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Obermann M, Gebauer A, Arweiler-Harbeck D, Lang S, Seilheimer B, Kleinschnitz C, Diener HC, Holle D, Naegel S. Cognitive deficits in patients with peripheral vestibular dysfunction. Eur J Neurol 2023. [PMID: 37272216 DOI: 10.1111/ene.15907] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Previous studies demonstrated cognitive deficits in patients with peripheral vestibulopathy with dysfunction of spatial navigation and orientation, but also documented cognitive decline in non-spatial abilities. This study evaluates cognitive deficits in patients with unilateral (UVP) as well as bilateral vestibulopathy (BVP) in multiple cognitive domains using common screening tests to reliably detect these deficits in clinical practice. METHODS Prospective study in patients with UVP and BVP compared to age and sex matched healthy controls (HC). Tests included the Alzheimer's Disease Assessment Scale, Mini-Mental Status Examination, Trail Making Test Part A and B, Clock Drawing Task, Executive Interview-25, Dementia Detection, and the Judgement of Line Orientation. The Montgomery-Åsberg Depression Rating Scale was used to control for depression. Videonystagmography objectively reconfirmed peripheral vestibulopathy. The Vertigo Symptoms Scale and the Dizziness Handicap Inventory were used to assess for symptom severity and restrictions of activities of daily living. RESULTS Eighty-one patients (65 UVP, 16 BVP) were compared to 55 HC. Patients showed impairment in ADAS, MMSE, DemTect, EXIT25 and JLO. No differences between UVP and BVP were detected. The relative risk (RR) estimates of developing cognitive deficits following PVP were increased. The RR for the ADAS was higher in BVP (RR 4.91 95%CI 1.87 - 12.9, p=0.001) than in UVP (RR 3.75 95%CI 1.65 - 8.51, p=0.002), but was similar for the MMSE and DemTect between groups. CONCLUSION Patients with PVP showed deficits in multiple cognitive domains including non-spatial cognitive abilities. Vestibulopathy could be a risk factor for the development of cognitive impairment.
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Affiliation(s)
- Mark Obermann
- Department of Neurology, Dizziness and Vertigo Center Essen, University Hospital Essen, Germany
- Department of Neurology, Weser-Egge Hospital Höxter, Germany
| | - Alexander Gebauer
- Department of Neurology, Dizziness and Vertigo Center Essen, University Hospital Essen, Germany
| | | | - Stephan Lang
- Department of Otorhinolaryngology, University Hospital Essen, Germany
| | | | - Christoph Kleinschnitz
- Department of Neurology, Dizziness and Vertigo Center Essen, University Hospital Essen, Germany
| | - Hans-Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-, Essen, Germany
| | - Dagny Holle
- Department of Neurology, Dizziness and Vertigo Center Essen, University Hospital Essen, Germany
| | - Steffen Naegel
- Department of Neurology, Dizziness and Vertigo Center Essen, University Hospital Essen, Germany
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
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2
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Nsaka M, Scheffler A, Wurthmann S, Schenk H, Kleinschnitz C, Glas M, Holle D. Real-world evidence following a mandatory treatment break after a 1-year prophylactic treatment with calcitonin gene-related peptide (pathway) monoclonal antibodies. Brain Behav 2022; 12:e2662. [PMID: 35687795 PMCID: PMC9304830 DOI: 10.1002/brb3.2662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Current German and European guidelines suggest migraine patients undertake a treatment break after 9 to 12 months of treatment with CGRP (pathway) monoclonal antibodies. METHODS Clinical routine data of highly resistant migraine patients were analyzed before treatment with CGRP monoclonal antibodies (baseline), after 12 months of treatment, and following a treatment break between November 2018 and December 2020 in the West German Headache Centre, University Hospital Essen, Germany. Monthly migraine days (MMD), monthly headache days (MHD), and days of acute medication intake (AMD) were assessed. RESULTS Complete clinical data from 46 migraine patients (14 episodic migraine (EM), 32 chronic migraine (CM) patients) treated with erenumab (n = 40), galcanezumab (n = 4), and fremanezumab (n = 2) were analyzed. The mean number of MMDs among EM and CM patients after 12 months of CGRP antibody treatment increased during the treatment break by 5.18 (SE 0.92, p < .001) and 5.06 (SE 1.22, p = .003) days, respectively. There was an increased intake of acute medications among episodic (4.72, SE 0.87, p = .004) and chronic migraine patients (3.01, SE 1.08, p = .013) during treatment break. Eighty-three percent of patients (n = 38) were dissatisfied with the mandatory treatment break. All patients continued with a CGRP (pathway) monoclonal antibody after the mandatory treatment break. CONCLUSION A mandatory break in CGRP (pathway) monoclonal antibody therapy had a negative short-term impact on migraine patients.
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Affiliation(s)
- Michael Nsaka
- Department of Neurology and Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Armin Scheffler
- Department of Neurology and Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Sebastian Wurthmann
- Department of Neurology and Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Hannah Schenk
- Department of Neurology and Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Martin Glas
- Department of Neurology and Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Division of Clinical Neurooncology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Dagny Holle
- Department of Neurology and Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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3
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Schenk H, Holle D, Nsaka M, Kleinschnitz C, Glas M, Scheffler A. Twelve-month safety, tolerability and susceptibility to adverse events of prophylactic migraine therapy with erenumab: a retrospective real-world study. J Headache Pain 2022; 23:55. [PMID: 35538414 PMCID: PMC9092816 DOI: 10.1186/s10194-022-01426-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/30/2022] [Indexed: 01/03/2023] Open
Abstract
Background Erenumab is a monoclonal antibody (mAb) against the calcitonin gene related peptide (CGRP) receptor and is commonly used in migraine prophylaxis. Pivotal and open-label studies show a good safety and tolerability. However, little is known about possible predictors, dose dependence and time course of development of adverse events (AEs) during the treatment under real-world conditions. Methods Clinical routine data of 128 patients with migraine treated in the West German Headache Center Essen were analyzed regarding AEs during a treatment interval of up to 12 months (3mo n = 128, 6mo n = 105, 9mo n = 74, 12mo n = 54). Patients obtained subcutaneous erenumab injections with either 70 mg or 140 mg per month. The occurrence and alterations of AEs were evaluated. All reported AEs, regardless of their severity, were included. AEs were graded using the common terminology criteria for adverse events (CTCAE). Possible parameters that could influence the occurrence of AEs (sex, episodic or chronic migraine, medication overuse headache, aura and the dosage of erenumab) were analyzed using the Chi-squared test, alpha adjustment was done using the Bonferroni’s correction (6 tests, adjusted alpha = 0.0083). Results The proportion of patients who reported at least one AE were stable over the course of 12 months (after 3mo = 37%, 6mo = 36%, 9mo = 32%, 12mo = 35%). All reported AEs were grade 1 according to CTCAE with one exception (grade 2). Throughout the interval, five AEs were mostly reported: constipation, skin reactions, fatigue, sleep disturbances and nausea/emesis. Discontinuation of erenumab therapy was rarely caused by AEs (5/49). Increasing the dosage from 70 mg to 140 mg per month caused no higher frequency of AEs (Chi-squared test, p = 0.57). Significant more AEs were reported by females and by patients with aura (Chi-squared test, p < 0.001, respectively). Conclusion In general, erenumab is well tolerated up to a treatment interval of 12 months and reported AEs rarely lead to discontinuation of therapy. A higher dosage does not increase the patient reported AEs. Furthermore, no habituation of AEs is observed. Nevertheless, females and patients with aura seem to be more prone to have AEs. Trial registration No registration, retrospective analysis.
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Affiliation(s)
- Hannah Schenk
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Dagny Holle
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Michael Nsaka
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Martin Glas
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Armin Scheffler
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
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4
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Ornello R, Baraldi C, Guerzoni S, Lambru G, Andreou AP, Raffaelli B, Gendolla A, Barbanti P, Aurilia C, Egeo G, Cevoli S, Favoni V, Vernieri F, Altamura C, Russo A, Silvestro M, Valle ED, Mancioli A, Ranieri A, Alfieri G, Latysheva N, Filatova E, Talbot J, Cheng S, Holle D, Scheffler A, Nežádal T, Čtrnáctá D, Šípková J, Matoušová Z, Casalena A, Maddestra M, Viola S, Affaitati G, Giamberardino MA, Pistoia F, Reuter U, Sacco S. Comparing the relative and absolute effect of erenumab: is a 50% response enough? Results from the ESTEEMen study. J Headache Pain 2022; 23:38. [PMID: 35305579 PMCID: PMC8933935 DOI: 10.1186/s10194-022-01408-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/03/2022] [Indexed: 12/22/2022] Open
Abstract
Background Monoclonal antibodies acting on the calcitonin gene-related peptide (CGRP) or its receptor have changed migraine preventive treatment. Those treatments have led to reconsidering the outcomes of migraine prevention. Available data mostly considered benefits in terms of relative efficacy (percent or absolute decrease in monthly migraine days [MMDs] or headache days compared with baseline). However, not enough attention has been paid to residual MMDs and/or migraine-related disability in treated patients. In the present study, we aimed at comparing the relative and absolute efficacy of erenumab. Methods ESTEEMen was a collaborative project among 16 European headache centers which already performed real-life data collections on patients treated with erenumab for at least 12 weeks. For the present study, we performed a subgroup analysis on patients with complete data on MMDs at baseline and at weeks 9-12 of treatment. Starting from efficacy thresholds proposed by previous literature, we classified patients into 0-29%, 30-49%, 50-74%, and ≥75% responders according to MMD decrease from baseline to weeks 9-12 of treatment. For each response category, we reported the median MMDs and Headache Impact test-6 (HIT-6) scores at baseline and at weeks 9-12. We categorized the number of residual MMDs at weeks 9-12 as follows: 0-3, 4-7, 8-14, ≥15. We classified HIT-6 score into four categories: ≤49, 50-55, 56-59, and ≥60. To keep in line with the original scope of the ESTEEMen study, calculations were performed in men and women. Results Out of 1215 patients, at weeks 9-12, 381 (31.4%) had a 0-29% response, 186 (15.3%) a 30-49% response, 396 (32.6%) a 50-74% response, and 252 (20.7%) a ≥75% response; 246 patients (20.2%) had 0-3 residual MMDs, 443 (36.5%) had 4-7 MMDs, 299 (24.6%) had 8-14 MMDs, and 227 (18.7%) had ≥15 MMDs. Among patients with 50-74% response, 246 (62.1%) had 4-7 and 94 (23.7%) 8-14 residual MMDs, while among patients with ≥75% response 187 (74.2%) had 0-3 and 65 (25.8%) had 4-7 residual MMDs. Conclusions The present study shows that even patients with good relative response to erenumab may have a clinically non-negligible residual migraine burden. Relative measures of efficacy cannot be enough to thoroughly consider the efficacy of migraine prevention. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01408-w.
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Affiliation(s)
- Raffaele Ornello
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Via Vetoio 1, L'Aquila, Italy
| | - Carlo Baraldi
- PhD school in neurosciences; Department of biomedical, metabolic and neural sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona Guerzoni
- Medical toxicology - Headache and Drug Abuse Research Center; Department of biomedical, metabolic and neural sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giorgio Lambru
- The Headache Service, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Anna P Andreou
- The Headache Service, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Bianca Raffaelli
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Piero Barbanti
- Headache and Pain Unit, IRCCS San Raffaele, Rome, Italy.,San Raffaele University, Rome, Italy
| | | | | | - Sabina Cevoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Valentina Favoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Claudia Altamura
- Headache and Neurosonology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Antonio Russo
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marcello Silvestro
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Andrea Mancioli
- Headache Centre, Ospedale S. Antonio Abate, ASST Valle Olona, Gallarate, Italy
| | - Angelo Ranieri
- Headache Centre, Division of Neurology and Stroke Unit, "A. Cardarelli" Hospital, Naples, Italy
| | - Gennaro Alfieri
- Headache Centre, Division of Neurology and Stroke Unit, "A. Cardarelli" Hospital, Naples, Italy
| | - Nina Latysheva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Elena Filatova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Jamie Talbot
- Southwest Neurology Audit and Research group (SoNAR), Department of Neurology, Derriford Hospital, Plymouth, PL6 8DH, UK
| | - Shuli Cheng
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Dagny Holle
- Department of Neurology, West German Headache Center, University hospital Essen, Essen, Germany
| | - Armin Scheffler
- Department of Neurology, West German Headache Center, University hospital Essen, Essen, Germany
| | - Tomáš Nežádal
- Military University Hospital Prague, Department of Neurology, 1st Faculty of Medicine Charles University, Prague, Czech Republic
| | - Dana Čtrnáctá
- Military University Hospital Prague, Department of Neurology, 1st Faculty of Medicine Charles University, Prague, Czech Republic
| | - Jitka Šípková
- Military University Hospital Prague, Department of Neurology, 1st Faculty of Medicine Charles University, Prague, Czech Republic
| | - Zuzana Matoušová
- Motol University Hospital Prague, Department of Neurology, 2nd Faculty of Medicine Charles University, Prague, Czech Republic
| | | | - Maurizio Maddestra
- Department of Neurology, "F. Renzetti" Hospital, Lanciano, Chieti, Italy
| | - Stefano Viola
- Department of Neurology, "S. Pio da Pietrelcina" Hospital, Vasto, Chieti, Italy
| | - Giannapia Affaitati
- Headache Center, Geriatrics Clinic, Department of Medicine and Science of Aging and Center for Advanced Studies and Technology (CAST), G. D'Annunzio University, Chieti, Italy
| | - Maria Adele Giamberardino
- Headache Center, Geriatrics Clinic, Department of Medicine and Science of Aging and Center for Advanced Studies and Technology (CAST), G. D'Annunzio University, Chieti, Italy
| | - Francesca Pistoia
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Via Vetoio 1, L'Aquila, Italy
| | - Uwe Reuter
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Universitätsmedizin Greifswald, Greifswald, Germany
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Via Vetoio 1, L'Aquila, Italy.
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5
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Ornello R, Baraldi C, Guerzoni S, Lambru G, Fuccaro M, Raffaelli B, Gendolla A, Barbanti P, Aurilia C, Cevoli S, Favoni V, Vernieri F, Altamura C, Russo A, Silvestro M, Dalla Valle E, Mancioli A, Ranieri A, Alfieri G, Latysheva N, Filatova E, Talbot J, Cheng S, Holle D, Scheffler A, Nežádal T, Čtrnáctá D, Šípková J, Matoušová Z, Sette L, Casalena A, Maddestra M, Viola S, Affaitati G, Giamberardino MA, Pistoia F, Reuter U, Sacco S. Gender Differences in 3-Month Outcomes of Erenumab Treatment-Study on Efficacy and Safety of Treatment With Erenumab in Men. Front Neurol 2022; 12:774341. [PMID: 34975732 PMCID: PMC8717149 DOI: 10.3389/fneur.2021.774341] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/02/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: We reported gender-specific data on the efficacy and safety of erenumab, a monoclonal antibody antagonizing the calcitonin gene-related peptide (CGRP) receptor. Methods: Our pooled patient-level analysis of real-world data included patients treated with erenumab and followed up for 12 weeks. We considered the following outcomes at weeks 9–12 of treatment compared with baseline: 0–29%, 30–49%, 50–75%, and ≥75% responder rates, according to the decrease in monthly headache days (MHDs), rate of treatment stopping, change in MHDs, monthly migraine days (MMDs), monthly days of acute medication and triptan use, and Headache Impact Test-6 (HIT-6) score from baseline to weeks 9–12. Outcomes were compared between men and women by the chi-squared test or t-test, as appropriate. An analysis of covariance (ANCOVA) was performed to identify factors influencing the efficacy outcomes. Results: We included 1,410 patients from 16 centers, of which 256 (18.2%) were men. Men were older than women and had a lower number of MHDs at baseline. At weeks 9–12, compared with baseline, 46 (18.0%) men had a ≥75% response, 75 (29.3%) had a 50–74% response, 35 (13.7%) had a 30–49% response, and 86 (33.6%) had a 0–29% response, while 14 (5.5%) stopped the treatment. The corresponding numbers for women were 220 (19.1%), 314 (27.2%), 139 (12.0%), 402 (34.8%), and 79 (6.8%). No gender difference was found in any of the outcomes. The ANCOVA showed that gender did not influence the efficacy of outcomes. Conclusion: We found that erenumab is equally safe and effective in men compared with women after 12 weeks.
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Affiliation(s)
- Raffaele Ornello
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Carlo Baraldi
- Department of Biomedical, Metabolic and Neural Sciences, School in Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona Guerzoni
- Medical Toxicology - Headache and Drug Abuse Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giorgio Lambru
- The Headache Service, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Matteo Fuccaro
- The Headache Service, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Bianca Raffaelli
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Piero Barbanti
- Headache and Pain Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Rome, Italy.,San Raffaele University, Rome, Italy
| | - Cinzia Aurilia
- Headache and Pain Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Rome, Italy
| | - Sabina Cevoli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Valentina Favoni
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Claudia Altamura
- Headache and Neurosonology Unit, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Antonio Russo
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marcello Silvestro
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Andrea Mancioli
- Headache Centre, Ospedale S. Antonio Abate, ASST Valle Olona, Gallarate, Italy
| | - Angelo Ranieri
- Headache Centre, Division of Neurology and Stroke Unit, "A. Cardarelli" Hospital, Naples, Italy
| | - Gennaro Alfieri
- Headache Centre, Division of Neurology and Stroke Unit, "A. Cardarelli" Hospital, Naples, Italy
| | - Nina Latysheva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Elena Filatova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Jamie Talbot
- Southwest Neurology Audit and Research Group, Department of Neurology, Derriford Hospital, Plymouth, United Kingdom
| | - Shuli Cheng
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Dagny Holle
- Department of Neurology, West German Headache Center, University Hospital Essen, Essen, Germany
| | - Armin Scheffler
- Department of Neurology, West German Headache Center, University Hospital Essen, Essen, Germany
| | - Tomáš Nežádal
- Department of Neurology, Military University Hospital Prague, First Faculty of Medicine Charles University, Prague, Czechia
| | - Dana Čtrnáctá
- Department of Neurology, Military University Hospital Prague, First Faculty of Medicine Charles University, Prague, Czechia
| | - Jitka Šípková
- Department of Neurology, Military University Hospital Prague, First Faculty of Medicine Charles University, Prague, Czechia
| | - Zuzana Matoušová
- Department of Neurology, Motol University Hospital Prague, First Faculty of Medicine Charles University, Prague, Czechia
| | - Lucia Sette
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | | | | | - Stefano Viola
- Department of Neurology, "S. Pio da Pietrelcina" Hospital, Chieti, Italy
| | - Giannapia Affaitati
- Headache Center, Geriatrics Clinic, Department of Medicine and Science of Aging and Center for Advanced Studies and Technology, G. D'Annunzio University, Chieti, Italy
| | - Maria Adele Giamberardino
- Headache Center, Geriatrics Clinic, Department of Medicine and Science of Aging and Center for Advanced Studies and Technology, G. D'Annunzio University, Chieti, Italy
| | - Francesca Pistoia
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Uwe Reuter
- The Headache Service, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom.,Universitätsmedizin Greifswald, Greifswald, Germany
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
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6
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Wurthmann S, Holle D, Obermann M, Roesner M, Nsaka M, Scheffler A, Kleinschnitz C, Naegel S. Reduced vestibular perception thresholds in persistent postural-perceptual dizziness- a cross-sectional study. BMC Neurol 2021; 21:394. [PMID: 34641808 PMCID: PMC8507224 DOI: 10.1186/s12883-021-02417-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/20/2021] [Indexed: 01/17/2023] Open
Abstract
Background Persistent postural-perceptual dizziness (PPPD) is the most common functional vestibular disorder. A multisensory mismatch altered by psychological influences is considered to be an important pathophysiological mechanism. Increased cortical and subcortical excitability may play a role in the pathophysiology of PPPD. We hypothesized that decreased motion perception thresholds reflect one mechanism of the abnormal vestibular responsiveness in this disorder. We investigated the vestibular perception thresholds and the vestibular ocular reflex with a rotatory chair experiment to gain insights in the processing and adaption to vestibular provocation. Methods In this cross-sectional study 26 female PPPD patients and 33 healthy female age matched controls (HC) were investigated sitting in a motorized rotary chair shielded regarding visual and acoustic stimuli. The chair was rotated for 20 minutes with slowly increasing velocity to a maximum of 72°/s. We functionally tested motion perception thresholds and vegetative responses to rotation as well as vestibular-ocular reflex thresholds. We additionally investigated several psychological comorbidities (i.e. depression, anxiety, somatosensory amplification) using validated scores. Conventional dizziness scores were obtained to quantify the experienced dizziness and impact on daily life. Results PPPD patients showed a significant reduced vestibulo-perceptual threshold (PPPD: 10.9°/s vs. HC: 29.5°/s; p<0.001) with increased motion sensitivity and concomitant vegetative response during and after the chair rotation compared to healthy controls. The extent of increased vestibular sensitivity was in correlation with the duration of the disease (p=0.043). No significant difference was measured regarding nystagmus parameters between both groups. Conclusion PPPD patients showed increased vegetative response as well as decreased vestibulo-perceptual thresholds which are related to disease duration. This is of interest as PPPD might be sustained by increased vestibular excitability leading to motion intolerance and induction of dizziness when exposed to movement. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02417-z.
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Affiliation(s)
- Sebastian Wurthmann
- Department of Neurology and Dizziness and Vertigo Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany. .,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany.
| | - Dagny Holle
- Department of Neurology and Dizziness and Vertigo Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Mark Obermann
- Department of Neurology, Weser-Egge Hospital Höxter, University of Duisburg-Essen, Höxter, Germany
| | - Miriam Roesner
- Department of Neurology and Dizziness and Vertigo Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Michael Nsaka
- Department of Neurology and Dizziness and Vertigo Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Armin Scheffler
- Department of Neurology and Dizziness and Vertigo Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Dizziness and Vertigo Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Steffen Naegel
- Department of Neurology and Dizziness and Vertigo Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
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Naegel S, Zeller J, Hougard A, Weise CM, Zuelow S, Kleinschnitz C, Obermann M, Solbach K, Holle D. No structural brain alterations in new daily persistent headache - a cross sectional VBM/SBM study. Cephalalgia 2021; 42:335-344. [PMID: 34601946 DOI: 10.1177/03331024211045653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify grey matter alterations in patients suffering new daily persistent headache to enrich the pathophysiological concept of this rare headache disorder characterised by a distinct, clearly remembered onset and its instant chronification. METHOD Magnetic resonance-based voxel-based and surface-based morphometry was used to investigate 23 patients suffering from new daily persistent headache and 23 age- and gender-matched healthy controls with 1.5 Tesla MRI.Independent statistical analysis was performed at three sites using statistical parametric mapping, as well as FSL(FMRIB Software Library)-based approaches. RESULTS No grey matter changes were detected using this sophisticated and cross-checked method. CONCLUSION The absence of structural brain changes in patients with new daily persistent headache contribute to the recent discussion regarding structural alterations in primary headache disorders in general and does not provide evidence for grey matter changes being associated with the pathophysiology of new daily persistent headache. Future research will have to determine the underlying pathophysiological mechanisms of this disorder.
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Affiliation(s)
- Steffen Naegel
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany.,Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Julia Zeller
- Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.,Paediatric Haematology and Oncology, Paediatrics III, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Anders Hougard
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty of the University Duisburg-Essen, Essen, Germany
| | - Stefan Zuelow
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.,Department of Diagnostic and Interventional Radiology and Neuroradiology, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Mark Obermann
- Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.,Department of Neurology, Klinikum Weser-Egge, Höxter, Germany
| | - Kasja Solbach
- Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Dagny Holle
- Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
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Scheffler A, Schenk H, Wurthmann S, Nsaka M, Kleinschnitz C, Glas M, Holle D. CGRP antibody therapy in patients with drug resistant migraine and chronic daily headache: a real-world experience. J Headache Pain 2021; 22:111. [PMID: 34544359 PMCID: PMC8454157 DOI: 10.1186/s10194-021-01323-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/06/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Calcitonin gene-related peptide (CGRP) (receptor) antibodies (erenumab, fremanezumab and galcanezumab) are increasingly used in prophylactic treatment of migraine. In the approval studies, severely affected patients with migraine and chronic daily headache without any headache free days were excluded. Thus, less is known about the effectiveness of CGRP antibody treatment in this cohort. METHODS Clinical routine data of 32 patients with migraine and daily headache were analysed after three months of treatment with a CGRP antibody (16 erenumab, 7 galcanezumab, 9 fremanezumab), including changes of monthly headache days (MHD) monthly migraine days (MMD) and monthly acute medication intake (AMD) as well as migraine characteristics. Statistical analysis was performed with the Wilcoxon-Test. Migraine characteristics were analysed descriptively. RESULTS The number of MHD was significantly reduced (mean reduction (standard error), p-value): (-4.2 (1.3), p = 0.009) as well as MMD (-4.3 (1.6), p = 0.033). Four patients (13 %) reached a 50 % reduction regarding MHD and 8 patients (25 %) regarding MMD, migraine duration and intensity improved under therapy. CONCLUSIONS Despite the low responder rate, CGRP antibodies can be effective at least in a few cases of severely affected patients with drug resistant migraine and chronic daily headache. TRIAL REGISTRATION Retrospective registered.
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Affiliation(s)
- Armin Scheffler
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Hannah Schenk
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Sebastian Wurthmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Michael Nsaka
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Martin Glas
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Dagny Holle
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
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Wurthmann S, Naegel S, Nsaka M, Scheffler A, Kleinschnitz C, Holle D, Obermann M. Response to the Letter to the Editor by Arshad and Bronstein "Motion perception in vestibular migraine". Eur J Neurol 2021; 28:e95-e96. [PMID: 34379826 DOI: 10.1111/ene.15059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Sebastian Wurthmann
- Department of Neurology, Dizziness and Vertigo Center Essen, West-German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Steffen Naegel
- Department of Neurology, Dizziness and Vertigo Center Essen, West-German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Michael Nsaka
- Department of Neurology, Dizziness and Vertigo Center Essen, West-German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Armin Scheffler
- Department of Neurology, Dizziness and Vertigo Center Essen, West-German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, Dizziness and Vertigo Center Essen, West-German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Dagny Holle
- Department of Neurology, Dizziness and Vertigo Center Essen, West-German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Mark Obermann
- Department of Neurology, Weser-Egge Hospital Höxter, and University of Duisburg-Essen, Essen, Germany
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Wurthmann S, Naegel S, Roesner M, Nsaka M, Scheffler A, Kleinschnitz C, Holle D, Obermann M. Sensitized rotatory motion perception and increased susceptibility to motion sickness in vestibular migraine: A cross-sectional study. Eur J Neurol 2021; 28:2357-2366. [PMID: 33914990 DOI: 10.1111/ene.14889] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND PURPOSE Vestibular migraine (VM) patients are ictally and interictally hypersensitive for self-motion and visual perception. Increased cortical excitability of the vestibular system represented by lowered motion perception thresholds might play an important role in the pathophysiology of VM. We aimed to compare motion perception thresholds and the vegetative response to rotatory motion, as well as the vestibulo-ocular reflex (VOR) during rotation in VM patients compared to healthy controls (HC). METHODS In this cross-sectional study, 28 female VM patients in the interictal state and 33 age- and gender-matched HC were investigated sitting in a motorized rotary chair shielded regarding visual and acoustic stimuli for 20 min with slowly increasing velocity (maximum = 72°/s). The motion perception threshold was indicated by the participants by pushing a button. During and after rotation, participants rated the presence and extent of motion sickness using a sickness rating scale. RESULTS We detected lower motion perception thresholds (7.54°/s vs. 23.49°/s; p < 0.001) in VM patients compared to HC but no difference at the basic VOR thresholds. Furthermore, the patients showed enhanced susceptibility to motion sickness during and after the rotation. CONCLUSIONS We provide evidence for decreased motion perception thresholds and pronounced susceptibility to motion sickness in VM patients in the interictal state, which could indicate alterations in higher levels of vestibular processing. Future studies should determine whether this could be the pathophysiological hallmark of VM either as a unique disease entity or in differentiation from other forms of migraine.
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Affiliation(s)
- Sebastian Wurthmann
- Department of Neurology, Dizziness and Vertigo Center Essen, West German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Steffen Naegel
- Department of Neurology, Dizziness and Vertigo Center Essen, West German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Neurology, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Miriam Roesner
- Department of Neurology, Dizziness and Vertigo Center Essen, West German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Michael Nsaka
- Department of Neurology, Dizziness and Vertigo Center Essen, West German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Armin Scheffler
- Department of Neurology, Dizziness and Vertigo Center Essen, West German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, Dizziness and Vertigo Center Essen, West German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Dagny Holle
- Department of Neurology, Dizziness and Vertigo Center Essen, West German Headache Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Mark Obermann
- Department of Neurology, Weser-Egge Hospital Höxter, University of Duisburg-Essen, Essen, Germany
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Naegel S, Burow P, Holle D, Stoevesandt D, Heintz S, Thaele A, Zierz S, Kraya T. Erenumab for migraine prevention in a patient with mitochondrial encephalopathy, lactate acidosis, and stroke-like episodes syndrome: A case report. Headache 2021; 61:694-696. [PMID: 33779998 DOI: 10.1111/head.14101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Steffen Naegel
- Department of Neurology, Martin Luther University Halle-Wittenberg, University Hospital Halle, Halle (Saale), Germany
| | - Philipp Burow
- Department of Neurology, Martin Luther University Halle-Wittenberg, University Hospital Halle, Halle (Saale), Germany
| | - Dagny Holle
- Department of Neurology, West German Headache Center, University of Duisburg-Essen, Essen, Germany
| | - Dietrich Stoevesandt
- Department of Radiology, Martin Luther University Halle-Wittenberg, University Hospital Halle, Halle (Saale), Germany
| | - Simon Heintz
- Department of Neurology, Martin Luther University Halle-Wittenberg, University Hospital Halle, Halle (Saale), Germany
| | - Annemarie Thaele
- Department of Neurology, Martin Luther University Halle-Wittenberg, University Hospital Halle, Halle (Saale), Germany
| | - Stephan Zierz
- Department of Neurology, Martin Luther University Halle-Wittenberg, University Hospital Halle, Halle (Saale), Germany
| | - Torsten Kraya
- Department of Neurology, Martin Luther University Halle-Wittenberg, University Hospital Halle, Halle (Saale), Germany.,Department of Neurology, St. Georg Hospital Leipzig, Leipzig, Germany
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Obermann M, Nägel S, Ose C, Sonuc N, Scherag A, Storch P, Gaul C, Böger A, Kraya T, Jansen JP, Straube A, Freilinger T, Kaube H, Jürgens TP, Diener HC, Katsarava Z, Kleinschnitz C, Holle D. Safety and efficacy of prednisone versus placebo in short-term prevention of episodic cluster headache: a multicentre, double-blind, randomised controlled trial. Lancet Neurol 2021; 20:29-37. [DOI: 10.1016/s1474-4422(20)30363-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/29/2020] [Accepted: 09/04/2020] [Indexed: 01/20/2023]
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Scheffler A, Messel O, Wurthmann S, Nsaka M, Kleinschnitz C, Glas M, Naegel S, Holle D. Erenumab in highly therapy-refractory migraine patients: First German real-world evidence. J Headache Pain 2020; 21:84. [PMID: 32620151 PMCID: PMC7333436 DOI: 10.1186/s10194-020-01151-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/18/2020] [Indexed: 12/20/2022] Open
Abstract
Background Calcitonin gene related peptide (CGRP) monoclonal antibodies (mAB) are the first specific migraine prophylactic medication. Erenumab is the only CGRP mAB targeting the CGRP receptor. Clinical data regarding efficacy and tolerability of erenumab in highly therapy-refractory patients are not available, yet, although many patients treated with CGRP mAB under real world conditions can be considered as highly therapy-refractory. Methods Clinical routine data of highly therapy-refractory migraine patients treated with erenumab 70 mg for 3 months between November 2018 and December 2019 in the West German Headache Center, University Hospital Essen, Germany, were analysed. Monthly migraine days (MMD), monthly headache days (MHD) and days of acute medication intake (AMD) were assessed. Statistical analysis was performed using the Wilcoxon test. Descriptive statistics were performed to evaluate changes of vegetative symptoms, acute medication response, side effects, as well as treatment satisfaction. Results Complete clinical data were available for 26 episodic (EM) and 74 chronic (CM) migraineurs. Sixty-six % (n = 49) of CM patients had an additional medication overuse headache (MOH). After 3 months 57.7% of EM patients and 41.9% of CM patients had a 50% or greater reduction of MMD. The mean number of MMD was reduced by 3.43 (SE 1.26) in EM, and by 4.72 (SE 0.87) in CM. Thirty-nine patients (52.7%) returned from chronic to episodic course of migraine. After 3 months, 23 patients (46.9%) were not suffering from a MOH anymore. Conclusions Erenumab seems to be a promising therapeutic option in highly therapy-refractory migraine patients. Trial registration Retrospective registered.
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Affiliation(s)
- Armin Scheffler
- Department of Neurology, West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Olga Messel
- Department of Neurology, West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Sebastian Wurthmann
- Department of Neurology, West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Michael Nsaka
- Department of Neurology, West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Martin Glas
- Department of Neurology, Division of Clinical Neurooncology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Steffen Naegel
- Department of Neurology, West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,Department of Neurology, Martin Luther University Halle-Wittenberg, University Hospital Halle, Ernst-Grube-Str. 40, 06097, Halle (Saale), Germany
| | - Dagny Holle
- Department of Neurology, West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
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Wurthmann S, Nägel S, Hadaschik E, Schlott S, Scheffler A, Kleinschnitz C, Holle D. Impaired wound healing in a migraine patient as a possible side effect of calcitonin gene-related peptide receptor antibody treatment: A case report. Cephalalgia 2020; 40:1255-1260. [PMID: 32536268 DOI: 10.1177/0333102420933571] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Wound healing disturbances as possible side effects of calcitonin gene-related peptide (CGRP) antibody treatment have been discussed previously but not yet described in humans. Basic research suggests that calcitonin gene-related peptide plays an important role in keratinocyte migration, vascularization and immune response and lack of calcitonin gene-related peptide may lead to impaired wound healing. CASE A 51-year-old female migraine patient was treated with the CGRP receptor antibody erenumab for 6 months, which led to a relevant reduction of migraine days. During the treatment, two periods of severely impaired wound healing occurred after a trivial skin injury without spatial relation to the injection site. Skin biopsy confirmed a deep perivascular and interstitial lymphohistiocytic infiltrate with admixed eosinophils, ulceration of the epithelium, a heavy edema of the papillary dermis and focally thrombosed vessels. CONCLUSION Impaired wound healing might be relevant side effects of CGRP antibody therapy and anamnesis within the course of treatment should also include possible observation of impaired wound healing or planned surgery.
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Affiliation(s)
- Sebastian Wurthmann
- Department of Neurology, West German Headache Center, University of Duisburg-Essen, Essen, Germany
| | - Steffen Nägel
- Department of Neurology, West German Headache Center, University of Duisburg-Essen, Essen, Germany.,Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Eva Hadaschik
- Department of Dermatology, Wound Care Ambulance, University of Duisburg-Essen, Essen, Germany
| | - Swantje Schlott
- Department of Dermatology, Wound Care Ambulance, University of Duisburg-Essen, Essen, Germany
| | - Armin Scheffler
- Department of Neurology, West German Headache Center, University of Duisburg-Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, West German Headache Center, University of Duisburg-Essen, Essen, Germany
| | - Dagny Holle
- Department of Neurology, West German Headache Center, University of Duisburg-Essen, Essen, Germany
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Bornstein NM, Saver JL, Diener HC, Gorelick PB, Shuaib A, Solberg Y, Devlin T, Leung T, Molina CA, Skoloudik D, Fiksa J, Krieger D, Andersen G, Berrouschot J, Hobohm C, Schneider D, Griewing B, Endres M, Hausler KG, Kimmig H, Ringleb P, Weimar C, Schilling M, Kohrmann M, Hetzel A, Kaps M, Cheung R, Sobolewski P, Nyke W, Czlonkowska A, Stepien A, Waldemar B, Słowik A, Zbigniewem S, Lubiński I, Portela P, Segure T, Marti-Fabregas J, Alonso M, Nunez A, Miguel MB, Campello A, Arenillas J, Marshall N, Chiu D, Shownkeen H, Rymer M, Sen S, Roubec M, Kuliha M, Lakomý C, Tyl D, Kemlink D, Doležal O, Rekova P, Krejčí V, Christensen A, Belhage B, Maschmann C, Kruse Larsen C, Pott F, Christensen H, Marstrand J, Nielsen JK, Meden P, Prytz S, Rosenbaum S, Hedemann Sorensen JC, Stenhoj Meier K, Schmift Ettrup K, Dupont Hougaard K, Von Wietzel P, Stoll A, Schwetlick H, Pradel H, Hemprich A, Schulz A, Frerich B, Hobohm C, Weise C, Michalski D, Schaller F, Schiefke F, Helmrich J, Pelz J, Schnieder M, Schneider M, Matzen P, Langos R, Müller-Duerwald S, Lukhaup S, Bauer U, Kloppig W, Hiermann E, Mucha G, Soda H, Weinhardt R, Mucha T, Ziegler V, Abbushi A, Hotter B, Winter B, Anthofer B, Noack C, Laubisch D, Heldge Schneider G, Jan Jungehulsing G, Mueller H, Dreier J, Fiebach J, Flechsenhar J, Villringer K, Ebinger M, Rozanski M, Vajkoczy P, Klingebiel R, Steinicke R, Pittl S, Hoffmann S, Maul S, Krause T, Liman T, Plath T, Nowe T, Schmidt W, Fritzsch C, Haas C, Will HG, Haußmann-Betz K, Bayat M, Pordzik T, Hug A, Staff CJ, Lichy C, Eggers G, Kloss M, Bendszus M, Herrmann O, Seeberger R, Schwarting S, Rhode S, Rizos T, Hacke W, Frank B, Bozkurt B, Holle D, Mueller D, Koch D, Shanib H, Sudendey J, Brenck J, Busch K, Gartzen K, Gasser T, Hagenacker T, Buerke B, Prigge G, Minnerup J, Albers J, Wermker K, Schwindt W, Kallmünzer RB, Hauer E, Breuer L, Schellinger P, Kollmar R, Sauer R, Schwab S, Struffert T, Funfack A, Stechmann A, Schlaeger A, Laeppchen C, Schuchardt F, Klingler JH, Reis J, Lambeck J, Friedrich M, Laible M, Wellermeyer P, Beck S, Rutsch S, Niesen WD, Tanislav C, Schaaf H, Kerkmann H, Schirotzek I, Allendörfer J, Wolff S, Yuk-Lun Lau A, Yin Yan Chan A, Siu D, Wong EHC, Chu Wong GK, Leung H, Wong LK, Zhu XL, Yan Soo YO, Ting Tse AC, Kit Leung GK, Leung KM, Ngai Hung K, Wai Mei Kwan M, Man Yu Tse M, Tse P, Hon Chan P, Lee R, Shek Kwan Chang R, Yin Yu Pang S, Fong Kwong Hon S, Cheng TS, Lui WM, Wo Mak WW, Sobota A, Wiater B, Loch B, Wolak G, Łabudzka I, Dabal J, Grzesik M, Sledzinska M, Hatalska-Żerebiec R, Szczuchniak W, Gójska A, Nałęcz D, Gasecki D, Kozera G, Dylewicz Ł, Niekra M, Kwarciany M, Chomik P, Skowron P, Kobayashi A, Chabik G, Makowicz G, Bembenek J, Jędrzejewska J, Karlinski M, Czepiel W, Brodacki B, Staszewski J, Kosek J, Jadczak M, Durka-Kęsy M, Kaluzny K, Ziomek M, Fudala M, Sosnowski Z, Ferens A, Szczygieł E, Banaszkiewicz K, Ziomek M, Wnuk M, Szczepańska-Szerej A, Jach E, Maslanko GE, Wojczal J, Luchowski P, Kowalczyk A, Jakubiak J, Kopcewicz J, Gajda M, Wichlinska-Lubinska M, Rodriguez D, Santamarin E, Pagola J, Lorente Guerrero J, Ribo M, Rubiera M, Maisterra O, Pinero S, Catalina Iglesias V, Plans G, Quesada H, Aparicio Caballero MA, Portela PC, De Diego AB, Garay DS, García Rodriguez MR, Martin OA, Braña SC, Garcia J, Hernandez FM, Catala I, Marti-Vilalta JL, Delgado Mederos R, de Quintana SC, Martinez-Ramirez S, Valcarcel Gonzalez J, Masjuan Vallejo J, Diamantopoulus J, Del Alamo M, Poveda PD, Pastor AG, Carballal CF, Diaz F, Garcia Leal R, Juretschke R, Echabe EA, Sanchez JC, Yanez MR, Garcia RS, Muino RL, Rivas SA, Lopez Gonzalez DM, Cuadrado E, Giralt E, Villalba G, Roquer J, Angel O, Jimenez M, Cedeño RR, Salinas R, Lejarreta S, Silva Y, Fraile A, Calleja A, Cepeda Landínez GA, Tellez N, Garcia Bermejo P, Santos PJ, Herranz RF, Hunt P, Browning D, Violette M, Hoddeson R, Rose J, Zhang J, Mazumdar A, Echiverri H, Chow J, Lovick D, Coleman M, Akhtar N, Sugg R, Zanation A, Germanwala A, Senior B, Huang D, Aucutt-Walter N, Kasner S, LeRoux P, von Kummer R, Palesch Y. Sphenopalatine Ganglion Stimulation to Augment Cerebral Blood Flow. Stroke 2019; 50:2108-2117. [DOI: 10.1161/strokeaha.118.024582] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Many patients with acute ischemic stroke are not eligible for thrombolysis or mechanical reperfusion therapies due to contraindications, inaccessible vascular occlusions, late presentation, or large infarct core. Sphenopalatine ganglion (SPG) stimulation to enhance collateral flow and stabilize the blood-brain barrier offers an alternative, potentially more widely deliverable, therapy.
Methods—
In a randomized, sham-controlled, double-masked trial at 41 centers in 7 countries, patients with anterior circulation ischemic stroke not treated with reperfusion therapies within 24 hours of onset were randomly allocated to active SPG stimulation or sham control. The primary efficacy outcome was improvement beyond expectations on the modified Rankin Scale of global disability at 90 days (sliding dichotomy), assessed in the modified intention-to-treat population. The initial planned sample size was 660 patients, but the trial was stopped early when technical improvements in device placement occurred, so that analysis of accumulated experience could be conducted to inform a successor trial.
Results—
Among 303 enrolled patients, 253 received at least one active SPG or sham stimulation, constituting the modified intention-to-treat population (153 SPG stimulation and 100 sham control). Age was median 73 years (interquartile range, 64–79), 52.6% were female, deficit severity on the National Institutes of Health Stroke Scale was median 11 (interquartile range, 9–15), and time from last known well median 18.6 hours (interquartile range, 14.5–22.5). For the primary outcome, improved 3-month disability beyond expectations, rates in the SPG versus sham treatment groups were 49.7% versus 40.0%; odds ratio, 1.48 (95% CI, 0.89–2.47);
P
=0.13. A significant treatment interaction with stroke location (cortical versus noncortical) was noted,
P
=0.04. In the 87 patients with confirmed cortical involvement, rates of improvement beyond expectations were 50.0% versus 27.0%; odds ratio, 2.70 (95% CI, 1.08–6.73);
P
=0.03. Similar response patterns were observed for all prespecified secondary efficacy outcomes. No differences in mortality or serious adverse event safety end points were observed.
Conclusions—
SPG stimulation within 24 hours of onset is safe in acute ischemic stroke. SPG stimulation was not shown to statistically significantly improve 3-month disability above expectations, though favorable outcomes were nominally higher with SPG stimulation. Beneficial effects may distinctively be conferred in patients with confirmed cortical involvement. The results of this study need to be confirmed in a larger pivotal study.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT03767192.
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Affiliation(s)
- Natan M. Bornstein
- From the Brain Division, Shaarei Zedek Medical Center, Jerusalem and Tel Aviv Sourasky Medical School, Tel Aviv University (N.M.B.)
| | - Jeffrey L. Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at UCLA, Los Angeles CA (J.L.S.)
| | | | - Philip B. Gorelick
- Davee Department of Neurology, Northwestern University, Chicago, IL (P.B.G.)
| | - Ashfaq Shuaib
- Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.)
| | | | - Thomas Devlin
- Department of Neurology, University of Tennessee College of Medicine, Chattanooga (T.D.)
| | - Thomas Leung
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong (T.L.)
| | - Carlos A. Molina
- and Stroke Unit, Department of Neurology, Vall d’Hebron University Hospital, Barcelona (C.A.M.)
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Naegel S, Biermann J, Theysohn N, Kleinschnitz C, Diener HC, Katsarava Z, Obermann M, Holle D. Polarity-specific modulation of pain processing by transcranial direct current stimulation - a blinded longitudinal fMRI study. J Headache Pain 2018; 19:99. [PMID: 30355321 PMCID: PMC6755563 DOI: 10.1186/s10194-018-0924-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/24/2018] [Indexed: 12/21/2022] Open
Abstract
Background To enrich the hitherto insufficient understanding regarding the mechanisms of action of transcranial direct current stimulation (tDCS) in pain disorders, we investigated its modulating effects on cerebral pain processing using functional magnetic resonance imaging (fMRI). Methods Thirteen right-handed healthy participants received 20 min of 1.5 mA tDCS applied over the primary motor cortex thrice and under three different stimulation pattern (1.anodal-tDCS, 2.cathodal-tDCS, and 3.sham-tDCS) in a blinded cross-over design. After tDCS neural response to electric trigeminal-nociceptive stimulation was investigated using a block designed fMRI. Results Pain stimulation showed a distinct activation pattern within well-established brain regions associated with pain processing. Following anodal tDCS increased activation was detected in the thalamus, basal ganglia, amygdala, cingulate, precentral, postcentral, and dorsolateral prefrontal cortex, while cathodal t-DCS showed decreased response in these areas (pFWE < 0.05). Interestingly the observed effect was reversed in both control conditions (visual- and motor-stimulation). Behavioral data remained unchanged irrespective of the tDCS stimulation mode. Conclusions This study demonstrates polarity-specific modulation of cerebral pain processing, in reconfirmation of previous electrophysiological data. Anodal tDCS leads to an activation of the central pain-network while cathodal tDCS does not. Results contribute to a network-based understanding of tDCS’s impact on cerebral pain-processing.
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Affiliation(s)
- Steffen Naegel
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.
| | - Josephine Biermann
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Nina Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Hans-Christoph Diener
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Zaza Katsarava
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.,Department of Neurology, Evangelical Hospital Unna, Holbeinstr. 10, 59423, Unna, Germany.,EVEX Medical Corporation, 40 Vazha-Pshavela Avenue, Tbilisi, 0177, Georgia.,Sechenov University Moscow, 8-2 Trubetskaya str., Moscow, 119991, Russian Federation
| | - Mark Obermann
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.,Center for Neurology, Asklepios Hospitals Schildautal, Karl-Herold-Straße 1, 38723, Seesen, Germany
| | - Dagny Holle
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
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Diener HC, Holle D, Dresler T, Gaul C. Chronic Headache Due to Overuse of Analgesics and Anti-Migraine Agents. Dtsch Arztebl Int 2018; 115:365-370. [PMID: 29932046 PMCID: PMC6039717 DOI: 10.3238/arztebl.2018.0365] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 10/30/2017] [Accepted: 03/15/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND The frequent or regular use of analgesics and anti-migraine drugs can make headache more frequent and induce the transformation of episodic to chronic headache. Chronic headache due to medication overuse is defined as headache that is present on ≥ 15 days per month for at least three months in a patient who previously suffered from primary headaches, and who takes analgesics on ≥ 15 days per month or anti-migraine drugs (triptans or ergot alkaloids), opioid drugs, or combined analgesics on ≥ 10 days per month. METHODS This review is based on pertinent articles published up to December 2017 that were retrieved by a selective search in PubMed employing the terms "medication overuse AND headache" and "medication overuse headache." RESULTS The prevalence of medication overuse headache in the general population in Germany is 0.7% -1%. This disorder is more common in women and in persons suffering from comorbid mental disorders or other painful conditions. The treatment of medication overuse headache consists of three steps. Patient education and counseling are given with the goal of reducing the intake of medication for acute headache treatment. The ensuing headache prophylaxis is with topiramate, amitriptyline, or onabotulinum toxin A. If these treatment strategies fail, a drug holiday is recommended. This can be in the outpatient, day clinic, or inpatient setting, depending on the severity of the condition and its comorbidities. CONCLUSION Patients who frequently take acute medication to treat headache episodes must be identified early in order to avoid headache chronification and medication overuse headache. The suggested treatment algorithm is still in need of validation by randomized trials.
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Affiliation(s)
| | - Dagny Holle
- Department of Neurology and West German Headache Center, Essen
| | - Thomas Dresler
- Department of Psychiatry and Psychotherapy, University Hospital and Faculty of Medicine, Tübingen LEAD Graduate School & Research Network, University of Tübingen
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18
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Abstract
Functional neuroimaging was able to identify key structures for the pathophysiology of trigeminal autonomic cephalalgias (TACs) including cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing or cranial autonomic features and hemicrania continua. The posterior hypothalamus was the structure most consistently depicted with functional imaging in different states of disease with and without pain. Network-oriented imaging techniques such as resting-state functional resonance imaging were able to show a broader involvement of human trigeminal pain processing in the underlying pathophysiological mechanisms of the different TACs, highlighting similarities between this distinct group of primary headache disorders, while also demonstrating the differences in brain activation across these disorders. The most important clinical assignment for neuroimaging research from the treating physician remains the objective and reliable distinction of each individual TAC syndrome from one another, to make the correct clinical diagnosis as the foundation for proper treatment. More research will be necessary to fulfill this unmet need.
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Affiliation(s)
- Mark Obermann
- Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany.,Department of Neurology and Westgerman Headache Center, University of Duisburg-Essen, Essen, Germany
| | - Dagny Holle
- Department of Neurology and Westgerman Headache Center, University of Duisburg-Essen, Essen, Germany
| | - Steffen Nagel
- Department of Neurology and Westgerman Headache Center, University of Duisburg-Essen, Essen, Germany
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19
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Wurthmann S, Naegel S, Schulte Steinberg B, Theysohn N, Diener HC, Kleinschnitz C, Obermann M, Holle D. Cerebral gray matter changes in persistent postural perceptual dizziness. J Psychosom Res 2017; 103:95-101. [PMID: 29167054 DOI: 10.1016/j.jpsychores.2017.10.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Persistent postural perceptual dizziness (PPPD) is the most common vestibular syndrome in middle-aged patients. Multisensory maladjustment involving alterations of sensory response pattern including vestibular, visual and motion stimuli is thought to be a key pathophysiological correlate of this disorder. OBJECTIVE We aimed to identify regional gray matter changes in PPPD patients that might be involved in the underlying pathophysiology of this disorder. METHODS 42 PPPD patients and healthy age and gender matched controls were investigated using magnetic resonance imaging-based voxel-based morphometry. All patients fulfilled the current diagnostic criteria for PPPD, established by the Bárány-Society based on previous criteria for chronic subjective dizziness and phobic postural vertigo. RESULTS PPPD patients showed gray matter volume decrease in the temporal cortex, cingulate cortex, precentral gyrus, hippocampus, dorsolateral prefrontal cortex, caudate nucleus and the cerebellum. A negative correlation of disease duration and gray matter volume was observed in the visual cortex, supplementary motor area and somatosensory processing structures. CONCLUSIONS In patients with PPPD areas involved in multisensory vestibular processing show gray matter volume decrease. These brain regions resemble those previously described for other vestibular disorders. Longer duration of disease leads to a more pronounced gray matter alteration, which might represent maladaptive mechanisms within the course of disease.
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Affiliation(s)
- Sebastian Wurthmann
- Department of Neurology and Dizziness, Vertigo Center Essen, University of Duisburg-Essen, Germany.
| | - Steffen Naegel
- Department of Neurology and Dizziness, Vertigo Center Essen, University of Duisburg-Essen, Germany.
| | | | - Nina Theysohn
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Germany.
| | - Hans-Christoph Diener
- Department of Neurology and Dizziness, Vertigo Center Essen, University of Duisburg-Essen, Germany.
| | - Christoph Kleinschnitz
- Department of Neurology and Dizziness, Vertigo Center Essen, University of Duisburg-Essen, Germany.
| | - Mark Obermann
- Department of Neurology and Dizziness, Vertigo Center Essen, University of Duisburg-Essen, Germany; Center for Neurology, Asklepios Hospitals Schildautal, Karl-Herold-Straße 1, 38723 Seesen, Germany.
| | - Dagny Holle
- Department of Neurology and Dizziness, Vertigo Center Essen, University of Duisburg-Essen, Germany.
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Obermann M, Katsarava Z, Holle D. An update on emerging therapeutic options for the treatment of trigeminal neuralgia. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1394183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mark Obermann
- Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - Zaza Katsarava
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany
| | - Dagny Holle
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
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21
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Diener HC, Gaul C, Göbel H, Holle D, Liesering-Latta E, Nägel S, Schäfer B, Sorgenfrei V, Storch P, Straube A, Israel-Willner H, Reuter U. Integrierte Versorgung Kopfschmerz. Akt Neurol 2017. [DOI: 10.1055/s-0043-107775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | - Dagny Holle
- Universitätsklinik für Neurologie, Kopfschmerz- und Schwindelzentrum Essen
| | | | - Steffen Nägel
- Universitätsklinik für Neurologie, Kopfschmerz- und Schwindelzentrum Essen
| | | | - Verena Sorgenfrei
- Kopfschmerzambulanz, Klinik und Poliklinik für Neurologie, LMU München
| | - Peter Storch
- Klinik für Neurologie, Universitätsklinikum Jena
| | - Andreas Straube
- Kopfschmerzambulanz, Klinik und Poliklinik für Neurologie, LMU München
| | - Heike Israel-Willner
- Kopfschmerzzentrum Berlin und Hochschulambulanz und Klinik für Neurologie, Charité – Universitätsmedizin Berlin
| | - Uwe Reuter
- Kopfschmerzzentrum Berlin und Hochschulambulanz und Klinik für Neurologie, Charité – Universitätsmedizin Berlin
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22
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Naegel S, Biermann J, Theysohn N, Diener HC, Obermann M, Holle D. P066 Polarity-specific modulation of central pain processing by transcranial direct current stimulation. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2016.10.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Naegel S, Huhn JI, Gaul C, Diener HC, Obermann M, Holle D. No Pattern Alteration in Single Nocturnal Melatonin Secretion in Patients With Hypnic Headache: A Case-Control Study. Headache 2016; 57:648-653. [DOI: 10.1111/head.12983] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/26/2016] [Accepted: 09/25/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Steffen Naegel
- Department of Neurology and Headache Center; University of Duisburg-Essen; Essen Germany
| | - Jana-Isabel Huhn
- Department of Neurology and Headache Center; University of Duisburg-Essen; Essen Germany
| | - Charly Gaul
- Department of Neurology and Headache Center; University of Duisburg-Essen; Essen Germany
- Migraine and Headache Clinic; Königstein Germany
| | - Hans-Christoph Diener
- Department of Neurology and Headache Center; University of Duisburg-Essen; Essen Germany
| | - Mark Obermann
- Department of Neurology and Headache Center; University of Duisburg-Essen; Essen Germany
- Asklepios Hospitals Schildautal; Center for Neurology; Seesen Germany
| | - Dagny Holle
- Department of Neurology and Headache Center; University of Duisburg-Essen; Essen Germany
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Abstract
Migraine remains one of the most disabling disorders worldwide. The high prevalence in the general population and the often-delicate treatment of patients account for that. Therapeutic management of migraine relies mainly on non-specific medical treatment and is affected by low patient adherence to the treatment regimens applied. The introduction of specific anti-migraine treatment occurred over 20 years ago when the first triptan was approved by regulatory authorities (sumatriptan, 28 December 1992). Triptan use is limited by side effects, time- and frequency-restricted application, and the risk of developing medication overuse headache. Within the past few years, new and promising drugs such as more specific 5-HT 1F receptor agonists (that is, lasmiditan) and monoclonal calcitonin gene-related peptide (CGRP) receptor antibodies entered advanced development phases while non-invasive neuromodulatory approaches were suggested to be potentially effective as non-pharmaceutical interventions for migraine.
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Affiliation(s)
- Mark Obermann
- Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany
| | - Dagny Holle
- Department of Neurology and West-German Headache Center, University of Duisburg-Essen, Essen, Germany
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25
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Gaul C, Liesering-Latta E, Schäfer B, Fritsche G, Holle D. Integrated multidisciplinary care of headache disorders: A narrative review. Cephalalgia 2016; 36:1181-1191. [DOI: 10.1177/0333102415617413] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Recent evidence shows that multidisciplinary treatment is effective in chronic pain syndromes, especially in headache disorders. Aim The aim of this review is to summarize current knowledge on integrative care concepts in headache patients regarding the optimal and necessary treatment parts, optimal duration and setting. Methods We present a narrative review reporting current literature and personal experience. Results and conclusion Based on current knowledge, multidisciplinary treatment programs appear to be reasonable and efficient in headache disorders. Sufficient controlled studies regarding the need for individual parts of the integrative care approach are missing as yet. Recommendations are therefore at least partly based on personal experiences. It seems to be unambiguous that patients should be referred to a specialized headache center offering such a program instead of being sent sequentially to various medical specialists. The extent and kind of required therapy (e.g. personal consultation versus group sessions) is not known yet. All patients should learn relaxation training, although it is unclear yet which training is the best for which patient. Physiotherapy with guidance on more activity and individual exercises should be used in all patients. Some patients might benefit from cognitive behavioral therapy. However, therapies often depend more on country-specific health care systems than on clinical needs or scientific data.
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Affiliation(s)
- Charly Gaul
- Migraine and Headache Clinic, Königstein, Germany
| | | | | | | | - Dagny Holle
- Department of Neurology, University Hospital, Essen, Germany
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Abstract
Drug-associated headache is a quite common phenomenon, e.g. as a side effect of distinct substances such as nitric oxide or as a result of medication overuse of analgesic drugs. A different drug-associated headache entity is headache in drug-induced aseptic meningitis (DIAM). This is a rare disorder and only described in few case reports or smaller case series. One of the main clinical features of DIAM despite fever is headache. Based on the literature, no typical or even pathognomonical clinical presentation of this headache entity can be described. Sometimes, migrainous features might be present, and treatment response to triptans was reported in single case reports. Headache in DIAM seems to be emerging from sterile meningeal inflammation, which is suggested to represent the underlying pathology in DIAM. Headache in DIAM usually ceases when treated sufficiently, mainly through termination or withdrawal of the causing agent. Migraine as a predisposing factor of DIAM has been discussed previously but remains unproven.
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Affiliation(s)
- Dagny Holle
- Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany,
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Diener HC, Charles A, Goadsby PJ, Holle D. New therapeutic approaches for the prevention and treatment of migraine. Lancet Neurol 2015; 14:1010-22. [PMID: 26376968 DOI: 10.1016/s1474-4422(15)00198-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 02/03/2023]
Abstract
The management of patients with migraine is often unsatisfactory because available acute and preventive therapies are either ineffective or poorly tolerated. The acute treatment of migraine attacks has been limited to the use of analgesics, combinations of analgesics with caffeine, ergotamines, and the triptans. Successful new approaches for the treatment of acute migraine target calcitonin gene-related peptide (CGRP) and serotonin (5-hydroxytryptamine, 5-HT1F) receptors. Other approaches targeting the transient receptor potential vanilloid (TRPV1) receptor, glutamate, GABAA receptors, or a combination of 5-HT1B/1D receptors and neuronal nitric oxide synthesis have been investigated but have not been successful in clinical trials thus far. In migraine prevention, the most promising new approaches are humanised antibodies against CGRP or the CGRP receptor. Non-invasive and invasive neuromodulation approaches also show promise as both acute and preventive therapies, although further studies are needed to define appropriate candidates for these therapies and optimum protocols for their use.
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Affiliation(s)
- Hans-Christoph Diener
- Department of Neurology and Headache Center, University of Duisburg-Essen, Essen, Germany.
| | - Andrew Charles
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peter J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK
| | - Dagny Holle
- Department of Neurology and Headache Center, University of Duisburg-Essen, Essen, Germany
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Burmeister J, Holle D, Bock E, Ose C, Diener HC, Obermann M. Botulinum neurotoxin type A in the treatment of classical Trigeminal Neuralgia (BoTN): study protocol for a randomized controlled trial. Trials 2015; 16:550. [PMID: 26634453 PMCID: PMC4669653 DOI: 10.1186/s13063-015-1052-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 11/11/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Trigeminal neuralgia is characterized by paroxysmal facial pain attacks. Adequate prophylactic drug therapy is often limited by the lack of efficacy and intolerance due to central nervous system side effects. Subcutaneous injections of botulinum toxin type A are a promising treatment option for patients with unsatisfactory response to drug therapy or neurosurgical intervention. Its effects are expected to last for at least 3 months, so it could be a potential long-term treatment. This is the study protocol of a prospective, placebo-controlled, double blind clinical trial investigating the add-on therapy of subcutaneous administration of botulinum toxin type A injections to standard treatment in therapy-refractory classical trigeminal neuralgia. METHODS AND DESIGN BoTN is a prospective, double blind, placebo-controlled trial with a randomized withdrawal design in which a single blind phase is followed by a double blind phase (see also Methods and design). Eligible patients with classical trigeminal neuralgia who are otherwise refractory to medical and neurosurgical treatment will receive subcutaneous injections of botulinum toxin type A into injection sites of the affected trigeminal branch. In the first phase all patients will receive botulinum toxin type A in a single blinded intervention. Twelve weeks later therapy responders will be allocated to the verum or placebo (saline) arm in a double blind, randomized manner. These injections will be performed at the same sites as the first injections. This trial will be conducted in a tertiary outpatient clinic specialized in the treatment of headache and facial pain. There will be three investigators performing the injections who are experienced in the treatment of headache and facial pain and trained in botulinum toxin type A injections. DISCUSSION BoTN is designed to assess the efficacy and safety of subcutaneous botulinum toxin type A injections in addition to standard prophylactic treatment in therapy-refractory trigeminal neuralgia. TRIAL REGISTRATION NUMBER EU Clinical Trials Register: EudraCT-No: 2014-001959-24 https://www.clinicaltrialsregister.eu/ctr-search/rest/download/trial/2014-001959-24/DE Date of trial registration 26 August 2014.
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Affiliation(s)
- Jan Burmeister
- Department of Neurology and Headache Center, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
| | - Dagny Holle
- Department of Neurology and Headache Center, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
| | - Eva Bock
- Center for Clinical Trials, Essen (ZKSE) and Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
| | - Claudia Ose
- Center for Clinical Trials, Essen (ZKSE) and Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
| | - Hans-Christoph Diener
- Department of Neurology and Headache Center, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
| | - Mark Obermann
- Department of Neurology and Headache Center, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
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Abstract
Recent studies from the UK give the debate about how to deal best with patients suffering from whiplash injury new impetus. Following whiplash injury, about 90% of patients complain about head and/or neck pain, as well as dizziness, sleep problems and anxiety. These symptoms are often referred to as whiplash-associated disorders. In the majority of cases, these complaints develop within a few days or weeks following the accident. However, 30-50% of patients experience prolonged symptoms for more than 6 months, with headache as the main complaint. In accordance with the bio-psycho-social model of chronic post-traumatic headache, the following treatment options have been suggested: (1) proper patient education with detailed explanation of the condition; (2) support of normal movement; (3) avoiding immobilization; (4) resumption of work; and (5) targeted physiotherapy. Based on current study data, intensified physiotherapy seems not to be superior to standard therapy with simple patient education and can therefore not be recommended considering cost-benefit aspects.
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Affiliation(s)
- Mark Obermann
- Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany, Department of Neurology, University of Duisburg-Essen,Hufelandstr. 55, Essen, 45122, Germany
| | - Steffen Naegel
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - Bert Bosche
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - Dagny Holle
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
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Holle D, Schulte-Steinberg B, Wurthmann S, Naegel S, Ayzenberg I, Diener HC, Katsarava Z, Obermann M. Persistent Postural-Perceptual Dizziness: A Matter of Higher, Central Dysfunction? PLoS One 2015; 10:e0142468. [PMID: 26569392 PMCID: PMC4646356 DOI: 10.1371/journal.pone.0142468] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/22/2015] [Indexed: 02/01/2023] Open
Abstract
Objective Persistent postural-perceptual dizziness (PPPD) is the most common vestibular disorder in the age group between 30 and 50 years. It is considered to be based on a multisensory maladjustment involving alterations of sensory response pattern including vestibular, visual and motion stimuli. Previous data supported a link between vestibular and pain mechanism. The aim of the study was to investigate whether other sensory inputs such as pain stimuli might be altered in terms of a more widespread central perception dysfunction in this disorder. Methods Nociceptive blink reflex was measured in 27 patients with PPPD and compared with 27 healthy, age and gender matched controls. The habituation of the R2 component of the blink reflex was evaluated as the percentage area-under-the curve (AUC) decrease in ten consecutive blocks of five averaged rectified responses. Additionally, clinical characteristics were evaluated. Results In patients with PPPD a lack of habituation was observed compared to healthy controls. Relative AUC decreased between the first and the tenth block by 19.48% in PPPD patients and by 31.63% (p = 0.035) in healthy controls. There was no correlation between clinical data (course of disease, comorbid depression, medication, trigger factors) or electrophysiological data (perception threshold, pain threshold, stimulus intensity) and habituation pattern. No trigeminal sensitization in terms of facilitation of absolute values could be detected. Conclusion Our study results supports the hypothesis of the multisensory dimension of impaired sensory processing in patients with PPPD extends beyond vestibular/visual motion stimuli and reflexive postural/oculomotor control mechanisms to other sensory inputs such as pain perception in terms of a more generalized disturbed habituation pattern.
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Affiliation(s)
- Dagny Holle
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- * E-mail:
| | | | | | - Steffen Naegel
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - Ilya Ayzenberg
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | | | - Zaza Katsarava
- Department of Neurology, Evangelical hospital Unna, Unna, Germany
| | - Mark Obermann
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
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Affiliation(s)
- D. Holle
- Klinik für Neurologie, Universitätsklinikum Essen
| | - H.C. Diener
- Klinik für Neurologie, Universitätsklinikum Essen
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Holle D, Diener H. Neue medikamentöse und neuromodulatorische Therapieansätze zur Behandlung der Migräne. Akt Neurol 2015. [DOI: 10.1055/s-0035-1555761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- D. Holle
- Klinik für Neurologie, Universitätsklinikum Essen
| | - H.C. Diener
- Klinik für Neurologie, Universitätsklinikum Essen
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Abstract
Migraine is a common neurological disorder, characterised by severe headaches. Epidemiological studies in the USA and Europe have identified a subgroup of migraine patients with chronic migraine. Chronic migraine is defined as ≥15 headache days per month for ≥3 months, in which ≥8 days of the month meet criteria for migraine with or without aura, or respond to treatment specifically for migraine. Chronic migraine is associated with a higher burden of disease, more severe psychiatric comorbidity, greater use of healthcare resources, and higher overall costs than episodic migraine (<15 headache days per month). There is a strong need to improve diagnosis and therapeutic treatment of chronic migraine. Primary care physicians, as well as hospital-based physicians, are integral to the identification and treatment of these patients. The latest epidemiological data, as well as treatment options for chronic migraine patients, are reviewed here.
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Affiliation(s)
| | - Kasja Solbach
- Headache Center, University Hospital Essen, Essen, Germany
| | - Dagny Holle
- Headache Center, University Hospital Essen, Essen, Germany
| | - Charly Gaul
- Migraine and Headache Clinic, Königstein, Germany, and consulting physician, Department of Neurology and Headache Center, University Hospital Essen, Essen, Germany
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Obermann M, Holle D, Nägel S, Burmeister J, Solbach K, Diener HC. Neues zu Kopfschmerzen 2015 – ein Update. Akt Neurol 2015. [DOI: 10.1055/s-0035-1548943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M. Obermann
- Klinik für Neurologie und Westdeutsches Kopfschmerzzentrum, Universitätsklinikum Essen
| | - D. Holle
- Klinik für Neurologie, Universitätsklinikum Essen
| | - S. Nägel
- Klinik für Neurologie, Universitätsklinikum Essen
| | - J. Burmeister
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Essen
| | - K. Solbach
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Essen
| | - H.-C. Diener
- Klinik für Neurologie, Universitätsklinikum Essen
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Abstract
INTRODUCTION Cluster headache (CH) is a primary headache disorder and the most common trigeminal autonomic cephalalgia. Patients suffer from very severe unilateral headache attacks accompanied by ipsilateral trigeminal autonomic symptoms. Previous studies described a high burden of disease due to its impact on social life as well as an increased suicide ideation rate. The mean time to diagnosis in western industrialized countries is estimated at 4 years. AREAS COVERED Many treatment options for CH exist, but due to the rarity of the disease, controlled randomized clinical studies remain difficult to perform. This review summarizes the current knowledge about the treatment of CH including internationally accepted treatment guidelines, and an additional MEDLINE search (1 February 2015). EXPERT OPINION International treatment recommendations and official guidelines give reassurance about specific pharmacotherapy options for CH, but only few of these are backed by sufficient scientific evidence. The limited therapeutic efficacy in some patients leads to the use of alternative, complementary, but also illicit drugs to better cope with the disease. Many single cases, case series and uncontrolled studies were performed with different substances in an attempt to find a better way to treat or prevent the excruciatingly painful attacks associated with CH. Large-scale, randomized controlled clinical trials are desperately needed in order to further increase the quality of patient care for this outstanding but terrifying disease.
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Affiliation(s)
- Mark Obermann
- University of Duisburg-Essen, Department of Neurology , Hufelandstr. 55, 45122 Essen , Germany +49 201 723 84385 ; +49 201 723 5542 ;
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Abstract
BACKGROUND Numerous studies have described a relationship between migraine and stroke, and there is emerging evidence that migraine is also associated with cardiovascular disease. The combination of migraine and both cerebrovascular and cardiovascular disease has implications for therapy. METHODS We conducted a review of the modifications in medical therapy in patients with comorbid migraine and cardio- and cerebrovascular disorders based on publications from the last 15 years. RESULTS Some drugs are contraindicated to treat migraine attacks (ergots, triptans) or for migraine prevention in patients after transient ischemic attack (TIA)/ischemic stroke. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated in patients with cerebral bleeding. Some drugs for the treatment of acute migraine attacks are contraindicated in patients with symptomatic coronary heart disease. CONCLUSIONS Given the large number of patients with comorbid migraine and cardiovascular as well as cerebrovascular disease, there is an unmet need to treat these patients.
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Affiliation(s)
| | - Tobias Kurth
- Inserm Research Center for Epidemiology and Biostatistics (U897)-Team Neuroepidemiology, Bordeaux, France University of Bordeaux, College of Health Sciences, Bordeaux, France
| | - Dagny Holle
- Department of Neurology and Headache Center, University Hospital Essen, Germany
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Fischer M, Gaul C, Shanib H, Holle D, Loacker L, Griesmacher A, Lackner P, Broessner G. Markers of endothelial function in migraine patients: Results from a bi-center prospective study. Cephalalgia 2014; 35:877-85. [DOI: 10.1177/0333102414564890] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 11/27/2014] [Indexed: 11/16/2022]
Abstract
Background Numerous studies suggest an increased vascular risk in patients with migraine, in particular in those with aura. A possible link between both conditions might be a dysfunction of the vascular endothelium. This observational study analyzed the endothelial markers angiopoietin-1, angiopoietin-2, Tie-2, sFlt-1 and NT-proBNP for the first time in migraineurs, patients with other primary headache disorders and healthy controls. Methods Patients with episodic migraine with and without aura, episodic cluster headache, tension-type headache and healthy controls were included. Blood samples were obtained during migraine attacks and headache-free periods in migraineurs, in and out of bout in cluster headache and during headache-free periods in tension-type headache and healthy individuals to analyze markers of endothelial function. Results No significant difference in endothelial markers between migraine, other headache disorders and healthy controls was detected. There was no significant difference between migraine attacks and headache-free intervals. Additionally, no distinction could be found between migraine with and without aura. Discussion The endothelial markers analyzed do not display a characteristic pattern in different headache disorders especially migraine compared to healthy controls. The novel findings of our study indicate that factors other than endothelial dysfunction seem to be responsible for the at least statistical association of migraine with vascular disease.
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Affiliation(s)
- Marlene Fischer
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Austria
| | - Charly Gaul
- Department of Neurology, University of Duisburg-Essen, Germany
- Migräne und Kopfschmerzklinik Königstein, Germany
| | - Hind Shanib
- Department of Neurology, University of Duisburg-Essen, Germany
| | - Dagny Holle
- Department of Neurology, University of Duisburg-Essen, Germany
| | - Lorin Loacker
- Central Institute of Medicinal and Chemical Laboratory Diagnostics, University Hospital, Austria
| | - Andrea Griesmacher
- Central Institute of Medicinal and Chemical Laboratory Diagnostics, University Hospital, Austria
| | - Peter Lackner
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Austria
| | - Gregor Broessner
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Austria
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Obermann M, Bude V, Holle D, Naegel S, Hagenacker T, Diener HC, Katsarava Z. EHMTI-0072. Anodal transcranial direct current stimulation alleviates pain in trigeminal neuralgia. J Headache Pain 2014. [PMCID: PMC4181854 DOI: 10.1186/1129-2377-15-s1-e21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Naegel S, Biermann J, Obermann M, Theysohn N, Diener HC, Holle D. EHMTI-0240. Modulation of central pain processing by anodal direct current stimulation – a fMRI study. J Headache Pain 2014. [PMCID: PMC4181993 DOI: 10.1186/1129-2377-15-s1-e20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Burmeister J, Holle D, Bock E, Ose C, Diener HC, Obermann M. EHMTI-0202. Study protocol of BoTN: a randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of botulinum toxin injections in the treatment of trigeminal neuralgia. J Headache Pain 2014. [PMCID: PMC4180179 DOI: 10.1186/1129-2377-15-s1-c9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Cluster headache is a rare primary headache disorder and the most common trigeminal-autonomic cephalalgia. Even though it has been extensively studied, its pathophysiology remains nebulous. Over the last two decades, cerebral imaging has increasingly been used to aid the investigation of pain and headache disorders. Pioneering work using magnetic resonance-based, voxel-based morphometry depicted an isolated increase of grey matter in the posterior hypothalamus and thereby reconfirmed the most commonly accepted pathophysiological concept. More recent works demonstrate structural changes across multiple structures related to pain processing, sensory integration, and emotional evaluation. These changes do not seem to be static, but rather appear to be dynamic in nature as they change over the course of the disease. This was interpreted as a reflection of the plasticity of the human brain and should guide future thoughts towards a more complex pathophysiological model involving a maladaptive pain modulatory network.
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Affiliation(s)
- Steffen Naegel
- Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany,
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Obermann M, Steinbach R, Kastrup O, Holle D. Testen Sie Ihr Fachwissen. Akt Neurol 2014. [DOI: 10.1055/s-0034-1370278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M. Obermann
- Klinik für Neurologie, Universitätsklinikum Essen
| | - R. Steinbach
- Klinik für Augenheilkunde, Universitätsklinikum Essen
| | - O. Kastrup
- Klinik für Neurologie, Universitätsklinikum Essen
| | - D. Holle
- Klinik für Neurologie, Universitätsklinikum Essen
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Holle D, Heber A, Naegel S, Diener HC, Katsarava Z, Obermann M. Influences of smoking and caffeine consumption on trigeminal pain processing. J Headache Pain 2014; 15:39. [PMID: 24928141 PMCID: PMC4068369 DOI: 10.1186/1129-2377-15-39] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 05/20/2014] [Indexed: 11/10/2022] Open
Abstract
Background Many human and animal studies have shown the influence of nicotine and caffeine on pain perception and processing. This study aims to investigate whether smoking or caffeine consumption influences trigeminal pain processing. Methods Sixty healthy subjects were investigated using simultaneous recordings of the nociceptive blink reflex (nBR) and pain related evoked potentials (PREP) following nociceptive electrical stimulation on both sides of the forehead (V1). Thirty subjects were investigated before and after smoking a cigarette, as well as before and after taking a tablet of 400 mg caffeine. Results After smoking PREP showed decreased N2 and P2 latencies indicating central facilitation at supraspinal (thalamic or cortical) level. PREP amplitudes were not changed. NBR showed a decreased area under the curve (AUC) indicating central inhibition at brainstem level. After caffeine intake no significant changes were observed comparing nBR and PREP results before consumption. Conclusions Smoking influences trigeminal pain processing on supraspinal and brainstem level. In the investigated setting, caffeine consumption does not significantly alter trigeminal pain processing. This observation might help in the further understanding of the pathophysiology of pain disorders that are associated with excessive smoking habits such as cluster headache. Previous smoking has to be taken into account when performing electrophysiological studies to avoid bias of study results.
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Affiliation(s)
- Dagny Holle
- Department of Neurology, University of Duisburg-Essen, Hufeland street 55, Essen 45147, Germany.
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Abstract
Background Hypnic headache (HH) is a rare primary headache disorder that is characterized by strictly sleep related headache attacks. Purpose The underlying pathophysiology of HH is mainly enigmatic but some clinical characteristics such as circadian rhythmicity and caffeine responsiveness may point toward possible underlying mechanisms. Method Current studies that deal with the pathophysiology of HH are summarized. Data on cerebral imaging, sleep, electrophysiology studies, effectiveness of drugs, and symptomatic headache types are discussed to illuminate underlying pathophysiologic mechanisms. Conclusion HH can be clearly differentiated by its clinical presentation as well as imaging and electrophysiological study results from other primary headaches such as migraine or cluster headache. The underlying pathophysiology is still enigmatic but a hypothalamic involvement seems to be likely.
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Affiliation(s)
- Dagny Holle
- Department of Neurology and Westgerman Headache Center Essen, University Duisburg-Essen, Germany
| | - Steffen Naegel
- Department of Neurology and Westgerman Headache Center Essen, University Duisburg-Essen, Germany
| | - Mark Obermann
- Department of Neurology and Westgerman Headache Center Essen, University Duisburg-Essen, Germany
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Abstract
Background The combination of vertigo, dizziness and balance disturbance with migraine is called vestibular migraine. Although it is estimated that up to 1% of the population suffers from this disease, it is still widely unknown and often underdiagnosed. Recently, the International Headache Society and the Báràny Society published the first joint document with mutually accepted diagnostic criteria for vestibular migraine. Method This review summarizes current knowledge on vestibular migraine with regard to epidemiology, clinical presentation, pathophysiology, differential diagnosis and therapeutic options. Results Approximately 30–50% of patients with migraine report vertigo, dizziness or balance disturbances with at least one migraine attack. Vestibular migraine often appears in a temporal delay to the first onset of migraine headache. In some patients the symptom of sudden onset disequilibrium was the main complaint and more worrisome than the accompanying migraine headache. The duration of attacks varies from a few seconds up to few days. The underlying pathophysiology of vestibular migraine is still widely unknown. As an important differential diagnosis, Ménière’s disease has to be considered and excluded. Conclusion As randomized controlled treatment trials are still missing in vestibular migraine, the therapeutic recommendations for vestibular migraine are currently based on the guidelines of migraine.
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Affiliation(s)
- Benjamin Stolte
- Department of Neurology, Headache Center and Vertigo and Dizziness Center, University of Duisburg-Essen, Germany
| | - Dagny Holle
- Department of Neurology, Headache Center and Vertigo and Dizziness Center, University of Duisburg-Essen, Germany
| | - Steffen Naegel
- Department of Neurology, Headache Center and Vertigo and Dizziness Center, University of Duisburg-Essen, Germany
| | - Hans-Christoph Diener
- Department of Neurology, Headache Center and Vertigo and Dizziness Center, University of Duisburg-Essen, Germany
| | - Mark Obermann
- Department of Neurology, Headache Center and Vertigo and Dizziness Center, University of Duisburg-Essen, Germany
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Rabe K, Küper M, Holle D, Savidou I, Kastrup O, Jähne-Blasberg A, Diener HC, Katsarava Z, Frings M. No evidence of jugular venous valve insufficiency in patients with migraine – a controlled study. J Headache Pain 2013; 14:52. [PMID: 23782952 PMCID: PMC3691823 DOI: 10.1186/1129-2377-14-52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 06/12/2013] [Indexed: 12/20/2022] Open
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Gaul C, Holle D, May A. [Update on trigeminal autonomic cephalalgia]. Nervenarzt 2013; 84:1451-1459. [PMID: 24212418 DOI: 10.1007/s00115-012-3624-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Cluster headache, paroxysmal hemicrania and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome) are classified under trigeminal autonomic cephalalgia (TAC). The proposed revision of the international classification of headache disorders (ICDH-3 beta) adds hemicrania continua to this diagnostic group. Moreover, diagnostic criteria of the other TACs were modified and are characterized by persistent headache or headache attacks accompanied by cranial autonomic symptoms. The main difference between the various TACs is the duration of attacks. Differentiation is important because different pharmacological strategies are necessary.
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Affiliation(s)
- C Gaul
- Migräne- und Kopfschmerzklinik Königstein, Ölmühlweg 31, 61462, Königstein im Taunus, Deutschland,
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Abstract
Headache is a common clinical feature in patients in the emergency room and in general neurology clinics. For physicians not experienced in headache disorders it might be difficult sometimes to decide in which patients neuroimaging is necessary to diagnose an underlying brain pathology and in which patients cerebral imaging is unnecessary. Most patients presenting to the primary-care physician with a nonacute headache and no further neurological signs or symptoms will not be suffering from an underlying serious condition. This review focuses on the main primary headache diseases, including migraine, tension-type headache and cluster headache, as well as frequent secondary headache entities with common clinical presentation and appropriate diagnostic and therapeutic algorithms to help guide the decision on the utilization of neuroimaging in the diagnostic workup.
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Affiliation(s)
- Dagny Holle
- Department of Neurology, University of Duisburg-Essen, Hufelandstrasse, 55, 45122 Essen, Germany
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