.51-0.84]), mainly involving orbitofrontal, occipital, temporal pole and orbitofrontal, superior temporal, occipital, cingulate areas, and hypoconnected networks in α band (p = 0.029, AUC [0.80-0.99], Cohen's κ [0.42-0.77]), predominantly involving cingulate, temporal pole, and precuneus. Patients with CM at T1, compared to T0, showed hypoconnected networks in δ band (p = 0.032, AUC [0.73-0.99], Cohen's κ [0.53-0.90]) and hyperconnected networks in α band (p = 0.048, AUC [0.58-0.93], Cohen's κ [0.37-0.78]), involving the sensorimotor, orbitofrontal, cingulate, and temporal cortex. CONCLUSION These preliminary results showed that patients with CM presented disrupted EEG-FC compared to controls restored by a single session of OBTA treatment, suggesting a primary central modulatory action of OBTA.
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Affiliation(s)
- Matteo Conti
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Roberta Bovenzi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Fabio Placidi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Alessandro Stefani
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Maria Albanese
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Neurology Unit, Regional Referral Headache Center, University of Rome "Tor Vergata", Rome, Italy
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Fukazawa R, Ishii R, Higashimoto Y, Hanya M, Shimizu Y, Shinomoto M, Fujii A, Mizuno T. Zinc Administration Favorably Affects Prophylactic Therapy-refractory Migraine Attacks: A Case Series. Intern Med 2024; 63:1631-1635. [PMID: 37926551 PMCID: PMC11189699 DOI: 10.2169/internalmedicine.2111-23] [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: 04/11/2023] [Accepted: 09/18/2023] [Indexed: 11/07/2023] Open
Abstract
Notably, certain nutrients are effective in preventing migraine. Nonetheless, zinc replacement therapy for migraine treatment has yet to be explored. We herein report four patients with migraine who were refractory to prophylactic therapy and whose headache frequency and severity improved with zinc supplementation. Zinc administration may be an option for treating patients with prophylaxis-refractory migraine. Further investigation is required to determine the efficacy of zinc replacement therapy as a treatment option for migraine.
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Affiliation(s)
- Ryosuke Fukazawa
- Department of Neurology, Kyoto Prefectural University of Medicine, Japan
- Department of Neurology, Saiseikai Shiga Hospital, Japan
| | - Ryotaro Ishii
- Department of Neurology, Kyoto Prefectural University of Medicine, Japan
| | - Yuki Higashimoto
- Department of Neurology, Kyoto Prefectural University of Medicine, Japan
- Department of Neurology, Japanese Red Cross Kyoto Daini Hospital, Japan
| | - Misaki Hanya
- Department of Neurology, Kyoto Prefectural University of Medicine, Japan
- Department of Neurology, North Medical Center Kyoto Prefectural University of Medicine, Japan
| | - Yuki Shimizu
- Department of Neurology, Kyoto Prefectural University of Medicine, Japan
- Department of Neurology, Japanese Red Cross Kyoto Daini Hospital, Japan
| | - Makiko Shinomoto
- Department of Neurology, Kyoto Prefectural University of Medicine, Japan
| | - Akihiro Fujii
- Department of Neurology, Saiseikai Shiga Hospital, Japan
| | - Toshiki Mizuno
- Department of Neurology, Kyoto Prefectural University of Medicine, Japan
- Department of Neurology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, Japan
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Zhao YJ, Ong JJY, Sonu SK, Dang J, Ng CC, Herr KJ, Bose R, Jion YI. A real-world prospective observational study of eptinezumab in Asian patients with migraine. Headache 2024. [PMID: 38785386 DOI: 10.1111/head.14737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To evaluate the real-world effectiveness of eptinezumab for migraine prevention in Asian patients. BACKGROUND Eptinezumab is a monoclonal antibody that targets calcitonin gene-related peptide (CGRP), a potent vasodilator with an important role in migraine pathophysiology. Although there is robust clinical evidence from pivotal Phase 3 placebo-controlled trials of the efficacy of eptinezumab for migraine prevention, there are limited data on the real-world effectiveness of eptinezumab in Asian patient cohorts. METHODS This was a non-interventional, prospective, multisite cohort study of adults with migraine (International Classification of Headache Disorders, 3rd edition criteria) in Singapore who were prescribed eptinezumab (100 mg at baseline and Month 3, administered intravenously) and were followed until Month 6. The primary endpoint was change from baseline in monthly migraine days (MMDs) at Month 3 and Month 6. Secondary endpoints were ≥30% and ≥50% responder rates, and change from baseline in the Headache Impact Test-6 (HIT-6), Migraine Disability Assessment (MIDAS), Migraine-Specific Quality of Life (MSQ), patient-identified most bothersome symptom (PI-MBS), acute medication use at Month 3 and Month 6, and safety. RESULTS Enrolled patients (completed = 29/30) had on average 3.4 (SD 2.9) previous preventive treatments; 29/30 of the patients had trialed at least one previous preventive treatment without benefit. Most had previously trialed oral preventives (87%, 26/30) and anti-CGRP (70%, 21/30). Relative to baseline, mean MMDs decreased by 4.3 days (95% CI 2.1-6.4; p < 0.001) at Month 3 and 4.9 days (95% CI 2.1-7.7; p < 0.001) at Month 6. At Month 3 and Month 6, 14/30 (47%) and 15/29 (52%) of the patients were ≥30% responders, and 6/30 (20%) and 8/29 (28%) patients were ≥50% responders, respectively. The number of patients with severe life impairment based on the HIT-6 score (total score 60-78) decreased from 24/30 (80%) at baseline to 19/30 (63%) at Month 3 and 19/29 (66%) at Month 6. The mean MIDAS score decreased by 24.6 points (95% CI 2.82-46.38; p = 0.028) at Month 6, and the mean MSQ score increased by 12.2 points (95% CI 5.18-19.20; p = 0.001) at Month 3 and 13.6 points (95% CI 4.58-22.66; p = 0.004) at Month 6. Most patients reported improvement in the PI-MBS at Month 3 (73%, 22/30) and Month 6 (55%, 16/29). Acute medication use for headache relief decreased by 3.3 days/month (95% CI 1.0-5.6; p = 0.007) at Month 3 and 4.7 days/month (95% CI 1.7-7.7; p = 0.003) at Month 6. Treatment-emergent adverse events (TEAEs) were reported in 16/30 (54%) patients, mostly mild/moderate in severity. No serious TEAEs led to treatment discontinuation. CONCLUSION Quarterly eptinezumab administration was effective and well-tolerated in Asian patients with chronic migraine.
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Affiliation(s)
- Yi Jing Zhao
- Mount Elizabeth Medical Centre, Singapore, Singapore
| | - Jonathan Jia Yuan Ong
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
- YLL School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sumit Kumar Sonu
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Jiaojiao Dang
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Chai Ching Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | | | - Rohini Bose
- Lundbeck Singapore Pte. Ltd., Singapore, Singapore
| | - Yasmin Idu Jion
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
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Giesen S, Rimmele F, Jürgens TP, Scheidt J, Drescher J, Leonhardt AK, Schulze S, Harbeck B, Meyer W, Müller B, Kropp P, Keller A. Relationship between Contingent Negative Variation and afterimage duration in migraine patients. Front Neurol 2024; 15:1401212. [PMID: 38827574 PMCID: PMC11141693 DOI: 10.3389/fneur.2024.1401212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/03/2024] [Indexed: 06/04/2024] Open
Abstract
Background Abnormalities in electrocortical parameters and persistence of afterimage after visual stimulation are known to occur in migraine patients. The results of studies on Contingent Negative Variation (CNV) and afterimage persistence in migraine patients suggest a link between these two phenomena and a connection to the pathomechanism of migraine. Objectives To date, no studies have investigated both afterimage duration and CNV parameters in the same subjects. The aim of this study was to investigate the relationship between the early component of CNV (iCNV) and the duration of the afterimage in migraine patients. Methods Sixty seven migraine patients from the headache center of the University of Rostock Medical Center were examined for iCNV amplitude, iCNV habituation and afterimage duration. The subjects also completed questionnaires developed for this study and the MIDAS (Migraine Disability Assessment) questionnaire. Results Associations were found between iCNV amplitude and afterimage duration and between habituation capacity and afterimage duration. A deficit in habituation capacity correlated with a significantly prolonged afterimage duration. Increased iCNV amplitude and prolonged afterimage duration were also significantly correlated. Conclusion Conclusions about the pathophysiology of migraine can be drawn from the results of this study. The results support the hypothesis of cortical hyperexcitability as a consequence of a low pre-activation level, which may be a possible contributory cause of migraine. Furthermore, they allow assessment of whether the afterimage examination, which is easier and quicker to perform than the CNV examination, can be used as a diagnostic tool or as a parameter to monitor the course of therapy in people with migraine.
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Affiliation(s)
- Simeon Giesen
- Institute of Medical Psychology and Medical Sociology, University of Rostock Medical Center, Rostock, Germany
| | - Florian Rimmele
- Department of Neurology, University of Rostock Medical Center, Rostock, Germany
| | - Tim P. Jürgens
- Department of Neurology, University of Rostock Medical Center, Rostock, Germany
- Department of Neurology, KMG Hospital Güstrow, Güstrow, Germany
| | - Jörg Scheidt
- Institute for Informations Systems, University of Applied Sciences, Hof, Germany
| | - Johannes Drescher
- Institute for Informations Systems, University of Applied Sciences, Hof, Germany
| | - Ann-Kristin Leonhardt
- Institute of Medical Psychology and Medical Sociology, University of Rostock Medical Center, Rostock, Germany
| | - Sophia Schulze
- Institute of Medical Psychology and Medical Sociology, University of Rostock Medical Center, Rostock, Germany
| | - Birgit Harbeck
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Amedes Experts, Endocrinology, Hamburg, Germany
| | - Wolfgang Meyer
- Institute of Medical Psychology and Medical Sociology, University of Rostock Medical Center, Rostock, Germany
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Britta Müller
- Institute of Medical Psychology and Medical Sociology, University of Rostock Medical Center, Rostock, Germany
| | - Peter Kropp
- Institute of Medical Psychology and Medical Sociology, University of Rostock Medical Center, Rostock, Germany
| | - Armin Keller
- Institute of Medical Psychology and Medical Sociology, University of Rostock Medical Center, Rostock, Germany
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Gago-Veiga AB, Lopez-Alcaide N, Quintas S, Fernández Lázaro I, Casas-Limón J, Calle C, Latorre G, González-García N, Porta-Etessam J, Rodriguez-Vico J, Jaimes A, Gómez García A, García-Azorín D, Guerrero-Peral ÁL, Sierra Á, Lozano Ros A, Sánchez-Soblechero A, Díaz-de-Teran J, Membrilla JA, Treviño C, Gonzalez-Martinez A. Evaluation of the concomitant use of prophylactic treatments in patients with migraine under anti-calcitonin gene-related peptide therapies: The PREVENAC study. Eur J Neurol 2024; 31:e16215. [PMID: 38323742 DOI: 10.1111/ene.16215] [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: 08/30/2023] [Revised: 12/23/2023] [Accepted: 01/04/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND AND PURPOSE Anti-calcitonin gene-related peptide (CGRP) therapies are recent preventive therapies approved for both episodic and chronic migraine. One of the measures of effectiveness is the withdrawal of other preventive treatments. The objective of this study is to quantify the impact of anti-CGRP drugs in concomitant preventive treatment in patients with migraine. METHODS This was an observational, retrospective, multicenter cohort study with patients from nine national headache units. Patients with migraine undergoing treatment for at least 6 months with anti-CGRP antibodies, who were initially associated with some preventive treatment (oral and/or onabotulinumtoxinA) were included. Demographic and clinical variables were collected, as well as variables related to headache. Differences according to withdrawal or nonwithdrawal were evaluated. RESULTS A total of 408 patients were included, 86.52% women, 48.79 (SD = 1.46) years old. Preventive treatment was withdrawn in 43.87% (179/408), 20.83% partially and 23.04% totally. In 27.45% (112/408), it was maintained exclusively due to comorbidity and in 28.6% (117/408) due to partial efficacy. The most frequent time of withdrawal was between 3 and 5 months after the start of treatment. The baseline characteristics associated with nonwithdrawal were comorbidities: insomnia, hypertension and obesity, chronic migraine, and medication overuse. In the multivariate analysis, the absence of high blood pressure, a greater number of preventive treatments at the start, and a lower number of migraine days/month after anti-CGRP treatment were independently associated with withdrawal of the treatment (p < 0.05). CONCLUSIONS Anti-CGRP antibodies allow the withdrawal of associated preventive treatment in a significant percentage of patients, which supports its effectiveness in real-life conditions.
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Affiliation(s)
- Ana Beatriz Gago-Veiga
- Headache Unit, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - Noelia Lopez-Alcaide
- Headache Unit, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - Sonia Quintas
- Headache Unit, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - Iris Fernández Lázaro
- Headache Unit, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - Javier Casas-Limón
- Headache Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Carlos Calle
- Headache Unit, Hospital de Fuenlabrada, Madrid, Spain
| | | | | | | | | | - Alex Jaimes
- Headache Unit, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | - David García-Azorín
- Headache Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Ángel Luis Guerrero-Peral
- Headache Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Álvaro Sierra
- Headache Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | | | | | - Cristina Treviño
- Headache Unit, Hospital Clínico Universitario de la Paz, Madrid, Spain
| | - Alicia Gonzalez-Martinez
- Headache Unit, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
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Oliveira R, Neves-Costa A, Pedroso D, Paixão T, Barros AB, Moita LF, Gil-Gouveia R. CLOCK gene circannual expression in cluster headache. Cephalalgia 2024; 44:3331024241247845. [PMID: 38676534 DOI: 10.1177/03331024241247845] [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: 04/29/2024]
Abstract
BACKGROUND Cluster headache is a primary headache disorder characterized by bouts with circadian and circannual patterns. The CLOCK gene has a central role in regulating circadian rhythms. Here, we investigate the circannual CLOCK expression in a population of cluster headache patients in comparison to matched controls. METHODS Patients with cluster headache were sampled two to four times over at least one year, both in or outside bouts, one week after each solstice and equinox. The expression of CLOCK was measured by quantitative real-time polymerase chain reaction (RT-PCR) in the peripheral blood. RESULTS This study included 50 patients and 58 matched controls. Among the patient population, composed of 42/50 males (84%) with an average age of 44.6 years, 45/50 (90%) suffered from episodic cluster headache. Two to four samples were collected from each patient adding up to 161 samples, 36 (22.3%) of which were collected within a bout. CLOCK expression for cluster headache patients was considerably different from that of the control population in winter (p-value mean = 0.006283), spring (p-value mean = 0.000006) and summer (p-value mean = 0.000064), but not in autumn (p-value mean = 0.262272). For each season transition, the variations in CLOCK expression were more pronounced in the control group than in the cluster headache population. No statistically significant differences were found between bout and non-bout samples. No individual factors (age, sex, circadian chronotype, smoking and coffee habits or history of migraine) were related to CLOCK expression. CONCLUSIONS We observed that CLOCK expression in cluster headache patients fluctuates less throughout the year than in the control population. Bout activity and lifestyle factors do not seem to influence CLOCK expression.
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Affiliation(s)
- Renato Oliveira
- Department of Neurosciences, Barking, Havering and Redbridge University Hospitals, NHS, London, United Kingdom
- Hospital da Luz Headache Center, Lisbon, Portugal
| | - Ana Neves-Costa
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Dora Pedroso
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Tiago Paixão
- Quantitative Biology and Digital Science Unit, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - André B Barros
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Luís F Moita
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
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10
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Midtlien JP, Kittel C, Klever LA, Kiritsis NR, Aldridge JB, Fargen KM. Redefining treatment expectations: exploring mid- and long-term outcomes of venous sinus stenting in idiopathic intracranial hypertension. J Neurointerv Surg 2024:jnis-2023-021336. [PMID: 38453459 DOI: 10.1136/jnis-2023-021336] [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: 12/01/2023] [Accepted: 02/18/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Venous sinus stenting (VSS) is recognized as a safe and effective intervention for medically-refractory idiopathic intracranial hypertension (IIH). However, its long-term efficacy remains uncertain. METHODS This retrospective review analyzed a single-center database of adult patients with severe, medically-refractory IIH, who underwent VSS and had minimum 3-month follow-up (FU). Patients were divided into three groups based on post-stenting symptom trajectories: group 1 (sustained improvement without relapse), group 2 (temporary improvement with relapse), and group 3 (no improvement). RESULTS Of 178 patients undergoing VSS, the majority were female (94%), with a median opening pressure (OP) of 31 cm H2O and trans-stenosis gradient of 14 mm Hg. Of these, 153 (86%) received transverse sinus (TS) stenting, and 19 (11%) underwent concurrent TS and superior sagittal sinus stenting. At a mean FU of 166 days, 53 patients (30%) showed long-term improvement without relapse (group 1). Symptomatic recurrence was noted in 101 patients (57%; group 2) within a mean FU of 390 days. Despite recurrent headache and tinnitus, the average OP reduction was 9.6 cm H2O on repeat lumbar puncture, with 75% showing papilledema improvement or resolution post-VSS. Only 17% required further surgical intervention. CONCLUSIONS The most common clinical outcome post-VSS in IIH patients is initial symptomatic improvement followed by symptom recurrence in about 60% at a mean of 274 days, despite a consistent intracranial pressure reduction. These findings can guide physicians in setting realistic expectations with patients regarding VSS outcomes.
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Affiliation(s)
- Jackson P Midtlien
- Department of Neurological Surgery, Atrium Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Carol Kittel
- Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Lucas A Klever
- Department of Neurological Surgery, Atrium Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Nicholas R Kiritsis
- Department of Neurological Surgery, Atrium Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | | | - Kyle M Fargen
- Department of Neurological Surgery, Atrium Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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11
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Patil DS, Tikhile P, Gangwani N. Effectiveness of Nonpharmacological Measures on Improving Headache Score, Strength, Pain, and Quality of Life in Cervicogenic Headaches: A Systematic Review. Cureus 2024; 16:e57361. [PMID: 38699082 PMCID: PMC11063809 DOI: 10.7759/cureus.57361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/31/2024] [Indexed: 05/05/2024] Open
Abstract
Cervicogenic headache (CGH) is a common condition affecting a significant portion of the population and is effectively managed through various interventions, including nonpharmacological approaches. Physical therapy plays a crucial role in CGH management, with numerous studies supporting its effectiveness. This systematic review aimed to evaluate the effectiveness of specific nonpharmacological physical therapy interventions for CGH. A comprehensive search was conducted across various databases (PubMed, Medline, PEDro, and Cochrane Library) for randomized controlled trials (RCTs) published between January 2017 and January 2023 investigating the effectiveness of specific nonpharmacological physical therapy interventions for CGH. We employed manual searches to capture potentially missed studies. Independent reviewers screened all studies based on predefined eligibility criteria. Extracted data included methodology, specific interventions, outcome measures (headache score, strength, pain, and quality of life (QOL)), and study conclusions. Eight RCTs were identified as meeting all inclusion criteria and were thus included in the data synthesis. The findings from these trials revealed a diverse range of nonpharmacological physical therapy interventions, including but not limited to manual therapy, exercise therapy, and multimodal approaches. Specifically, the interventions demonstrated significant improvements in headache scores, strength, pain levels, and overall QOL among individuals with CGH. These results underscore the multifaceted benefits of physical therapy in managing CGH and highlight its potential as a comprehensive treatment option. This review identified eight relevant RCTs investigating nonpharmacological interventions for CGH. Despite the promising findings, this review acknowledges several limitations, including the limited sample size and the heterogeneity of interventions across studies. These limitations emphasize the necessity for further research to elucidate optimal intervention strategies and refine treatment protocols. Nevertheless, the comprehensive analysis presented herein reinforces the pivotal role of physical therapy in not only alleviating pain but also enhancing function and improving the QOL for individuals suffering from CGH.
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Affiliation(s)
- Deepali S Patil
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Priya Tikhile
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Nikita Gangwani
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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12
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Schweiger V, Bellamoli P, Taus F, Gottin L, Martini A, Nizzero M, Bonora E, Del Balzo G, Donadello K, Secchettin E, Finco G, Santis DD, Polati E. Anti-CGRP and Anti-CGRP Receptor Monoclonal Antibodies for Migraine Prophylaxis: Retrospective Observational Study on 209 Patients. J Clin Med 2024; 13:1130. [PMID: 38398444 PMCID: PMC10889238 DOI: 10.3390/jcm13041130] [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: 12/27/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Migraine is a neurological disorder characterized by attacks of head pain with prevalent unilateral localization, moderate to high intensity and specifically associated accompanying symptoms. METHODS In this retrospective observational study, we analyzed data regarding 209 patients who had previously been diagnosed with migraine and who were prescribed, between 2019 and 2022, subcutaneous injections of anti-CGRP monoclonal antibodies (mAbs) fremanezumab or galcanezumab or anti-CGRP receptors mAb erenumab regardless of the concomitant assumption of any other acute-phase or prophylactic migraine medication. RESULTS Regarding efficacy, in the 205 analyzed patients, the change from baseline in terms of MIDAS, HIT-6, MMDs and MAD scores was statistically significant for erenumab and galcanezumab, while for fremanezumab a statistical significance was not achieved likely due to the small sample size. In the treated population, 36 patients (17.5%) reported AEs (pain during injection, transient injection site erythema, nausea, constipation and fatigue). Only 5 patients (2.4%) discontinued the treatment for AEs while 15 patients (7.3%) left for lack of efficacy. CONCLUSIONS this retrospective study comes out in favor of both significant efficacy and safety of anti-CGRP and anti-CGRP receptors mAbs in migraine patients. Further methodologically stronger studies are necessary to validate our observation.
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Affiliation(s)
- Vittorio Schweiger
- Anesthesiology, Intensive Care and Pain Therapy Center, Department of Surgery, University of Verona, 37124 Verona, Italy; (P.B.); (L.G.); (A.M.); (M.N.); (E.B.); (K.D.); (E.S.); (E.P.)
| | - Paola Bellamoli
- Anesthesiology, Intensive Care and Pain Therapy Center, Department of Surgery, University of Verona, 37124 Verona, Italy; (P.B.); (L.G.); (A.M.); (M.N.); (E.B.); (K.D.); (E.S.); (E.P.)
| | - Francesco Taus
- Department of Diagnostics and Public Health, Section of Statistics, University of Verona, 37124 Verona, Italy;
| | - Leonardo Gottin
- Anesthesiology, Intensive Care and Pain Therapy Center, Department of Surgery, University of Verona, 37124 Verona, Italy; (P.B.); (L.G.); (A.M.); (M.N.); (E.B.); (K.D.); (E.S.); (E.P.)
| | - Alvise Martini
- Anesthesiology, Intensive Care and Pain Therapy Center, Department of Surgery, University of Verona, 37124 Verona, Italy; (P.B.); (L.G.); (A.M.); (M.N.); (E.B.); (K.D.); (E.S.); (E.P.)
| | - Marta Nizzero
- Anesthesiology, Intensive Care and Pain Therapy Center, Department of Surgery, University of Verona, 37124 Verona, Italy; (P.B.); (L.G.); (A.M.); (M.N.); (E.B.); (K.D.); (E.S.); (E.P.)
| | - Eleonora Bonora
- Anesthesiology, Intensive Care and Pain Therapy Center, Department of Surgery, University of Verona, 37124 Verona, Italy; (P.B.); (L.G.); (A.M.); (M.N.); (E.B.); (K.D.); (E.S.); (E.P.)
| | - Giovanna Del Balzo
- Department of Diagnostics and Public Health, Section of Forensic Medicine, University of Verona, 37129 Verona, Italy;
| | - Katia Donadello
- Anesthesiology, Intensive Care and Pain Therapy Center, Department of Surgery, University of Verona, 37124 Verona, Italy; (P.B.); (L.G.); (A.M.); (M.N.); (E.B.); (K.D.); (E.S.); (E.P.)
| | - Erica Secchettin
- Anesthesiology, Intensive Care and Pain Therapy Center, Department of Surgery, University of Verona, 37124 Verona, Italy; (P.B.); (L.G.); (A.M.); (M.N.); (E.B.); (K.D.); (E.S.); (E.P.)
| | - Gabriele Finco
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy;
| | - Daniele De Santis
- Head and Neck Department, University of Verona, 37129 Verona, Italy;
| | - Enrico Polati
- Anesthesiology, Intensive Care and Pain Therapy Center, Department of Surgery, University of Verona, 37124 Verona, Italy; (P.B.); (L.G.); (A.M.); (M.N.); (E.B.); (K.D.); (E.S.); (E.P.)
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13
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Wei HL, Yang Q, Zhou GP, Chen YC, Yu YS, Yin X, Li J, Zhang H. Abnormal causal connectivity of anterior cingulate cortex-visual cortex circuit related to nonsteroidal anti-inflammatory drug efficacy in migraine. Eur J Neurosci 2024; 59:446-456. [PMID: 38123158 DOI: 10.1111/ejn.16219] [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: 06/30/2023] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 12/23/2023]
Abstract
The anterior cingulate cortex (ACC) and visual cortex are integral components of the neurophysiological mechanisms underlying migraine, yet the impact of altered connectivity patterns between these regions on migraine treatment remains unknown. To elucidate this issue, we investigated the abnormal causal connectivity between the ACC and visual cortex in patients with migraine without aura (MwoA), based on the resting-state functional magnetic resonance imaging data, and its predictive ability for the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs). The results revealed increased causal connectivity from the bilateral ACC to the lingual gyrus (LG) and decreased connectivity in the opposite direction in nonresponders compared with the responders. Moreover, compared with the healthy controls, nonresponders exhibited heightened causal connectivity from the ACC to the LG, right inferior occipital gyrus (IOG) and left superior occipital gyrus, while connectivity patterns from the LG and right IOG to the ACC were diminished. Based on the observed abnormal connectivity patterns, the support vector machine (SVM) models showed that the area under the receiver operator characteristic curves for the ACC to LG, LG to ACC and bidirectional models were 0.857, 0.898, and 0.939, respectively. These findings indicate that neuroimaging markers of abnormal causal connectivity in the ACC-visual cortex circuit may facilitate clinical decision-making regarding NSAIDs administration for migraine management.
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Affiliation(s)
- Heng-Le Wei
- Department of Radiology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Qian Yang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Gang-Ping Zhou
- Department of Radiology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yu-Sheng Yu
- Department of Radiology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Junrong Li
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Hong Zhang
- Department of Radiology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
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14
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Akbar A, Ford J, Tripathi S. The Use of Botulinum Toxin Type A in Medically Refractory Pediatric Patients With Chronic Daily Headaches and Its Impact on the Quality of Life. J Child Neurol 2024; 39:55-60. [PMID: 38351705 DOI: 10.1177/08830738241227061] [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] [Indexed: 05/12/2024]
Abstract
Background: Chronic migraine in children has been a challenging condition to treat, prompting the investigation of alternative therapies. This retrospective single-center chart review aimed to evaluate the efficacy and safety of Botox injections for managing chronic migraine in children. Methods: The study included children with chronic daily headaches and chronic migraine who were medically refractory to previous treatments at OSF Healthcare/Illinois Neurological Institute, Peoria, between 2015 and 2021. Botox injections were administered quarterly following a specific protocol. Data were obtained from electronic medical records by manual review. Results: Twenty-four patients met the inclusion criteria (median age 15.4 years, 87% female). Comorbidities included depression (41.6%) and sleep disturbances (33.2%). Prior to Botox treatment, patients had been tried on a median number of 5 (interquartile range [IQR] 4, 7) medications. Botox injections resulted in a significant reduction in headache frequency, with a mean difference (6 months vs pretreatment) in the Headache Impact Test (HIT 3) scores of -19.6 (95% CI -24.8, -14.3), P < .001, and mean difference in the Migraine Disability Assessment (MIDAS) scores of -50.8 (95% CI -62.6, -39.0, P < .001). Subjective improvements included mood enhancement (13/24, 54.2%) and improved concentration (12/24, 50%). Treatment-related side effects were reported by 5/24 (20%) of patients and were mostly mild to moderate. Conclusions: Botox injections offer a promising therapeutic option for managing chronic migraine in children who have not responded to traditional medications. Future controlled trials and long-term follow-up studies are needed to further evaluate Botox treatment's benefits and adverse effects in children with chronic migraine.
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Affiliation(s)
- Asra Akbar
- Division of Pediatric Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Jenna Ford
- Advanced Practice Nurse, Illinois Neurological Institute, Peoria, IL, USA
| | - Sandeep Tripathi
- Division of Pediatric Critical Care, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
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15
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de Oliveira FAA, Dourado-Filho MG, Sampaio Rocha-Filho PA. Persistent headache attributed to past ischemic stroke: A prospective cohort study. Headache 2024; 64:48-54. [PMID: 38238973 DOI: 10.1111/head.14668] [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: 06/11/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To assess the incidence, characteristics, and risk factors for developing persistent headache attributed to past ischemic stroke. BACKGROUND Although the most recent International Classification of Headache Disorders has recognized the existence of persistent headache attributed to past ischemic stroke, there has been limited research in this area. METHODS This was a prospective cohort study. We initially assessed patients hospitalized with ischemic stroke admitted within 72 h of symptom onset. All patients underwent diffusion-weighted magnetic resonance imaging. These patients were re-interviewed by telephone 1 year after the stroke. Semi-structured questionnaires, the National Institutes of Health Stroke Scale (NIHSS), and six-item Headache Impact Test were used. RESULTS A total of 119 participants answered the interview conducted 1 year after the stroke. The mean (standard deviation) age was 64 (13.1) years, 82/119 (68.9%) were female, and the median (interquartile range) NIHSS score was 2 (1.0-4.0). The incidence rate of persistent headache attributed to past ischemic stroke was 12/119 (10.1%; 95% confidence interval [CI] 5.3-17.0%). The most frequent pattern presented was a migraine-like pattern in seven of the 12 (58.3%) patients, which had a substantial/severe impact on five of the 12 (41.7%). For most patients this headache continued, although it began to improve. Previous migraine (odds ratio 7.1, 95% CI 1.06-50.0; p = 0.043) and headache intensity in the acute phase of stroke (odds ratio 1.75, 95% CI 1.13-2.7; p = 0.012) were associated with the occurrence of persistent headache attributed to past ischemic stroke. CONCLUSION Persistent headache attributed to past ischemic stroke is a frequent complication after stroke. It often has a significant impact on patients' lives and presents a migraine-like pattern as its most frequent phenotype.
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Affiliation(s)
- Felipe A A de Oliveira
- Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
- Real Hospital Português de Beneficência de Pernambuco, Recife, Brazil
| | | | - Pedro A Sampaio Rocha-Filho
- Division of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
- Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco, Recife, Brazil
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16
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Wei HL, Wei C, Feng Y, Yan W, Yu YS, Chen YC, Yin X, Li J, Zhang H. Predicting the efficacy of non-steroidal anti-inflammatory drugs in migraine using deep learning and three-dimensional T1-weighted images. iScience 2023; 26:108107. [PMID: 37867961 PMCID: PMC10585394 DOI: 10.1016/j.isci.2023.108107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/19/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
Deep learning (DL) models based on individual images could contribute to tailored therapies and personalized treatment strategies. We aimed to construct a DL model using individual 3D structural images for predicting the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) in migraine. A 3D convolutional neural network model was constructed, with ResNet18 as the classification backbone, to link structural images to predict the efficacy of NSAIDs. In total, 111 patients were included and allocated to the training and testing sets in a 4:1 ratio. The prediction accuracies of the ResNet34, ResNet50, ResNeXt50, DenseNet121, and 3D ResNet18 models were 0.65, 0.74, 0.65, 0.70, and 0.78, respectively. This model, based on individual 3D structural images, demonstrated better predictive performance in comparison to conventional models. Our study highlights the feasibility of the DL algorithm based on brain structural images and suggests that it can be applied to predict the efficacy of NSAIDs in migraine treatment.
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Affiliation(s)
- Heng-Le Wei
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu 211100, China
| | - Cunsheng Wei
- Department of Neurology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu 211100, China
| | - Yibo Feng
- Infervision Medical Technology Co., Ltd, Beijing, China
| | - Wanying Yan
- Infervision Medical Technology Co., Ltd, Beijing, China
| | - Yu-Sheng Yu
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu 211100, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Jiangsu Province, Nanjing 210006, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Jiangsu Province, Nanjing 210006, China
| | - Junrong Li
- Department of Neurology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu 211100, China
| | - Hong Zhang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu 211100, China
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Ashina M, Mitsikostas DD, Amin FM, Kokturk P, Schankin CJ, Sahin G, Pozo-Rosich P, Dorman PJ, Nežádal T, Poole AC, Martins IP, Sumelahti ML, Ramirez Campos V, Ahn AH, Lyras L, Tassorelli C. Real-world effectiveness of fremanezumab for the preventive treatment of migraine: Interim analysis of the pan-European, prospective, observational, phase 4 PEARL study. Cephalalgia 2023; 43:3331024231214987. [PMID: 37987641 DOI: 10.1177/03331024231214987] [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: 11/22/2023]
Abstract
BACKGROUND The ongoing Pan-European Real Life (PEARL) phase 4 study is evaluating fremanezumab effectiveness and safety for the prevention of episodic and chronic migraine. This interim analysis reports primary, secondary and exploratory endpoints from when 500 participants completed at least six months of treatment. METHODS Adults with episodic migraine or chronic migraine maintaining daily headache diaries were enrolled upon initiation of fremanezumab. Primary endpoint: proportion of participants with ≥50% reduction in monthly migraine days during the six-month period after fremanezumab initiation. Secondary endpoints: mean change from baseline across months 1-12 in monthly migraine days, acute migraine medication use, and headache-related disability. Exploratory endpoint: mean change in headache severity from baseline across months 1-12. Safety was assessed through adverse events reported. RESULTS Overall, 897 participants were enrolled and 574 included in the effectiveness analyses (episodic migraine, 25.8%; chronic migraine, 74.2%). Of participants with data available, 175/313 (55.9%) achieved ≥50% monthly migraine days reduction during the six-month period post-initiation. Across months 1-12, there were sustained reductions in mean monthly migraine days, acute medication use, disability scores, and headache severity. Few adverse events were reported. CONCLUSION PEARL interim results support the effectiveness and safety of fremanezumab for migraine prevention in a real-world population across several European countries.Trial registration: encepp.eu: EUPAS35111.
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Affiliation(s)
- Messoud Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Dimos D Mitsikostas
- First Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Faisal Mohammad Amin
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Neurorehabilitation/Traumatic Brain Injury, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Christoph J Schankin
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Gurdal Sahin
- Department of Clinical Sciences of Lund, Lund University, Skåneuro Neurology Clinic, Lund, Sweden
| | - Patricia Pozo-Rosich
- Headache Unit & Research Group, Vall d'Hebron Hospital & Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Paul J Dorman
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tomáš Nežádal
- Institute of Neuropsychiatric Care, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Isabel Pavão Martins
- Centro de Estudos Egas Moniz, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | | | | | - Andrew H Ahn
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | | | - Cristina Tassorelli
- Department of Brain & Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
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Tereshko Y, Dal Bello S, Di Lorenzo C, Pittino A, Filippi F, Belgrado E, Lettieri C, Merlino G, Gigli GL, Valente M. The Effect of Three Different Ketogenic Diet Protocols on Migraine and Fatigue in Chronic and High-Frequency Episodic Migraine: A Pilot Study. Nutrients 2023; 15:4334. [PMID: 37892410 PMCID: PMC10609491 DOI: 10.3390/nu15204334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/03/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
AIMS We aimed to evaluate the efficacy of three different ketogenic diets on migraine and fatigue in chronic and high-frequency episodic migraineurs. METHODS 76 patients with migraine were treated with the KD for at least three months. Three different KD protocols were used (2:1 KD, LGID, and VLCKD). We evaluated the fatigue severity scale (FSS), migraine frequency, migraine intensity, MIDAS, and HIT-6 at the baseline and 3-month follow-up, and we compared the results. We also correlated the mean FSS reduction with the mean migraine frequency, migraine intensity, BMI, fat mass, free-fat mass, MIDAS, and HIT-6 reduction. RESULTS FSS improved from 4.977 ± 1.779 to 3.911 ± 1.779 at the 3-month follow-up (p < 0.001). This improvement was significant in both high-frequency and chronic migraineurs. Moreover, the three KD protocols effectively improved migraine intensity, frequency, MIDAS, and HIT-6. There was a mild correlation between mean FSS reduction (p < 0.001), mean MIDAS (p = 0.001), and HIT-6 (p = 0.002) reduction. CONCLUSIONS The VLCKD, LGID, and 2:1 KD may improve migraine intensity, frequency, and fatigue in chronic and high-frequency episodic migraineurs.
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Affiliation(s)
- Yan Tereshko
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Simone Dal Bello
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, 04100 Latina, Italy
| | - Alice Pittino
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Francesca Filippi
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Enrico Belgrado
- Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy;
| | - Christian Lettieri
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Giovanni Merlino
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Gian Luigi Gigli
- Department of Medicine (DAME), University of Udine, Via Colugna 50, 33100 Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
- Department of Medicine (DAME), University of Udine, Via Colugna 50, 33100 Udine, Italy
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Guo Z, Qu Y, Gao Y, Xing Y, Ma H, Liu J, Guo Y, Chang J, Zhang P, Jin H, Sun X, Han K, Hu H, He Q, Simpson DM, Yang Y. Changes in cerebral autoregulation, stroke-related blood biomarkers, and autonomic regulation after patent foramen ovale closure in severe migraine patients. CNS Neurosci Ther 2023; 29:3031-3042. [PMID: 37157233 PMCID: PMC10493653 DOI: 10.1111/cns.14244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/31/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023] Open
Abstract
AIMS This study aimed to investigate changes in dynamic cerebral autoregulation (dCA), 20 stroke-related blood biomarkers, and autonomic regulation after patent foramen ovale (PFO) closure in severe migraine patients. METHODS Patent foramen ovale severe migraine patients, matched non-PFO severe migraine patients, and healthy controls were included. dCA and autonomic regulation were evaluated in each participant at baseline, and within 48-h and 30 days after closure in PFO migraineurs. A panel of stroke-related blood biomarkers was detected pre-surgically in arterial-and venous blood, and post-surgically in the arterial blood in PFO migraineurs. RESULTS Forty-five PFO severe migraine patients, 50 non-PFO severe migraine patients, and 50 controls were enrolled. The baseline dCA function of PFO migraineurs was significantly lower than that of non-PFO migraineurs and controls but was rapidly improved with PFO closure, remaining stable at 1-month follow-up. Arterial blood platelet-derived growth factor-BB (PDGF-BB) levels were higher in PFO migraineurs than in controls, which was immediately and significantly reduced after closure. No differences in autonomic regulation were observed among the three groups. CONCLUSION Patent foramen ovale closure can improve dCA and alter elevated arterial PDGF-BB levels in migraine patients with PFO, both of which may be related to the preventive effect of PFO closure on stroke occurrence/recurrence.
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Affiliation(s)
- Zhen‐Ni Guo
- Stroke Center, Department of NeurologyThe First Hospital of Jilin UniversityChangchunChina
- Neuroscience Research CentreThe First Hospital of Jilin UniversityChangchunChina
| | - Yang Qu
- Stroke Center, Department of NeurologyThe First Hospital of Jilin UniversityChangchunChina
| | - Yongsheng Gao
- Department of Cardiac SurgeryThe First Hospital of Jilin UniversityChangchunChina
| | - Yingqi Xing
- Center for Neurovascular Ultrasound, Department of NeurologyThe First Hospital of Jilin UniversityChangchunChina
| | - Hongyin Ma
- Stroke Center, Department of NeurologyThe First Hospital of Jilin UniversityChangchunChina
| | - Jia Liu
- Laboratory for Engineering and Scientific Computing, Institute of Advanced Computing and Digital Engineering, Shenzhen Institute of Advanced TechnologyChinese Academy of SciencesShenzhenChina
| | - Yu‐Zhu Guo
- Stroke Center, Department of NeurologyThe First Hospital of Jilin UniversityChangchunChina
| | - Junlei Chang
- Center for Protein and Cell‐Based DrugsInstitute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of SciencesShenzhenChina
| | - Peng Zhang
- Stroke Center, Department of NeurologyThe First Hospital of Jilin UniversityChangchunChina
| | - Hang Jin
- Stroke Center, Department of NeurologyThe First Hospital of Jilin UniversityChangchunChina
| | - Xin Sun
- Stroke Center, Department of NeurologyThe First Hospital of Jilin UniversityChangchunChina
| | - Ke Han
- Cerebrovascular Disease Research Center, Department of Neurology, Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Han‐Hwa Hu
- Cerebrovascular Treatment and Research Center, College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Qianyan He
- Stroke Center, Department of NeurologyThe First Hospital of Jilin UniversityChangchunChina
| | | | - Yi Yang
- Stroke Center, Department of NeurologyThe First Hospital of Jilin UniversityChangchunChina
- Neuroscience Research CentreThe First Hospital of Jilin UniversityChangchunChina
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20
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González R, Aymerich FX, Alberich M, Caronna E, Gallardo VJ, Pozo-Rosich P, Rovira À, Pareto D. Estimation of the density of veins from susceptibility-weighted imaging by using Mamdani fuzzy-type rule-based system. Investigating the neurovascular coupling in migraine. Neuroimage Clin 2023; 39:103489. [PMID: 37611372 PMCID: PMC10466899 DOI: 10.1016/j.nicl.2023.103489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/25/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND AND PURPOSE An impaired neurovascular coupling has been described as a possible player in neurodegeneration and cognitive decline. Migraine is a recurrent and incapacitating disorder that starts early in life and has shown neurovascular coupling abnormalities. Despite its high prevalence, the physiology and underlying mechanisms are poorly understood. In this context, new biomarkers from magnetic resonance imaging (MRI) are needed to bring new knowledge into the field. The aim of this study was to determine the vein density from Susceptibility-Weighted Imaging (SWI) MRI, in subjects with migraine and healthy controls; and to assess whether it relates to Resting-State functional MRI (RS-fMRI). MATERIALS AND METHODS The cohort included 30 healthy controls and 70 subjects with migraine (26 episodic, 44 chronic) who underwent a brain 3.0 T MRI. Clinical characteristics were also collected. Maps of density of veins were generated based on a Mamdani Fuzzy-Type Rule-Based System from the SWI MRI. Mean values of vein density were obtained in grey (GM) and white matter (WM) Freesurfer lobar parcellations. The Amplitude of Low-Frequency Fluctuations (ALFF) image was calculated for the RS-fMRI, and the mean values over the parcellated GM lobes were estimated. Differences between groups were assessed through and analysis of variance (age, sex, education and anxiety as covariates; p < 0.05), followed by post-hoc comparisons. Associations were run between clinical and MRI-derived variables. RESULTS When comparing the density of veins in GM, no differences between groups were found, neither associations with clinical variables. The density of veins was significantly higher in the WM of the occipital lobe for subjects with chronic migraine compared to controls (30%, p < 0.05). WM vein density in either frontal, temporal or cingulate regions was associated with clinical variables such as headache days, disability scores, and cognitive impairment (r between 0.25 and 0.41; p < 0.05). Mean values of ALFF did not differ significantly between controls and subjects with migraine. Strong significant associations between vein density and ALFF measures were obtained in most GM lobes for healthy subjects (r between 0.50 and 0.67; p < 0.05), instead, vein density in WM was significantly associated with ALFF for subjects with migraine (r between 0.32 and 0.58; p < 0.05). CONCLUSIONS Results point towards an increase in vein density in subjects with migraine, when compared to healthy controls. In addition, the association between GM vein density and ALFF found in healthy subjects was lost in migraine. Taken together, these results support the idea of abnormalities in the neurovascular coupling in migraine. Quantitative SWI MRI indicators in migraine might be an interesting target that may contribute to its comprehension.
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Affiliation(s)
- R González
- Neuroradiology Group, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F X Aymerich
- Neuroradiology Group, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Radiology Department (IDI), Vall Hebron University Hospital, Barcelona, Spain; Automatic Control Department (ESAII), Univesitat Politècnica de Catalunya Barcelona Tech, Barcelona, Spain
| | - M Alberich
- Neuroradiology Group, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Radiology Department (IDI), Vall Hebron University Hospital, Barcelona, Spain
| | - E Caronna
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V J Gallardo
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Pozo-Rosich
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - À Rovira
- Neuroradiology Group, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Radiology Department (IDI), Vall Hebron University Hospital, Barcelona, Spain
| | - D Pareto
- Neuroradiology Group, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Radiology Department (IDI), Vall Hebron University Hospital, Barcelona, Spain.
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21
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Wei HL, Hu TT, Wang JJ, Wang MY, Yu YS, Zhang H. Potential predictors for the efficacy of non-steroidal anti-inflammatory drugs in patients with migraine. Saudi Pharm J 2023; 31:692-697. [PMID: 37181139 PMCID: PMC10172565 DOI: 10.1016/j.jsps.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
Objectives To explore potential predictors of the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with migraine. Methods Consecutive migraine patients were recruited and divided into responders and non-responders to NSAIDs according to follow-up for at least three months. Demographic data, migraine-related disabilities and characteristics, and psychiatric comorbidities were evaluated and used to build multivariable logistic regression models. Subsequently, we generated receiver operating characteristic (ROC) curves to explore the performance of these traits in predicting NSAIDs efficacy. Results A total of 567 patients with migraine who completed at least three months of follow-up were enrolled. In the multivariate regression analysis, five factors were identified as potential predictors for NSAIDs efficacy in treating migraine. Namely, attack duration (odds ratio (OR) = 0.959; p < 0.001), headache impact (OR = 0.966; p = 0.015), depression (OR = 0.889; p < 0.001), anxiety (OR = 0.748; p < 0.001), and education level (OR = 1.362; p < 0.001) were associated with response to NSAIDs treatment. The area under the curve, sensitivity, and specificity combining these five factors for predicting the efficacy of NSAIDs were 0.834, 0.909 and 0.676. Conclusions These findings suggest that migraine-related and psychiatric factors are associated with the response to NSAIDs in migraine management. Identifying such key factors may help to optimize individualized migraine management strategy.
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22
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Mahon R, Vo P, Pannagl K, Tiwari S, Heemstra H, Ferraris M, Zhao J, Betts KA, Proot P. Assessment of the relative effectiveness of erenumab compared with onabotulinumtoxinA for the prevention of chronic migraine. Curr Med Res Opin 2023; 39:105-112. [PMID: 36189948 DOI: 10.1080/03007995.2022.2131299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To assess the available clinical and economic evidence of erenumab vs onabotulinumtoxinA for chronic migraine (CM) and present de-novo indirect treatment comparisons (ITCs) based on available clinical trial data. METHODS We conducted ITCs based on results from the pivotal 295 trial (NCT02066415) of erenumab vs placebo and published aggregate data from the PREEMPT 1 (NCT00156910) and PREEMPT 2 (NCT00168428) trials of onabotulinumtoxinA vs placebo. ITCs were conducted for CM patients with and without prior administration of onabotulinumtoxinA and among CM patients with ≥3 prior preventive treatment failures. Efficacy was assessed based on responder rates of ≥50% reductions in monthly headache days (MHDs) and monthly migraine days (MMDs) as well as change from baseline in both MHDs and MMDs. RESULTS Among patients with CM, 140 mg erenumab was associated with a reduction of 1.2 MHD (p = .092) and a reduction of 1.0 MMD (p = .174) compared to onabotulinumtoxinA at Week 12. Among onabotulinumtoxinA-naïve patients, erenumab was associated with a reduction of 1.8 MHD (p = .026) and 1.4 MMD (p = .080) at Week 12. Among patients that had received ≥3 prior preventive treatments, the odds ratios comparing erenumab vs onabotulinumtoxinA were 1.7 for ≥50% responder rates based on reductions in MHD (p = .155) and 1.7 for ≥50% responder rates based on reductions in MMD (p = .140). CONCLUSION These findings suggest directional benefits (although not reaching the threshold of statistical significance) associated with erenumab vs onabotulinumtoxinA for the preventive treatment of CM. Evidence from this study may inform healthcare stakeholders in treatment selection and optimization for patients with CM.
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Affiliation(s)
| | - Pamela Vo
- Novartis Pharma AG, Basel, Switzerland
| | | | | | | | | | - Jing Zhao
- Analysis Group, Inc, Los Angeles, CA, USA
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23
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Bai X, Wang W, Zhang X, Hu Z, Zhang Y, Li Z, Zhang X, Yuan Z, Tang H, Zhang Y, Yu X, Zhang P, Wang Y, Sui B. Cerebral perfusion variance in new daily persistent headache and chronic migraine: an arterial spin-labeled MR imaging study. J Headache Pain 2022; 23:156. [PMID: 36482334 PMCID: PMC9733035 DOI: 10.1186/s10194-022-01532-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE New daily persistent headache (NDPH) and chronic migraine (CM) are two different types of headaches that might involve vascular dysregulation. There is still a lack of clarity about altered brain perfusion in NDPH and CM. This study aimed to investigate the cerebral perfusion variances of NDPH and CM using multi-delay pseudo-continuous arterial spin-labeled magnetic resonance imaging (pCASL-MRI). METHODS Fifteen patients with NDPH, 18 patients with CM, and 15 age- and sex-matched healthy controls (HCs) were included. All participants underwent 3D multi-delay pCASL-MRI to obtain cerebral perfusion data, including arrival-time-corrected cerebral blood flow (CBF) and arterial cerebral blood volume (aCBV). The automated anatomical labeling atlas 3 (AAL3) was used to parcellate 170 brain regions. The CBF and aCBV values in each brain region were compared among the three groups. Correlation analyses between cerebral perfusion parameters and clinical variables were performed. RESULTS Compared with HC participants, patients with NDPH were found to have decreased CBF and aCBV values in multiple regions in the right hemisphere, including the right posterior orbital gyrus (OFCpost.R), right middle occipital gyrus (MOG.R), and ventral anterior nucleus of right thalamus (tVA.R), while patients with CM showed increased CBF and aCBV values presenting in the ventral lateral nucleus of left thalamus (tVL.L) and right thalamus (tVL.R) compared with HCs (all p < 0.05). In patients with NDPH, after age and sex adjustment, the increased aCBV values of IFGorb. R were positively correlated with GAD-7 scores; and the increased CBF and aCBV values of tVA.R were positively correlated with disease duration. CONCLUSION The multi-delay pCASL technique can detect cerebral perfusion variation in patients with NDPH and CM. The cerebral perfusion changes may suggest different variations between NDPH and CM, which might provide hemodynamic evidence of these two types of primary headaches.
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Affiliation(s)
- Xiaoyan Bai
- grid.411617.40000 0004 0642 1244Tiantan Neuroimaging Center for Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China ,grid.411617.40000 0004 0642 1244Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Wei Wang
- grid.411617.40000 0004 0642 1244Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Xueyan Zhang
- grid.412633.10000 0004 1799 0733Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, Henan Province, 450000 China
| | - Zhangxuan Hu
- GE Healthcare, No.1 Tongji Nan Road, Beijing Economic Technological Development Area, Beijing, 100176 China
| | - Yingkui Zhang
- grid.411617.40000 0004 0642 1244Tiantan Neuroimaging Center for Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Zhiye Li
- grid.411617.40000 0004 0642 1244Tiantan Neuroimaging Center for Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China ,grid.411617.40000 0004 0642 1244Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Xue Zhang
- grid.411617.40000 0004 0642 1244Tiantan Neuroimaging Center for Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China ,grid.411617.40000 0004 0642 1244Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Ziyu Yuan
- grid.411617.40000 0004 0642 1244Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Hefei Tang
- grid.411617.40000 0004 0642 1244Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Yaqing Zhang
- grid.411617.40000 0004 0642 1244Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Xueying Yu
- grid.411617.40000 0004 0642 1244Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Peng Zhang
- grid.411617.40000 0004 0642 1244Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Yonggang Wang
- grid.411617.40000 0004 0642 1244Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Binbin Sui
- grid.411617.40000 0004 0642 1244Tiantan Neuroimaging Center for Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
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Lu ZX, Dong BQ, Wei HL, Chen L. Prediction and associated factors of non-steroidal anti-inflammatory drugs efficacy in migraine treatment. Front Pharmacol 2022; 13:1002080. [PMID: 36532762 PMCID: PMC9754055 DOI: 10.3389/fphar.2022.1002080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/10/2022] [Indexed: 12/10/2023] Open
Abstract
Background: The selection strategy of non-steroidal anti-inflammatory drugs (NSAIDs) for migraine is hard to judge whether it is effective, leading to unnecessary exposure to insufficient or lengthy treatment trials. The goal of the study was to investigate potential predictors of NSAIDs efficacy in migraine therapy and to explore their influence on efficacy. Methods: 610 migraine patients were recruited and assigned into responders and non-responders. Potential predictors among demographic and clinical characteristics for NSAIDs efficacy were extracted using multivariable logistic regression (LR) analysis, and were applied to construct prediction models via machine learning (ML) algorithms. Finally, Cochran-Mantel-Haenszel tests were used to examine the impact of each predictor on drug efficacy. Results: Multivariate LR analysis revealed migraine-related (disease duration, headache intensity and frequency) and psychiatric (anxiety, depression and sleep disorder) characteristics were predictive of NSAIDs efficacy. The accuracies of ML models using support vector machine, decision tree and multilayer perceptron were 0.712, 0.741, and 0.715, respectively. Cochran-Mantel-Haenszel test showed that, for variables with homogeneity of odds ratio, disease duration, frequency, anxiety, and depression and sleep disorder were associated with decreased likelihood of response to all NSAIDs. However, the variabilities in the efficacy of acetaminophen and celecoxib between patients with mild and severe headache intensity were not confirmed. Conclusion: Migraine-related and psychiatric parameters play a critical role in predicting the outcomes of acute migraine treatment. These models based on predictors could optimize drug selection and improve benefits from the start of treatment.
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Affiliation(s)
- Zhao-Xuan Lu
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Bing-Qing Dong
- Department of Radiology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - Heng-Le Wei
- Department of Radiology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Liang Chen
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Berger AA, Keefe J, Stark CW, Moore M, Ramírez GF, Cucarola JR, Han AH, Kaye AD, Ganti L. Eptinezumab-jjmr, a humanized monoclonal specific to Calcitonin Gene Related Peptide, for the preventive treatment of migraine in adults. Health Psychol Res 2022; 10:38439. [DOI: 10.52965/001c.38439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose of Review Migraines are prevalent and cause significant morbidity, decline in quality of life and healthcare costs universally. Treatment options are varied, but efficacy is limited. This review centers on Eptinezumab-jjmr, a humanized monoclonal specific to CGRP for the prevention of migraines in adults. Herein presented are the science and mechanism of action, indication and clinical evidence for use. Recent Findings Migraines are severe, recurrent headaches, which are either episodic or chronic in nature. The pain is severe, often accompanied by co-morbid symptoms, such as photophobia, phonophobia, nausea and emesis, and is limiting in nature. It is a prevalent disorder that causes significant, worldwide disability, morbidity, suffering, and costs. The pathophysiology of migraines is actively studied, though recent research points to an initiating event causing migraine generation, that is then propagated by other brain regions, a significant one being the trigeminocervical complex. This is driven by biochemical transmitters, chiefly CGRP. This discovery led to the development of CGRP-targeting drugs, including gepants (small molecular antagonists) and anti-CGRP antibodies, such as Eptinezumab-jjmr. Traditional therapy includes preventative and abortive treatment; however, adherence with preventative treatment has been historically poor, and certain types of abortive therapy carry risks and side effects that preclude them from a large patient population. Moreover, traditional therapy often falls short in migraine therapy. CGRP antagonist, including Eptinezumab, aims to cover the gaps in migraine therapy. We present here evidence to support the safe and effective use of Eptinezumab for the prevention of migraines. Summary Migraines are a prevalent primary headache disorder causing significant morbidity worldwide. Traditional abortive and preventative treatments fall short for many patients. Eptinezumab is part of new generation of CGRP-targeting medications and has shown significant evidence to support its use for the prevention of migraines. Further research is required to properly compare eptinezumab with existing pharmacotherapy and update guidelines on the appropriate combinations of therapies that are not available and the correct patient selection for each.
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Affiliation(s)
| | | | | | - Matthew Moore
- Louisiana State University Shreveport School of Medicine
| | | | | | | | | | - Latha Ganti
- University of Central Florida School of Medicine
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Kim BK, Chu MK, Yu SJ, Dell'Agnello G, Hundemer HP, Panni T, Alonso SP, Roche SL, Han JH, Cho SJ. Prevalence Rates of Primary Headache Disorders and Evaluation and Treatment Patterns Among Korean Neurologists. J Clin Neurol 2022; 18:571-580. [PMID: 36062775 PMCID: PMC9444561 DOI: 10.3988/jcn.2022.18.5.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Several studies have found that the prevalence of migraine is higher among healthcare professionals than in the general population. Furthermore, several investigations have suggested that the personal experiences of neurologists with migraine can influence their perception and treatment of the disease. This study assessed these relationships in Korea. Methods A survey was used to investigate the following characteristics among neurologists: 1) the prevalence rates of migraine, primary stabbing headache, and cluster headache, and 2) their perceptions of migraine and the pain severity experienced by patients, diagnosing migraine, evaluation and treatment patterns, and satisfaction and difficulties with treatment. Results The survey was completed by 442 actively practicing board-certified Korean neurologists. The self-reported lifetime prevalence rates of migraine, migraine with aura, primary stabbing headache, and cluster headache were 49.8%, 12.7%, 26.7%, and 1.4%, respectively. Few of the neurologists used a headache diary or validated scales with their patients, and approximately half were satisfied with the effectiveness of preventive medications. Significant differences were observed between neurologists who had and had not experienced migraine, regarding certain perceptions of migraine, but no differences were found between these groups in the evaluation and preventive treatment of migraine. Conclusions The high self-reported lifetime prevalence rates of migraine and other primary headache disorders among Korean neurologists may indicate that these rates are underreported in the general population, although potential population biases must be considered. From the perspective of neurologists, there is an unmet need for the proper application of headache diaries, validated scales, and effective preventive treatments for patients. While the past experiences of neurologists with migraine might not influence how they evaluate or apply preventive treatments to migraine, they may influence certain perceptions of the disease.
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Affiliation(s)
- Byung-Kun Kim
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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Monterrey P, González M, Ramírez D, Gracia F, Henríquez F, Pérez‐Franco E, Díaz A, Vásquez JF, Benzadón A, Obage J, Luna D, Pertuz W. Characteristics of migraine in patients with headache disorders: A clinic‐based study from Central American and Caribbean countries. Headache 2022; 62:1029-1038. [PMID: 36017947 PMCID: PMC9545062 DOI: 10.1111/head.14375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 06/23/2022] [Indexed: 12/03/2022]
Abstract
Objective The objective of the study was to measure the proportion of patients who consulted for headache and of those who had a final diagnosis of migraine. We also assessed the proportion and characteristics of patients with migraine and the impact of migraine on the daily activities and the professional and social lives of patients visiting private/public medical centers in Guatemala, Costa Rica, Panama, and the Dominican Republic. Background Underdiagnosis of migraine is high in Central America and Caribbean urban communities. However, there is limited knowledge on characteristics of headache disorders for the appropriate classification of migraine, which is a prerequisite for targeted treatment. Hence, there is a need to improve migraine awareness among patients and medical professionals in this region. Methods Central America and Caribbean countries epidemioLogy study of Migraine (CALM) was a non‐interventional, cross‐sectional, multinational study in adults aged 18–65 years with a history of or current headache. The primary outcome was the proportion of patients with migraine visiting medical centers due to headache disorders. Using a specially designed migraine survey questionnaire, patients self‐reported migraine characteristics, duration, and severity of attacks and impact on work and social life. Results Of the 313 enrolled patients, 308 (98.4%) completed the study. Approximately 75.3% (232/308) of patients with headache visiting medical centers had migraine, with episodic migraine being the most common (193 [83.2%]). Overall, 34/308 (11.0%) patients had a new diagnosis of migraine. Among patients with migraine, 66 (28.4%) had a history of migraine for ≥20 years and 59 (25.4%) experienced severe pain. Overall, 52.2% (121/232) of patients reported that migraine affected their professional life and 78.4% (182/232) reported an impact on social life. Conclusion The CALM study establishes that a high proportion of patients with migraine had a long duration and high severity of migraine attacks, leading to a direct impact on work/social life as well as on costs incurred by patients in these countries.
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Affiliation(s)
| | | | | | | | | | | | - Alejandro Díaz
- Guatemalan Institute of Social Security Cdad. de Guatemala Guatemala
| | | | - Aarón Benzadón
- Complejo Hospitalario Dr. Arnulfo Arias Madrid, CSS Panama City Panama
| | - Jeanine Obage
- Novartis Caribe S.A. Santo Domingo Dominican Republic
| | - Diego Luna
- Novartis Pharma Logistics, Inc. Panama City Panama
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Gonzalez-Martinez A, Pagán J, Sanz-García A, García-Azorín D, Rodriguez Vico JS, Jaimes A, Gómez García A, Díaz de Terán J, González-García N, Quintas S, Belascoaín R, Casas Limón J, Latorre G, Calle de Miguel C, Sierra Á, Guerrero-Peral ÁL, Trevino-Peinado C, Gago-Veiga AB. Machine-learning based approach to predict anti-CGRP response in patients with migraine: multicenter Spanish study. Eur J Neurol 2022; 29:3102-3111. [PMID: 35726393 DOI: 10.1111/ene.15458] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND To date, several variables have been associated with anti-CGRP receptor or ligand-antibody response with disparate results. Our objective is to determine whether machine learning (ML)-based models can predict 6, 9 and 12 months response to anti-CGRP receptor or ligand therapies among migraine patients. METHODS We performed a multicenter analysis of a prospectively collected data cohort of patients with migraine receiving anti-CGRP therapies. Demographic and clinical variables were collected. Response rate defined in the 30% to 50% range -or at least 30%-, in the 50% to 75% range -or at least 50%-, and response rate over 75% reduction in the number of headache days per month at 6, 9 and 12 months. A sequential forward feature selector was used for variable selection and ML-based predictive models response to anti-CGRP therapies at 6, 9 and 12 months, with models' accuracy not less than 70%, were generated. RESULTS A total of 712 patients were included, 93% women, aged 48 years (SD=11.7). Eighty-three percent had chronic migraine. ML models using headache days/month, migraine days/month and HIT-6 variables yielded predictions with a F1 score range of 0.70-0.97 and AUC (area under the receiver operating curve) score range of 0.87-0.98. SHAP (SHapley Additive exPlanations) summary plots and dependence plots were generated to evaluate the relevance of the factors associated with the prediction of the above-mentioned response rates. CONCLUSIONS According to our study, ML models can predict anti-CGRP response at 6, 9 and 12 months. This study provides a predictive tool to be used in a real-world setting.
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Affiliation(s)
- Alicia Gonzalez-Martinez
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Josué Pagán
- Universidad Politécnica de Madrid and Center for Computational Simulation of Universidad Politécnica de Madrid, Madrid, Spain
| | - Ancor Sanz-García
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - David García-Azorín
- Headache Unit, Neurology Department, Department of Medicine, University of Valladolid, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Alex Jaimes
- Headache Unit, Neurology Department, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Javier Díaz de Terán
- Headache Unit, Neurology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Nuria González-García
- Headache Unit, Neurology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Sonia Quintas
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Rocio Belascoaín
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Javier Casas Limón
- Headache Unit Neurology Department, Hospital Universitario Fundación de Alcorcón, Alcorcón, Spain
| | - Germán Latorre
- Headache Unit, Neurology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Carlos Calle de Miguel
- Headache Unit, Neurology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Álvaro Sierra
- Headache Unit, Neurology Department, Department of Medicine, University of Valladolid, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ángel Luis Guerrero-Peral
- Headache Unit, Neurology Department, Department of Medicine, University of Valladolid, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Ana Beatriz Gago-Veiga
- Headache Unit, Neurology Department, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
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López‐Bravo A, Oliveros‐Cid A, Sevillano‐Orte L. Treatment satisfaction with calcitonin gene-related peptide monoclonal antibodies as a new patient-reported outcome measure: A real-life experience in migraine. Acta Neurol Scand 2022; 145:669-675. [PMID: 35243611 DOI: 10.1111/ane.13599] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate treatment satisfaction with galcanezumab as a patient-reported outcome measure (PROM) in migraine. METHODS Patients with ≥8 headache days/month that had failed at ≥3 medications were included. Demographic and medical history were collected. Patient´s satisfaction (effectiveness, safety, convenience, and global satisfaction [GS]) was assessed by the Treatment Satisfaction Questionnaire for Medication version 1.4 (TSQM-1.4©). RESULTS We included 30 patients with migraine (76.7% chronic migraine). After 12 weeks of galcanezumab treatment, median monthly headache days (MHDs) decreased 11.5 (IQR 14.0) and median monthly migraine days (MMDs) 9.0 (IQR 7.5); at 24 weeks, the change was 15.0 (IQR 12.0) and 8.0 days (IQR 6.0). HIT-6 score decreased from 68.0 (IQR 7.5) to 54.0 (IQR 9.5) at 12 weeks (p < .001) and to 52.0 (IQR12.0) at 24 weeks (p < .001) and MIDAS from 60.0 (IQR 62.7) to 25.5 (IQR 41.2, p = .004) and 7.0 (IQR 18.5, p < .001), respectively. TSQM-1.4© at 12 weeks was higher compared to other preventive therapy in effectiveness (80.6/50.4, p < .001), convenience (83.3/66.7, p = .001), and GS (78.6/50.0, p < .001). These rates of satisfaction were similar at 24 weeks of galcanezumab treatment. Reductions in HIT-6 (r = -.444, p = .014), MIDAS (r = -.423, p = .020), MMDs (r = -.515, p = .004), and MHDs (r = -.477, p = .008) were associated significantly with GS at 12 weeks. This correlation was significantly associated with changes in HIT-6 and MHDs at 24 weeks. CONCLUSIONS The results of this study suggest that migraine patients receiving galcanezumab are significantly more satisfied compared to other preventive therapies, associating treatment GS with meaningful reductions in frequency, impact, and disability caused by migraine.
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Affiliation(s)
- Alba López‐Bravo
- Department of Neurology Hospital Reina Sofia Navarra Spain
- Aragon Institute for Health Research (IIS Aragón) Zaragoza Spain
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Rafi A, Islam S, Hasan MT, Hossain G. Prevalence and impact of migraine among university students in Bangladesh: findings from a cross-sectional survey. BMC Neurol 2022; 22:68. [PMID: 35219314 PMCID: PMC8881749 DOI: 10.1186/s12883-022-02594-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Migraine is one of the main causes of long-term morbidity, and it is one of the major contributors of all types of headaches in worldwide. Despite its disruptive effect, it is frequently underdiagnosed and undertreated in Bangladesh. The aim of the present study was to determine the prevalence of migraines and its impact on daily life of university students in Bangladesh.
Methods
This cross-sectional study was conducted among 2,352 students of Rajshahi University and Jahangirnagar University during March 2020 through a self-administered online survey. ID Migraine™ scale and HIT-6 scale were used to screen migraine and its impact respectively. Frequency distribution, Chi-square test and t-test along with multiple logistic regressions model were used to determine the prevalence and associated factors of migraine respectively.
Results
The overall prevalence of migraine among the participants was 21.4%. The prevalence was higher among females (29%) than males (12%). A multivariable logistic regression model provided the following eight risk factors of migraine: (i) gender (p < 0.01), (ii) family income (p < 0.01), (iii) marital status (p < 0.01), (iv) infrequent exercise (p < 0.01), (v) family history of headache (p < 0.01), (vi) high screen time (p < 0.05), (vii) depressive symptoms (p < 0.05) and (viii) anxiety disorder (p < 0.01). More than two-thirds of the people with migraines reported more than five attacks during the past month with moderate to severe intense headache. Stress was the most reported trigger of migraine among university students (71%) followed by irregular sleep (47%), academic pressure (33%), and external noise (28%). Almost 37% of the participants who had migraines reported that headache caused severe impact in their day to day life.
Conclusions
The prevalence of migraine among university students of Bangladesh is alarmingly high. Frequent migraine attacks and severe intensity of headache cause a substantial level of impact among the sufferers. Cautious avoidance of the triggering factors through appropriate interventions and prophylactic medication can mitigate the negative impact of migraine as well as improve the quality of life.
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Kelishadi MR, Naeini AA, Khorvash F, Askari G, Heidari Z. The beneficial effect of Alpha-lipoic acid supplementation as a potential adjunct treatment in episodic migraines. Sci Rep 2022; 12:271. [PMID: 34997178 PMCID: PMC8742085 DOI: 10.1038/s41598-021-04397-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 12/20/2021] [Indexed: 01/10/2023] Open
Abstract
The current study was performed to evaluate the effects of alpha-lipoic acid (ALA) supplementation on lactate, nitric oxide (NO), vascular cell adhesion molecule-1 (VCAM-1) levels, and clinical symptoms in women with episodic migraines. Considering the inclusion and exclusion criteria, ninety-two women with episodic migraines participated in this randomized, double-blind, placebo-controlled, parallel-design trial. The participants were randomly assigned to receive either 300 mg/day ALA or placebo, twice per day for 12 weeks. The primary outcomes included headache severity, headache frequency per month, and duration of attacks and the secondary outcomes included lactate (a marker of mitochondrial function), NO, and VCAM-1 serum levels were measured at baseline and the end of the intervention. At the end of the study, there was a significant decrease in lactate serum levels (- 6.45 ± 0.82 mg/dl vs - 2.27 ± 1.17 mg/dl; P = 0.039) and VCAM-1 (- 2.02 ± 0.30 ng/ml vs - 1.21 ± 0.36 ng/ml; P = 0.025) in the ALA as compared to the placebo group. In addition, the severity (P < 0.001), frequency (P = 0.001), headache impact test (HIT-6) (P < 0.001), headache dairy results (HDR) (P = 0.003), and migraine headache index score (MHIS) (P < 0.001) had significantly decreased in the intervention as compared to the control group. No significant changes were observed for NO levels and duration of migraine pains. ALA supplementation can be considered a potential adjunct treatment in patients with migraine due to its improving mitochondrial and endothelial functions and clinical symptoms.
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Affiliation(s)
- Mahnaz Rezaei Kelishadi
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirmansour Alavi Naeini
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Fariborz Khorvash
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Deterioration of headache impact and health-related quality of life in migraine patients after cessation of preventive treatment with CGRP(-receptor) antibodies. J Headache Pain 2021; 22:158. [PMID: 34972502 PMCID: PMC8903665 DOI: 10.1186/s10194-021-01368-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/01/2021] [Indexed: 12/14/2022] Open
Abstract
Background Migraine preventive treatment with CGRP(−receptor) monoclonal antibodies (mAbs) has a positive effect on patients’ health-related quality of life (HRQoL). The German treatment guidelines recommend discontinuing successful treatment with CGRP(−receptor) mAbs after 6–12 months. We aimed to evaluate headache-specific and generic HRQoL for three months after discontinuation of CGRP(−receptor) mAb treatment. Methods We conducted a prospective, longitudinal cohort study, including patients with migraine after 8–12 months of therapy with a CGRP(−R) mAb and before a planned discontinuation attempt. HRQoL was assessed at the time of the last mAbs injection (V1), eight weeks later (V2), and sixteen weeks later (V3). For headache-specific HRQoL, we used the Headache Impact Test-6 (HIT-6). Generic HRQoL was determined with the EuroQol-5-Dimension-5-Level (ED-5D-5L) form, and the Short-Form 12 (SF-12), which comprises a Physical Component Summary (PCS-12) and a Mental Component Summary (MCS-12). Questionnaires’ total scores were compared across the three observation points using nonparametric procedures. Results The study cohort consisted of n = 61 patients (n = 29 treated with the CGRP-receptor mAb erenumab and n = 32 with the CGRP mAbs galcanezumab or fremanezumab). The HIT-6 sum score was 59.69 ± 6.90 at V1 and increased by 3.69 ± 6.21 at V3 (p < 0.001), indicating a greater headache impact on patients’ lives. The mean total EQ-D5-L5 score declined from 0.85 ± 0.17 at V1 by − 0.07 ± 0.18 at V3 (p = 0.013). Both Mental and Physical Component Scores of the SF-12 worsened significantly during treatment discontinuation: The PCS-12 total score decreased by − 4.04 ± 7.90 from V1 to V3 (p = 0.013) and the MCS-12 score by − 2.73 ± 9.04 (p = 0.003). Changes in all questionnaires’ scores but the MCS-12 were already significant in the first month of the drug holiday (V2). Conclusions Our results show a significant decline in headache impact and generic HRQoL of migraine patients after treatment discontinuation of a CGRP(−R) mAb. The observed deterioration is above the established minimally clinically important differences for each of the questionnaires and can therefore be considered clinically meaningful. Monitoring HRQoL during a discontinuation attempt could facilitate the decision whether or not to resume preventive treatment with CGRP(−R) mAbs.
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Zhang Y, Xu T, Wang Z, Li D, Du J, Wen Y, Zhao Y, Liao H, Liang F, Zhao L. Differences in topological properties of functional brain networks between menstrually-related and non-menstrual migraine without aura. Brain Imaging Behav 2021; 15:1450-1459. [PMID: 32705466 PMCID: PMC8286221 DOI: 10.1007/s11682-020-00344-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Menstrually-related migraine without aura refers to a specific type of migraine that is associated with the female ovarian cycle. Compared with non-menstrual migraine without aura, in menstrually-related migraine without aura, there are additional attacks of migraine outside of the menstrual period. Menstrually-related migraine without aura tends to be less responsive to acute treatment and more prone to relapse than non-menstrual migraine without aura. Currently menstrually-related migraine without aura is treated no differently from any other migraine but, the differences in the central mechanisms underlying menstrually-related migraine without aura and non-menstrual migraine without aura remain poorly understood. Here, using resting-state functional magnetic resonance imaging and graph theory approaches, we aimed to explore the differences in topological properties of functional networks in 51 menstrually-related migraine without aura patients and 47 non-menstrual migraine without aura patients. The major finding of our study was that significant differences in topological properties between the two groups were mainly evident in the nodal centrality of the inferior frontal gyrus and the thalamus. Nodal centrality in inferior frontal gyrus was negatively correlated with Headache Impact Test questionnaire scores in the menstrually-related migraine without aura patients. Partial least squares correlation analysis revealed enhanced correlations of inferior frontal gyrus to pain-related behavior in the non-menstrual migraine without aura group, while within the menstrually-related migraine without aura group these effects were non-significant. These results indicate that the regulatory mechanisms in the central nervous system may differ between the two subtypes of migraine. The results provide novel insights into the pathophysiology of different subtypes of migraine, and could help us to enhance their clinical diagnosis and treatment.
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Affiliation(s)
- Yutong Zhang
- College of Acupuncture, Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, 37 Shi'er Qiao Rd, Chengdu, 610075, Sichuan, China
| | - Tao Xu
- College of Acupuncture, Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, 37 Shi'er Qiao Rd, Chengdu, 610075, Sichuan, China
| | - Ziwen Wang
- College of Acupuncture, Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, 37 Shi'er Qiao Rd, Chengdu, 610075, Sichuan, China
| | - Dehua Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiarong Du
- College of Acupuncture, Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, 37 Shi'er Qiao Rd, Chengdu, 610075, Sichuan, China
| | - Yi Wen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu Zhao
- Chengdu Integrated Traditional Chinese Medicine &Western Medicine Hospital, Chengdu, China
| | - Huaqiang Liao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fanrong Liang
- College of Acupuncture, Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, 37 Shi'er Qiao Rd, Chengdu, 610075, Sichuan, China
| | - Ling Zhao
- College of Acupuncture, Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, 37 Shi'er Qiao Rd, Chengdu, 610075, Sichuan, China.
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Pensato U, Baraldi C, Favoni V, Cainazzo MM, Torelli P, Querzani P, Pascazio A, Mascarella D, Matteo E, Quintana S, Asioli GM, Cortelli P, Pierangeli G, Guerzoni S, Cevoli S. Real-life assessment of erenumab in refractory chronic migraine with medication overuse headache. Neurol Sci 2021; 43:1273-1280. [PMID: 34224026 DOI: 10.1007/s10072-021-05426-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/21/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether erenumab is effective and safe in refractory chronic migraine with medication overuse headache. METHODS In this prospective, multicentric, real-life study, chronic migraine with medication overuse headache patients who received erenumab were recruited. Study inclusion was limited to patients who previously failed onabotulinumtoxinA in addition to at least three other pharmacological commonly used migraine preventive medication classes. RESULTS Of 396 patients who received erenumab, 38% (n = 149) met inclusion criteria. After 3 months, 51% (n = 76) and 20% (n = 30) patients achieved ≥ 50% and ≥ 75% reduction in monthly headache days, respectively. Monthly pain medications intake decreased from 46.1 ± 35.3 to 16.8 ± 13.9 (p < 0.001), while monthly headache days decreased from 25.4 ± 5.4 to 14.1 ± 8.6 (p < 0.001). Increasing efficacy of erenumab over the study period was observed. Allodynia was a negative predictive factor of erenumab response (odds ratio = 0.47; p = 0.03). Clinical conversion to episodic migraine with no medication overuse was observed in 64% (n = 96) patients. No serious adverse events were observed. CONCLUSIONS Erenumab reduced significantly migraine frequency and pain medication intake in refractory chronic migraine with MOH patients.
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Affiliation(s)
- Umberto Pensato
- Department of Biomedical and NeuroMotor Sciences of Bologna, University of Bologna, Bologna, Italy
| | - Carlo Baraldi
- Medical Toxicology-Headache and Drug Abuse Research Centre, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Favoni
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Maria Michela Cainazzo
- Medical Toxicology-Headache and Drug Abuse Research Centre, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Torelli
- Headache Centre, University Hospital of Parma, AOUPR, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Pietro Querzani
- Neurology Unit, S. Maria Delle Croci Hospital-AUSL Romagna, Ravenna, Italy
| | - Alessia Pascazio
- Department of Biomedical and NeuroMotor Sciences of Bologna, University of Bologna, Bologna, Italy
| | - Davide Mascarella
- Department of Biomedical and NeuroMotor Sciences of Bologna, University of Bologna, Bologna, Italy
| | - Eleonora Matteo
- Department of Biomedical and NeuroMotor Sciences of Bologna, University of Bologna, Bologna, Italy
| | - Simone Quintana
- Headache Centre, University Hospital of Parma, AOUPR, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Gian Maria Asioli
- Department of Biomedical and NeuroMotor Sciences of Bologna, University of Bologna, Bologna, Italy
| | - Pietro Cortelli
- Department of Biomedical and NeuroMotor Sciences of Bologna, University of Bologna, Bologna, Italy.,IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Giulia Pierangeli
- Department of Biomedical and NeuroMotor Sciences of Bologna, University of Bologna, Bologna, Italy.,IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Simona Guerzoni
- Medical Toxicology-Headache and Drug Abuse Research Centre, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sabina Cevoli
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy.
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Mas JL, Guillon B, Charles-Nelson A, Domigo V, Derex L, Massardier E, Arquizan C, Vuillier F, Timsit S, Béjot Y, Detante O, Sablot D, Guidoux C, Sibon I, Dequatre-Ponchelle N, Touzé E, Canaple S, Alamowitch S, Aubry P, Teiger E, Derumeaux G, Chatellier G. Patent foramen ovale closure in stroke patients with migraine in the CLOSE trial. The CLOSE-MIG study. Eur J Neurol 2021; 28:2700-2707. [PMID: 33938088 DOI: 10.1111/ene.14892] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE The efficacy of patent foramen ovale (PFO) closure to reduce the frequency of migraine attacks remains controversial. METHODS This was a planned sub-study in migraine patients enrolled in a randomized, clinical trial designed to assess the superiority of PFO closure plus antiplatelet therapy over antiplatelet therapy alone to prevent stroke recurrence in patients younger than 60 years with a PFO-associated cryptogenic ischaemic stroke. The main outcome was the mean annual number of migraine attacks in migraine patients with aura and in those without aura, as recorded at each follow-up visit by study neurologists. RESULTS Of 473 patients randomized to PFO closure or antiplatelet therapy, 145 (mean age 41.9 years; women 58.6%) had migraine (75 with aura and 70 without aura). Sixty-seven patients were randomized to PFO closure and 78 to antiplatelet therapy. During a mean follow-up of about 5 years, there were no differences between antiplatelet-only and PFO closure groups in the mean annual number of migraine attacks, both in migraine patients with aura (9.2 [11.9] vs. 12.0 [19.1], p = 0.81) and in those without aura (12.1 [16.1] vs. 11.8 [18.4], p > 0.999). There were no differences between treatment groups regarding cessation of migraine attacks, migraine-related disability at 2 years and use of migraine-preventive drugs during follow-up. CONCLUSIONS In young and middle-aged adults with PFO-associated cryptogenic stroke and migraine, PFO closure plus antiplatelet therapy did not reduce the mean annual number of migraine attacks compared to antiplatelet therapy alone, in migraine patients both with and without aura.
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Affiliation(s)
- Jean-Louis Mas
- Stroke Unit, Department of Neurology, Sainte-Anne Hospital, Paris Descartes University, INSERM 1226, Paris, France
| | - Benoît Guillon
- Stroke Unit, Department of Neurology, University Hospital of Nantes, Nantes, France
| | - Anaïs Charles-Nelson
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Centre d'Investigations Cliniques 1418 (CIC1418), Paris, France
| | - Valérie Domigo
- Stroke Unit, Department of Neurology, Sainte-Anne Hospital, Paris Descartes University, INSERM 1226, Paris, France
| | - Laurent Derex
- Stroke Unit, Department of Neurology, Hospices Civils de Lyon, EA 7425 HESPER, Claude Bernard Lyon 1 University, Lyon, France
| | | | - Caroline Arquizan
- Department of Neurology, Gui de Chauliac Hospital, INSERM 1226, Montpellier, France
| | - Fabrice Vuillier
- Stroke Unit, Department of Neurology, CHU Besançon, Besançon, France
| | - Serge Timsit
- Stroke Unit, Department of Neurology, CHRU Brest, Bretagne Occidentale University, INSERM 1028, Brest, France
| | - Yannick Béjot
- Stroke Unit, Department of Neurology, Dijon Stroke Registry, CHU Dijon, EA7460 Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University of Burgundy, Dijon, France
| | - Olivier Detante
- Stroke Unit, CHU Grenoble, INSERM 836-UJF-CEA-CHU, Grenoble, France
| | - Denis Sablot
- Stroke Unit, Department of Neurology, Perpignan Hospital, Perpignan, France
| | - Céline Guidoux
- Stroke Unit, Department of Neurology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Igor Sibon
- Stroke Unit, Department of Neurology, University Hospital, Bordeaux University, CNRS 5287, Bordeaux, France
| | | | - Emmanuel Touzé
- Normandie Université, Université Caen Normandie, CHU Caen Normandie, INSERM U1237, Caen, France
| | - Sandrine Canaple
- Stroke Unit, Department of Neurology, Laboratoire de Neurosciences Fonctionnelles et Pathologies, Centre Hospitalier Régional et Universitaire, Amiens, France
| | - Sonia Alamowitch
- Service de Neurologie, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, INSERM, UMRS 938, Paris, France
| | - Pierre Aubry
- Department of Cardiology, Bichat Hospital, Paris, France
| | - Emmanuel Teiger
- Department of Cardiology, Henri Mondor Hospital, AP-HP, UPEC, Créteil, France
| | - Geneviève Derumeaux
- Department of Physiology, Henri Mondor Hospital, APHP, INSERM U955, Créteil, France
| | - Gilles Chatellier
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Centre d'Investigations Cliniques 1418 (CIC1418), Paris, France
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Khani S, Hejazi SA, Yaghoubi M, Sharifipour E. Comparative study of magnesium, sodium valproate, and concurrent magnesium-sodium valproate therapy in the prevention of migraine headaches: a randomized controlled double-blind trial. J Headache Pain 2021; 22:21. [PMID: 33827421 PMCID: PMC8028183 DOI: 10.1186/s10194-021-01234-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/26/2021] [Indexed: 02/07/2023] Open
Abstract
Objective This study aimed to assess the efficacy of concurrent magnesium-sodium valproate therapy and compare it with either magnesium or sodium valproate alone in migraine prophylaxis. Materials and methods This randomized single-center double-blind parallel-group controlled clinical trial study was conducted on migraine patients within the age range of 18–65 years. The subjects with at least four monthly attacks were randomly assigned to group A (n = 82) sodium valproate, group B (n = 70) magnesium with sodium valproate, and group C (n = 70) magnesium. The patients passed a one-month baseline without prophylactic therapy and then received a 3-month treatment. The characteristics of migraine, including frequency, severity, duration of the attacks, and the number of painkillers taken per month, were monthly recorded in each visit. The Migraine Disability Assessment (MIDAS) and Headache Impact Test-6 (HIT-6) scores were recorded at the baseline and after 3 months of treatment in each group. Within- and between-group analyses were performed in this study. Results The obtained results revealed a significant reduction in all migraine characteristics in all groups compared to those reported for the baseline (P < 0.001). Intragroup data analysis indicated that there was no statistically significant difference in headache frequency between groups A and B in the third month (P = 0.525); nevertheless, three other parameters showed a significant reduction in group B, compared to those reported for group A in the third month (P < 0.05). On the other hand, group C could not effectively reduce measured parameters in the patients, compared to groups A and B after 3 months (P < 0.001). Furthermore, the MIDAS and HIT-6 scores significantly diminished in groups A, B, and C compared to those reported at the baseline (P < 0.001), and these changes were more significant in groups A and B than in group C (P < 0.001). Conclusion The obtained results of this study revealed that magnesium could enhance the antimigraine properties of sodium valproate in combination therapy and reduce the required valproate dose for migraine prophylaxis.
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Affiliation(s)
- Samira Khani
- Department of Neurology, Neurosciences Research Center (NSRC), Qom University of Medical Sciences, Shahid-Beheshti hospital, Shahid-Beheshti street, Qom, Iran
| | - Seyed Amir Hejazi
- Department of Neurology, Neurosciences Research Center (NSRC), Qom University of Medical Sciences, Shahid-Beheshti hospital, Shahid-Beheshti street, Qom, Iran
| | - Mehdi Yaghoubi
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Ehsan Sharifipour
- Department of Neurology, Neurosciences Research Center (NSRC), Qom University of Medical Sciences, Shahid-Beheshti hospital, Shahid-Beheshti street, Qom, Iran.
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Sharawat IK, Panda PK. Caregiver Satisfaction and Effectiveness of Teleconsultation in Children and Adolescents With Migraine During the Ongoing COVID-19 Pandemic. J Child Neurol 2021; 36:296-303. [PMID: 33170754 DOI: 10.1177/0883073820968653] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The ongoing COVID-19 pandemic and the lockdown measures have forced clinicians across the world to look on telemedicine. Although migraine as such seems an ideal option for telemedicine, a systematic study reviewing feasibility, efficacy, and advantages of current advanced telecommunication technologies in children with migraine is lacking. METHODS Clinical details of telephonic consultations performed between March 25 and June 4, 2020, including migraine characteristics, analgesic/prophylactic drug regimens, headache frequency/severity/disability, compliance, drug-related/unrelated adverse effects and unavailability of drugs were recorded. Suitable change in the dose/commercial brand of drug regimen and the addition of new drugs were done as required. Voice call, text messages, picture/video messages, and all other possible measures were used to accumulate maximum clinical information in real time. Unless contacted for trivial reasons, most children were later followed up telephonically to ensure health care concern was resolved and to fill up one 6-item trichotomous quality control questionnaire. RESULTS A total of 146 telephone consultations were performed in 51 participants. Thirty-six patients were identified to have 42 significant clinical events (worsening clinical status/partial response to medications [18; 44%], drug-related adverse effects [10; 19%], unrelated systemic complaints [7; 13%], and worsening of headache due to stress/triggers [7; 13%]). In the rest of the patients, the query of the caregiver included concern regarding COVID-19-related symptoms. Twenty-nine children required increment in drug dose or addition of new drug or commercial brand. Around 90% of caregivers were satisfied with the quality of teleconsultation. CONCLUSION Teleconsultation is a feasible and efficacious option, with excellent caregiver satisfaction for children with migraine.
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Affiliation(s)
- Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Subjective cognitive impairment in patients with transformed migraine and the associated psychological and sleep disturbances. Sleep Breath 2021; 25:2119-2126. [PMID: 33543444 DOI: 10.1007/s11325-021-02308-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/20/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Migraines are associated with multiple comorbidities like depression, anxiety, poor sleep quality, and subjective cognitive impairment (SCI). This study aimed to evaluate the association of SCI with depression, anxiety, and modalities of sleep in those who have transformed migraines (TM). SUBJECTS AND METHODS The study was conducted on 120 participants with TM and 41 control group participants. The subjective cognitive decline questionnaire classified the participants as SCI and non-SCI. The Headache Impact Test-6, Migraine Disability Assessment, Montreal Cognitive Assessment, Mini-Mental State Examination, Patient Health Questionnaire-9, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Full Polysomnography, and Beck's Anxiety and the Depression Inventories were used and analyzed between patients with SCI and non-SCI. RESULTS Patients with TM who had SCI represented 34% with severe headache effects, disability, pain severity, increased depression, and increased anxiety. They showed shorter sleep duration during weekdays, lower sleep quality, less sleep time, lower efficiency, and less REM sleep along with greater sleep latency, periodic limb movements, a higher arousal index, snore index, and percent of NREM3. There was a positive correlation between certain polysomnography parameters like percent NREM3, sleep period, sleep index, sleep latency, sleep arousal index, and periodic limb movements, and an inverse correlation with the percent of REM sleep, total sleep time, and sleep efficiency. CONCLUSION Subjective cognitive complaints are common in patients with transformed migraine affecting about 34% of cases. TM patients with SCI had more sleep and psychological disturbances. TRIAL REGISTRATION Clinicaltrials.gov is NCT04413110.
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Pradela J, Bevilaqua-Grossi D, Chaves TC, Dach F, Carvalho GF. Measurement properties of the Headache Impact Test (HIT-6™ Brazil) in primary and secondary headaches. Headache 2021; 61:527-535. [PMID: 33432581 DOI: 10.1111/head.14049] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Headache Impact Test-6™ is a widely recommended questionnaire to evaluate the impact of headaches. However, its measurement properties were never evaluated in both primary and secondary headaches, and the Brazilian Portuguese version of the questionnaire was never assessed at all. OBJECTIVE To assess the reliability, and structural and construct validity of the Headache Impact Test-Brazil™ in patients with primary and secondary headaches. METHODS In total, 132 patients with primary and secondary headaches were included, screened from a headache tertiary clinic. They completed the Headache Impact Test-Brazil™ questionnaire, the 12-Item Short-Form Survey (SF-12), and the Headache Disability Inventory-Brazil. Pearson's correlation analysis was performed among the three questionnaires for validity assessment. One to three weeks after the first application, the Headache Impact Test-Brazil™ was answered again by 67 patients for reliability assessment. RESULTS The validity sample consisted of 86/132 (65.1%) patients with primary and 46/132 (34.9%) secondary headaches, with mean age of 39.6 (SD: 12.7) years. The reliability sample consisted of 39/67 (58.2%) patients with primary and 28/67 (41.8%) secondary headaches, with mean age of 36.8 (12.5) years. According to the confirmatory factor analysis, the Headache Impact Test-Brazil™ consists of single factor. Its internal consistency was α = 0.97 and the question number 3 had the lowest factor loading (0.31). The Headache Impact Test-Brazil™ exhibited a moderate correlation with both the SF-12 questionnaire (r = -0.64, 95%CI: -0.72 to -0.52, p = 0.001) and the Headache Disability Inventory-Brazil (r = 0.67, 95%CI: 0.56 to 0.75, p = 0.001). The correlation between the Headache Impact Test-Brazil™ and the headache frequency was weak (r = 0.22, 95%CI: 0.04 to 0.39, p = 0.001), and with the headache intensity, moderate (r = 0.44, 95%CI: 0.23 to 0.62, p = 0.001). The Headache Impact Test-Brazil™ test-retest reliability was excellent (ICC = 0.95) with a standard error of 1.58 and a smallest detectable change of 4.38 points. CONCLUSION The Headache Impact Test-6-Brazil™ can be considered as a valid and reliable tool to assess the impact of several headache types. Future studies may revise the questionnaire items to confirm its redundancy.
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Affiliation(s)
- Juliana Pradela
- Department of Health Sciences - Ribeirão Preto Medical School, University de São Paulo, Ribeirão Preto, Brazil
| | - Débora Bevilaqua-Grossi
- Department of Health Sciences - Ribeirão Preto Medical School, University de São Paulo, Ribeirão Preto, Brazil
| | - Thais C Chaves
- Department of Health Sciences - Ribeirão Preto Medical School, University de São Paulo, Ribeirão Preto, Brazil
| | - Fabiola Dach
- Department of Neurosciences and Behavioral Sciences - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Gabriela F Carvalho
- Department of Health Sciences - Ribeirão Preto Medical School, University de São Paulo, Ribeirão Preto, Brazil.,Institute of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Luebeck, Germany
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Talbot J, Stuckey R, Crawford L, Weatherby S, Mullin S. Improvements in pain, medication use and quality of life in onabotulinumtoxinA-resistant chronic migraine patients following erenumab treatment - real world outcomes. J Headache Pain 2021; 22:5. [PMID: 33421995 PMCID: PMC7797151 DOI: 10.1186/s10194-020-01214-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/26/2020] [Indexed: 12/21/2022] Open
Abstract
Background The CGRP antagonists offer a novel therapeutic approach in migraine. Their utility in patients with severe forms of chronic migraine is a subject of particular interest. We present outcomes of 9 months of erenumab treatment in a cohort of patients with difficult-to-control chronic migraine, all of whom had prior unsatisfactory response to onabotulinumtoxinA. Methods We offered erenumab to 98 patients with a prior unsatisfactory response to onabotulinumtoxinA. Eighty of 98 had trialled greater occipital nerve injections (82%), 32/98 peripheral neurostimulation (33%) and 18/98 intravenous dihydroergotamine (18%). Thirty eight of 98 (39%) met the definition of triptan overuse and 43/98 (44%) analgesic overuse. All patients met the EHF criteria for ‘resistant migraine’. Outcome measures (recorded monthly) included days with headache limiting activities of daily living (“red”), not limiting (“amber”), headache free (“green”), and requiring triptans or other analgesics. Quality of life scores - headache impact test 6 (HIT-6), patient health questionnaire 9 (PHQ-9) and pain disability index (PDI) - were also measured. Results Mean number of red days improved by − 6.4 days (SE 0.67, 95%CI − 7.7 to − 5.1, p=0.001) at 3 months; − 6.8 days (SE 0.96, 95%CI − 8.80 to − 4.9, p=0.001) at 6 months and − 6.5 days (SE 0.86, 95%CI − 8.3 to − 4.8, p=0.001) at 9 months. Repeated measures ANOVA confirmed improvements in the number of red (p=0.001), green (p=0.001), triptan (p=0.001) and painkiller days (p=0.001) as well as scores of the HIT-6 (p=0.001), PHQ-9 (p=0.001), and PDI (p=0.001) across the duration of study. Conclusion We observed improvements in pain, medication use and quality of life in onabotulinumtoxinA-resistant chronic migraine patients following erenumab treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-020-01214-2.
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Affiliation(s)
- J Talbot
- Southwest Neurology Audit and Research group (SoNAR), Department of Neurology, Derriford Hospital, Plymouth, PL6 8DH, UK.
| | - R Stuckey
- Southwest Neurology Audit and Research group (SoNAR), Department of Neurology, Derriford Hospital, Plymouth, PL6 8DH, UK
| | - L Crawford
- Southwest Neurology Audit and Research group (SoNAR), Department of Neurology, Derriford Hospital, Plymouth, PL6 8DH, UK
| | - S Weatherby
- Southwest Neurology Audit and Research group (SoNAR), Department of Neurology, Derriford Hospital, Plymouth, PL6 8DH, UK
| | - S Mullin
- Peninsula Medical School, University of Plymouth, Plymouth, UK.,UCL Queen Square Institute of Neurology, University College London, London, UK
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Niu X, Bai L, Sun Y, Wang Y, Bai G, Yin B, Wang S, Gan S, Jia X, Liu H. Mild traumatic brain injury is associated with effect of inflammation on structural changes of default mode network in those developing chronic pain. J Headache Pain 2020; 21:135. [PMID: 33228537 PMCID: PMC7684719 DOI: 10.1186/s10194-020-01201-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/10/2020] [Indexed: 02/09/2023] Open
Abstract
Background Mild traumatic brain injury (mTBI) has a higher prevalence (more than 50%) of developing chronic posttraumatic headache (CPTH) compared with moderate or severe TBI. However, the underlying neural mechanism for CPTH remains unclear. This study aimed to investigate the inflammation level and cortical volume changes in patients with acute PTH (APTH) and further examine their potential in identifying patients who finally developed CPTH at follow-up. Methods Seventy-seven mTBI patients initially underwent neuropsychological measurements, 9-plex panel of serum cytokines and MRI scans within 7 days post-injury (T-1) and 54 (70.1%) of patients completed the same protocol at a 3-month follow-up (T-2). Forty-two matched healthy controls completed the same protocol at T-1 once. Results At baseline, mTBI patients with APTH presented significantly increased GM volume mainly in the right dorsal anterior cingulate cortex (dACC) and dorsal posterior cingulate cortex (dPCC), of which the dPCC volume can predict much worse impact of headache on patients’ lives by HIT-6 (β = 0.389, P = 0.007) in acute stage. Serum levels of C-C motif chemokine ligand 2 (CCL2) were also elevated in these patients, and its effect on the impact of headache on quality of life was partially mediated by the dPCC volume (mean [SE] indirect effect, 0.088 [0.0462], 95% CI, 0.01–0.164). Longitudinal analysis showed that the dACC and dPCC volumes as well as CCL2 levels had persistently increased in patients developing CPTH 3 months postinjury. Conclusion The findings suggested that structural remodelling of DMN brain regions were involved in the progression from acute to chronic PTH following mTBI, which also mediated the effect of inflammation processes on pain modulation. Trial registration ClinicalTrial.gov ID: NCT02868684; registered 16 August 2016. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-020-01201-7.
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Affiliation(s)
- Xuan Niu
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Lijun Bai
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.
| | - Yingxiang Sun
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuan Wang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guanghui Bai
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bo Yin
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shan Wang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Shuoqiu Gan
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Xiaoyan Jia
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Hongjuan Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Brain structural and functional differences between pure menstrual migraine and menstrually-related migraine. Sci Rep 2020; 10:16454. [PMID: 33020518 PMCID: PMC7536204 DOI: 10.1038/s41598-020-73399-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 09/08/2020] [Indexed: 11/09/2022] Open
Abstract
The pathophysiological differences between menstrually-related migraine (MRM) and pure menstrual migraine (PMM) are largely unclear. The aim of this study was to investigate the potential differences in brain structure and function between PMM and MRM. Forty-eight menstrual migraine patients (32 MRM; 16 PMM) were recruited for this study. Voxel-based morphometry (VBM) was applied on structural magnetic resonance imaging (sMRI), and the amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) in resting state functional MRI (rsfMRI) were calculated. No significant between-group difference was observed in the grey matter volume (GMV). MRM patients exhibited lower ALFF values at the dorsolateral prefrontal cortex (DLPFC) and medial prefrontal cortex (mPFC) than PMM patients. Moreover, the MRM group showed significantly higher ReHo values in the DLPFC. Higher values in the mPFC were related to higher expression of calcitonin gene-associated peptide (CGRP) in the PMM group (r = 0.5, P = 0.048). Combined ALFF and ReHo analyses revealed significantly different spontaneous neural activity in the DLPFC and mPFC, between MRM and PMM patients, and ALFF values in the mPFC were positively correlated with CGRP expression, in the PMM group. This study enhances our understanding of the relationship between neural abnormalities and CGRP expression in individuals with PMM.
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Newman-Norlund RD, Rorden C, Maleki N, Patel M, Cheng B, Androulakis XM. Cortical and subcortical changes following sphenopalatine ganglion blocks in chronic migraine with medication overuse headache: a preliminary longitudinal study. Womens Midlife Health 2020; 6:7. [PMID: 32774872 PMCID: PMC7409446 DOI: 10.1186/s40695-020-00055-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/13/2020] [Indexed: 01/28/2023] Open
Abstract
Objective The purpose of this pilot study was to investigate potential changes in brain morphology (cortical thickness and cortical/subcortical volume) accompanying a series of sphenopalatine ganglion (SPG) blockade treatments in chronic migraine with medication overuse headaches (CMw/MOH). Background Local anesthetization of the SPG via intranasal application is used for the treatment for multiple types of headache disorders, including CM. Our previous longitudinal fMRI study revealed improved network connectivity after such treatment. However, the impact of SPG blocks on cortical, subcortical gray matter volume and cortical thickness has yet to be assessed. Methods Using magnetic resonance imaging (MRI), cortical/subcortical volume were measured in 12 chronic migraine patients before and after a series of 12 SPG blocks administered over a 6-week period (2 per week). The average time between MRI assessments was 6 weeks. Targeted, within-subjects t-tests comparing pre-treatment and post-treatment values in specific apriori brain regions of interest, including the hippocampus, amygdala, basal ganglia, somatosensory cortex, temporal cortex and occipital cortex, were used to estimate the impact of repetitive SPG blocks treatment on brain morphology in CMw/MOH. Results Compared to baseline values, the number of moderate/severe headache days per month, HIT-6, PHQ-9 scores and allodynia scores were all significantly improved at the end of treatment. Analysis of MRI data revealed that the volume of the right hippocampus and the right palladium significantly decreased following SPG block treatment, while the volume of the left nucleus accumbens significantly increased following treatment. Cortical thickness in the left temporal pole and left lateral occipito-temporal gyrus significantly decreased following SPG block treatment. Conclusion Our results suggest SPG block treatment is associated with significant symptom improvement as well as significant structural brain changes in regions known to be associated with migraine and chronic pain processing in CMw/MOH.
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Affiliation(s)
- Roger D Newman-Norlund
- Department of Psychology, University of South Carolina, 915 Greene Street, Discovery I Building, Office 138, Columbia, SC 29208 USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, 915 Greene Street, Discovery I Building, Office 138, Columbia, SC 29208 USA
| | | | - Milap Patel
- Department of Neurology, University of South Carolina, Columbia, SC USA
| | - Brian Cheng
- Department of Neurology, University of South Carolina, Columbia, SC USA
| | - X Michelle Androulakis
- Department of Neurology, University of South Carolina, Columbia, SC USA.,Division of Neurology, WJB Dorn VA Medical Center, Columbia, SC USA
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Farris SG, Thomas JG, Kibbey MM, Pavlovic JM, Steffen KJ, Bond DS. Treatment effects on pain catastrophizing and cutaneous allodynia symptoms in women with migraine and overweight/obesity. Health Psychol 2020; 39:927-933. [PMID: 32658497 DOI: 10.1037/hea0000920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Pain catastrophizing and cutaneous allodynia represent two risk factors for greater headache-related disability. Yet, there is limited knowledge of the extent to which these risk factors are modifiable and whether nonpharmacological treatment-related changes are associated with migraine improvements. Using data from the Women's Health and Migraine (WHAM) study, a randomized controlled trial that compared effects of behavioral weight loss (BWL) and migraine education (ME) in women with migraine and overweight/obesity, we tested whether: (a) BWL versus ME produced greater changes in pain catastrophizing and allodynia from baseline across posttreatment and follow-up time points, and (b) whether these improvements were associated with improvements in headache disability. METHOD Women (N = 110) were randomly assigned to 16 weeks of either BWL or ME and assessed at baseline, posttreatment, and follow up (32 weeks). Multilevel mixed effects modeling tested: (a) for between-groups differences in pain catastrophizing and allodynia changes over time, and (b) associations of changes in pain catastrophizing and allodynia with changes in headache disability, adjusting for migraine severity and weight loss. RESULTS Both BWL and ME had significant reductions in pain catastrophizing and allodynia from baseline to posttreatment and follow up, and the improvements were comparable across conditions. Reductions in pain catastrophizing and cutaneous allodynia were associated with significant reductions in headache disability, even when controlling for intervention-related improvements in migraine and weight loss. CONCLUSION Pain catastrophizing and allodynia are not only reduced after nonpharmacologic treatments for migraine, but greater improvements are associated with greater reductions in headache-related disability, independent of migraine severity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Impact of laser iridotomy on headache symptoms in angle-closure subjects. Graefes Arch Clin Exp Ophthalmol 2020; 258:1771-1777. [PMID: 32367284 DOI: 10.1007/s00417-020-04672-1] [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: 12/21/2019] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Migraine symptoms are frequently referred by glaucoma patients. Although most studies analyze headache in the acute setting of angle closure, many patients with chronic occludable angles also complain of headaches. The aim of this study was to determine the impact of laser peripheral iridotomy (LPI) on the magnitude and frequency of headache symptoms in patients with occludable angles. METHODS Prospective cohort study. Patients with indication for prophylactic LPI due to occludable iridocorneal angle were included. Headache symptoms were assessed before and at least 4 weeks after LPI using the Headache Impact Test-6 (HIT-6) questionnaire. A HIT-6 score of ≥ 50 points was labeled as a clinically significant headache. RESULTS Thirty-one subjects were included. Prophylactic LPI was performed in 60 eyes, as 2 patients were pseudophakic in the fellow eye. Baseline HIT-6 score was 59.9 ± 11.8, with over three quarters of these patients scoring higher than 50 points (n = 24). A statistically significant reduction in HIT-6 score was found after LPI treatment (45.4 ± 7.7, p < 0.01). Sub-analysis within the clinically symptomatic subjects disclosed a significant improvement after treatment in this group (baseline, 65.3 ± 6.2 vs post-LPI 46.2 ± 8.3, p < 0.01), with a high baseline HIT-6 score being predictive of a symptomatic improvement after LPI (χ2(8) = 15.3, p = 0.001). This is mimicked from the patient's perspective, as the two subjective questions after LPI, concerning pain intensity and frequency, report that 79.2% had a statistically significant improvement of the headaches. CONCLUSIONS Within our sample, the majority of patients with occludable angles had clinically relevant headaches. LPI provided symptomatic relief in the majority of those patients with high HIT-6 scores. Further studies are needed to explore the relationships between headache and angle anatomy.
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Togha M, Seyed-Ahadi M, Jafari E, Vahabi Z, Naderi-Behdani F, Nasergivehchi S, Haghighi S, Ghorbani Z, Farham F, Paknejad SMH, Rafiee P. Estimating quality of life in a headache referral population based on Migraine disability assessment scale and headache impact test. CURRENT JOURNAL OF NEUROLOGY 2020; 19:76-84. [PMID: 38011406 PMCID: PMC7874894 DOI: 10.18502/cjn.v19i2.4944] [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] [Received: 12/14/2019] [Accepted: 02/12/2020] [Indexed: 11/26/2022]
Abstract
Background: Headache is among the most common disabling neurologic disorders. We measured quality of life in chronic migraine (CM) and episodic migraine (EM), stratified by medication overuse headache (MOH) and presence of aura. Methods: In this observational study, conducted from January 2016 to December 2018, adult patients referred to the tertiary headache clinic of Sina Hospital in Tehran, Iran, who met International Classification of Headache Disorders, 3rd Edition-beta (ICHD-3 β) criteria for migraine were classified to EM and CM subtyped based on presence of aura and MOH. Validated Farsi versions of Migraine Disability Assessment Scale (MIDAS) and 6-item Headache Impact Test (HIT-6) questionnaires were used. Results: A total of 2454 patients (1907 women) were enrolled from which 1261 (51.4%) patients had EM and 1193 (48.6%) had CM, while 908 subjects (37.0%) had MOH, of whom 890 (98.0%) had CM. Median scores of MIDAS and HIT-6 were significantly higher in patients with CM compared to EM sufferers. Chronic migraineurs with MOH had a significantly higher median score of MIDAS and HIT-6 compared to patients with non-MOH CM. Also, there was a moderate positive correlation between MIDAS (disability) and HIT-6 scores (impact on patients' life) and a moderate correlation between HIT-6 and pain severity. Conclusion: The results of this study confirm that CM and MOH are associated with a higher headache-related disability and impact on life compared to EM. Therefore, treatment goals in prevention of MOH and migraine transformation warrant higher quality of life in patients with migraine.
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Affiliation(s)
- Mansoureh Togha
- Department of Headache, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Headache, Neurology Ward, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maral Seyed-Ahadi
- Department of Headache, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Jafari
- Department of Headache, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Headache, Neurology Ward, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Vahabi
- Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Division of Memory and Behavioral Neurology, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Naderi-Behdani
- Department of Headache, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Somayeh Nasergivehchi
- Department of Headache, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurology, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Haghighi
- Department of Headache, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Headache, Neurology Ward, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Ghorbani
- Cardiovascular Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Farham
- Department of Headache, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Headache, Neurology Ward, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Hassan Paknejad
- Department of Headache, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Pegah Rafiee
- Department of Headache, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Bao J, Ma M, Dong S, Gao L, Li C, Cui C, Chen N, Zhang Y, He L. Early Age of Migraine Onset is Independently Related to Cognitive Decline and Symptoms of Depression Affect Quality of Life. Curr Neurovasc Res 2020; 17:177-187. [PMID: 32031072 PMCID: PMC7536790 DOI: 10.2174/1567202617666200207130659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/16/2020] [Accepted: 01/18/2020] [Indexed: 02/08/2023]
Abstract
Background People with migraine experience cognitive decline more often than healthy controls, resulting in a significant functional impact. Early identifying influencing factors that contribute to cognitive decline in migraineurs is crucial for timely intervention. Although migraine may onset early in childhood and early onset migraine is related to significant disability, there is no research investigating the association between the age of migraine onset and migraineurs’ cognitive decline. Therefore we aim to explore possible factors that correlate to the cognitive function of migraineurs, especially focus on age of migraine onset. Methods 531 patients with migraine were included. Data on demographics and headache-related characteristics were collected and evaluated using face-to-face interviews and questionnaires. We used the Montreal Cognitive Assessment scale to assess cognitive function. In addition, we analyzed independent correlations between cognitive decline and the age of migraine onset in patients with migraine. And all patients completed the Headache Impact Test-6 to evaluate their quality of life. Results Migraineurs with cognitive decline showed significant differences from those without in age (OR=1.26, P<0.0001), years of education (OR=0.89, P=0.0182), the intensity of headache (OR=1.03, P=0.0217), age of onset (OR=0.92, P<0.0001) and anxiety scores (OR=1.09, P=0.0235). Furthermore, there was no interaction in the age of onset between subgroups. Multivariate linear regression analyses of HIT-6 scores showed that the intensity of headache (β=0.18, P<0.0001) and depression scores (β=0.26, P=0.0009) had independent effects on decreased quality of life. Conclusion Our findings suggest that younger age of migraine onset is independently related to migraineurs’ cognitive decline, and migraine accompanying anxiety symptoms significantly related to decreased quality of life in migraineurs.
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Affiliation(s)
- Jiajia Bao
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Wainan Guoxue Xiang, Chengdu 610041, Sichuan, China
| | - Mengmeng Ma
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Wainan Guoxue Xiang, Chengdu 610041, Sichuan, China
| | - Shuju Dong
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Wainan Guoxue Xiang, Chengdu 610041, Sichuan, China
| | - Lijie Gao
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Wainan Guoxue Xiang, Chengdu 610041, Sichuan, China
| | - Changling Li
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Wainan Guoxue Xiang, Chengdu 610041, Sichuan, China
| | - Chaohua Cui
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Wainan Guoxue Xiang, Chengdu 610041, Sichuan, China
| | - Ning Chen
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Wainan Guoxue Xiang, Chengdu 610041, Sichuan, China
| | - Yang Zhang
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Wainan Guoxue Xiang, Chengdu 610041, Sichuan, China
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Wainan Guoxue Xiang, Chengdu 610041, Sichuan, China
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Jeyagurunathan A, Abdin E, Vaingankar JA, Chua BY, Shafie S, Chang SHS, James L, Tan KB, Basu S, Chong SA, Subramaniam M. Prevalence and comorbidity of migraine headache: results from the Singapore Mental Health Study 2016. Soc Psychiatry Psychiatr Epidemiol 2020; 55:33-43. [PMID: 31456029 DOI: 10.1007/s00127-019-01755-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/20/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM Migraine is a highly prevalent and disabling neurological disorder associated with a wide range of psychiatric comorbidities. Studies have revealed that those with migraine headache and coexisting psychiatric disorders have poorer treatment outcomes and increased disability. The study aims to establish the prevalence, correlates, and comorbidities of migraine headache among the multi-ethnic Asian population in Singapore. METHOD Data were extracted from the Singapore Mental Health Study 2016 (SMHS 2016), a cross-sectional epidemiological survey of a nationally representative sample. Face-to-face interviews were completed with 6126 participants between 2016 and 2017. The data relating to chronic medical conditions, psychiatric conditions, and 30-day functioning and disability were captured using the World Mental Health Composite International Diagnostic Interview (CIDI) version 3.0. RESULTS The lifetime prevalence for migraine headache in the Singapore general population was 8.2%. Malay ethnicity (versus Chinese), female gender (versus male), and diploma holders (versus university) were significantly more likely to experience migraine headache. Participants belonging to the older age group (65 years and above versus 18-34 years of age), and those who were economically inactive (versus employed) were less likely to experience migraine headache. The mean age of onset for migraine was 26.4 years (SD = 11.1). Poisson regression analyses showed that migraine headache was also significantly associated with psychiatric conditions such as major depressive disorder (MDD) (prevalence ratio (PR), 1.80; 95% CI, 1.25-2.58), bipolar disorder (BD) (PR, 3.55; 95% CI, 2.29-5.51), generalized anxiety disorder (GAD) (PR, 2.04; 95% CI, 1.12-3.69), obsessive compulsive disorder (OCD) (PR, 2.20; 95% CI, 1.49-3.26), and alcohol use disorder (AUD) (PR, 1.93; 95% CI, 1.20-3.08). Those with migraine headache were significantly associated with poor functioning and disability compared to those without migraine headache. CONCLUSIONS AND DISCUSSION Our study showed significant associations between migraine headache and psychiatric disorders, as well as with role functioning and disability. The findings of our study emphasise the need for screening for psychiatric comorbidity among those with migraine and the development of appropriate interventions for this group.
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Affiliation(s)
- Anitha Jeyagurunathan
- Research Division, Institute of Mental Health (IMH), Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health (IMH), Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Janhavi Ajit Vaingankar
- Research Division, Institute of Mental Health (IMH), Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health (IMH), Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Saleha Shafie
- Research Division, Institute of Mental Health (IMH), Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Shi Hui Sherilyn Chang
- Research Division, Institute of Mental Health (IMH), Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Lyn James
- Ministry of Health (MOH), Singapore, Singapore
| | | | - Sutapa Basu
- Early Psychosis Intervention Programme (EPIP), Department of Psychosis, IMH, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health (IMH), Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health (IMH), Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
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Yu S, Ran Y, Wan Q, Yang X, Chen H, Wang H, Hu X, Mao S, Yu T, Luo G, Gao X, Li X, Zhou M, Li Y. Efficacy and Safety of Toutongning Capsule in Patients with Migraine: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial. J Altern Complement Med 2019; 25:1215-1224. [PMID: 31553228 DOI: 10.1089/acm.2018.0500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Ye Ran
- Department of Neurology, Chinese PLA General Hospital, Beijing, P.R. China
| | - Qi Wan
- Department of Neurology, Jiangsu Province Hospital, Nanjing, P.R. China
| | - Xiaosu Yang
- Department of Neurology, Xiangya Hospital Central South University, Changsha, P.R. China
| | - Huisheng Chen
- Department of Neurology, The General Hospital of Shenyang Military, Shenyang, P.R. China
| | - Hebo Wang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, P.R. China
| | - Xueqiang Hu
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Shanping Mao
- Department of Neurology, Hubei General Hospital, Wuhan, P.R. China
| | - Tingming Yu
- Department of Neurology, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Guogang Luo
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Xuguang Gao
- Department of Neurology, Peking University People's Hospital, Beijing, P.R. China
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, P.R. China
| | - Muke Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Yu Li
- Department of Neurology, Fuling Center Hospital of Chongqing City, Chongqing, P.R. China
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Lapp HS, Sabatowski R, Weidner K, Croy I, Gossrau G. C-tactile touch perception in migraineurs – a case-control study. Cephalalgia 2019; 40:478-492. [DOI: 10.1177/0333102419889349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Migraine is characterized by sensory hypersensitivity and habituation deficits. Slow brushing over the skin activates C-tactile nerve fibers, which mediate pleasant touch and analgesic effects in healthy subjects. As this function is altered in painful conditions, we aimed to examine whether the C-tactile processing is disrupted in migraines. Methods To psychophysically assess C-tactile function, we applied optimal and suboptimal C-tactile stroking stimuli on the dorsal forearm (body reference area) and the trigeminally innervated skin of 52 interictal migraineurs and 52 matched healthy controls. For habituation testing, 60 repeated C-tactile optimal stimuli were presented in both test areas. The participants rated each stimulus on a visual analogue scale by intensity, pleasantness, and painfulness. Results Regarding C-tactile function, migraineurs showed unphysiological rating patterns but no significantly different pleasantness ratings than controls. During repeated stimulation, controls showed stable pleasantness ratings while migraineurs’ ratings decreased, especially in those experiencing tactile allodynia during headaches. Migraineurs taking triptans responded like controls. Conclusion The C-tactile function of migraineurs is subclinically altered. Repeated C-tactile stimulation leads to altered habituation but differs from previous work by the direction of the changes. Although the pathophysiology remains unknown, causative mechanisms could include central and peripheral neuronal sensitization, tactile allodynia and hedonic stimulus attributions.
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Affiliation(s)
- Hanna Sophie Lapp
- Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
| | - Rainer Sabatowski
- Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
- Department of Anesthesiology, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
| | - Ilona Croy
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
| | - Gudrun Gossrau
- Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
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