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Oliveira Gonçalves AS, Laumeier I, Hofacker MD, Raffaelli B, Burow P, Dahlem MA, Heintz S, Jürgens TP, Naegel S, Rimmele F, Scholler S, Kurth T, Reuter U, Neeb L. Study Design and Protocol of a Randomized Controlled Trial of the Efficacy of a Smartphone-Based Therapy of Migraine (SMARTGEM). Front Neurol 2022; 13:912288. [PMID: 35785344 PMCID: PMC9243352 DOI: 10.3389/fneur.2022.912288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background Digitalization and electronic health (eHealth) offer new treatment approaches for patients with migraine. Current smartphone applications (apps) for migraine patients include a wide spectrum of functions ranging from digital headache diaries to app-based headache treatment by, among others, analysis of the possible triggers, behavioral therapy approaches and prophylactic non-drug treatment methods with relaxation therapy or endurance sport. Additional possibilities arise through the use of modern, location-independent communication methods, such as online consultations. However, there is currently insufficient evidence regarding the benefits and/or risks of these electronic tools for patients. To date, only few randomized controlled trials have assessed eHealth applications. Methods SMARTGEM is a randomized controlled trial assessing whether the provision of a new digital integrated form of care consisting of the migraine app M-sense in combination with a communication platform (with online consultations and medically moderated patient forum) leads to a reduction in headache frequency in migraine patients, improving quality of life, reducing medical costs and work absenteeism (DRKS-ID: DRKS00016328). Discussion SMARTGEM constitutes a new integrated approach for migraine treatment, which aims to offer an effective, location-independent, time-saving and cost-saving treatment. The design of the study is an example of how to gather high quality evidence in eHealth. Results are expected to provide insightful information on the efficacy of the use of electronic health technology in improving the quality of life in patients suffering from migraine and reducing resource consumption.
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Affiliation(s)
- Ana Sofia Oliveira Gonçalves
- Institute of Public Health, Corporate Member of Freie Universität Berlin, Charité—Universitätsmedizin Berlin, Humboldt Universität zu Berlin, Berlin, Germany
- *Correspondence: Ana Sofia Oliveira Gonçalves
| | - Inga Laumeier
- Department of Neurology, Corporate Member of Freie Universität Berlin, Charité—Universitätsmedizin Berlin, Humboldt Universität zu Berlin, Berlin, Germany
| | | | - Bianca Raffaelli
- Department of Neurology, Corporate Member of Freie Universität Berlin, Charité—Universitätsmedizin Berlin, Humboldt Universität zu Berlin, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health (BIH), Berlin, Germany
| | - Philipp Burow
- Department of Neurology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Wittenberg, Germany
| | | | - Simon Heintz
- Department of Neurology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Wittenberg, Germany
| | | | - Steffen Naegel
- Department of Neurology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Wittenberg, Germany
| | - Florian Rimmele
- Department of Neurology, University of Rostock, Rostock, Germany
| | | | - Tobias Kurth
- Institute of Public Health, Corporate Member of Freie Universität Berlin, Charité—Universitätsmedizin Berlin, Humboldt Universität zu Berlin, Berlin, Germany
| | - Uwe Reuter
- Department of Neurology, Corporate Member of Freie Universität Berlin, Charité—Universitätsmedizin Berlin, Humboldt Universität zu Berlin, Berlin, Germany
- Universitätsmedizin Greifswald, Greifswald, Germany
| | - Lars Neeb
- Department of Neurology, Corporate Member of Freie Universität Berlin, Charité—Universitätsmedizin Berlin, Humboldt Universität zu Berlin, Berlin, Germany
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Overeem LH, Peikert A, Hofacker MD, Kamm K, Ruscheweyh R, Gendolla A, Raffaelli B, Reuter U, Neeb L. Effect of antibody switch in non-responders to a CGRP receptor antibody treatment in migraine: A multi-center retrospective cohort study. Cephalalgia 2021; 42:291-301. [PMID: 34644203 PMCID: PMC8988456 DOI: 10.1177/03331024211048765] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Switching between antibody classes might be a treatment option in migraine patients who have not responded to one class of a CGRP-(receptor) monoclonal antibody (mAb), but there are no efficacy data so far. In this real-world analysis, we assessed the treatment response to a CGRP-mAb in patients that have previously failed the CGRP-receptor-mAb erenumab. METHODS We analyzed retrospective headache diary data of 78 patients with migraine who switched between CGRP-mAbs classes at four German headache centers either due to lack of efficacy or intolerable side effects. Among these, we identified 25 patients who did not respond to erenumab after three treatment cycles (defined as <30% reduction of monthly headache days) and had complete headache documentation at least one month before and during both treatments. We assessed the ≥30% responder rate at month three after switching from erenumab to a CGRP-mAb (galcanezumab or fremanezumab) (primary endpoint). Secondary endpoints included ≥50% responder rate, monthly headache days, and monthly days with acute medication use. In an exploratory subgroup analysis patients were stratified for daily and non-daily headache. RESULTS The switch from erenumab to a CGRP-mAb led to a ≥30% response in one-third (32%) of the patients after three treatment cycles. A ≥50% response was achieved in 12% of the patients. Monthly headache days were reduced in month three compared to baseline (20.8 ± 7.1 to 17.8 ± 9.1; p = 0.009). Stratified analysis revealed that no patient with daily headache (n = 9) responded to the treatment switch, while a 30% response was achieved by 50% of patients with non-daily headache (n = 16). CONCLUSION Our findings demonstrate that a relevant proportion of erenumab non-responders might benefit from a treatment switch to a CGRP-mAb. Switching seems to be a promising treatment option especially in migraine patients with non-daily headache.
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Affiliation(s)
| | | | - Maxi Dana Hofacker
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Kamm
- Department of Neurology, Ludwig Maximilians University Munich, Munich, Germany
| | - Ruth Ruscheweyh
- Department of Neurology, Ludwig Maximilians University Munich, Munich, Germany
| | | | - Bianca Raffaelli
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uwe Reuter
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Universitätsmedizin Greifswald, Greifswald, Germany
| | - Lars Neeb
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Raffaelli B, Overeem LH, Mecklenburg J, Hofacker MD, Knoth H, Nowak CP, Neeb L, Ebert AD, Sehouli J, Mechsner S, Reuter U. Plasma calcitonin gene-related peptide (CGRP) in migraine and endometriosis during the menstrual cycle. Ann Clin Transl Neurol 2021; 8:1251-1259. [PMID: 33934575 PMCID: PMC8164854 DOI: 10.1002/acn3.51360] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/16/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Migraine, endometriosis, and the comorbidity of both are frequent pain disorders of special relevance for women. The neuropeptide calcitonin gene-related peptide (CGRP) is critically involved in migraine, and circumstantial evidence suggests a role in endometriosis. We assessed CGRP levels at different times of menstrual cycle in four groups: healthy women, women with migraine or endometriosis and with the comorbidity of both. METHODS Women with episodic migraine and women with a histologically confirmed endometriosis were recruited from specialized centers. For CGRP determination with a commercial enzyme immunoassay kit, cubital vein blood samples were collected on menstrual cycle day 2 ± 2 (during menstruation) and on day 15 ± 2 (periovulatory period). The primary endpoint of the study was the absolute difference of CGRP plasma levels between the menstrual and the periovulatory phase of all study groups. Groups were compared using nonparametric test procedures. RESULTS A total of 124 women were included in the study. The change of CGRP plasma levels between menstruation and the periovulatory period was different between groups (p = 0.007). Women with comorbid migraine and endometriosis showed an increase of CGRP in the menstrual phase of +6.32 (interquartile range, IQR -3.64-13.60) compared to the periovulatory time, while healthy controls had a decrease of -10.14 (-22.54-0.91, p = 0.004). CGRP levels were different in the periovulatory phase among groups (p = 0.008), with highest values in healthy controls. INTERPRETATION CGRP levels change significantly during the menstrual cycle. Different patterns in women with the comorbidity point to a deviant regulation of CGRP release.
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Affiliation(s)
- Bianca Raffaelli
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Clinician Scientist Program, Berlin Institute of Health (BIH), Berlin, Germany
| | | | - Jasper Mecklenburg
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Maxi Dana Hofacker
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Henriette Knoth
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Claus Peter Nowak
- Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lars Neeb
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Dietmar Ebert
- Praxis für Frauengesundheit, Gynäkologie und Geburtshilfe, Endometriosezentrum, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center of Oncological Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sylvia Mechsner
- Department of Gynecology with Center of Oncological Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Benemei S, Labastida-Ramírez A, Abramova E, Brunelli N, Caronna E, Diana P, Gapeshin R, Hofacker MD, Maestrini I, Pías EM, Mikulenka P, Tikhonova O, Martelletti P, MaassenVanDenBrink A. Persistent post-traumatic headache: a migrainous loop or not? The preclinical evidence. J Headache Pain 2020; 21:90. [PMID: 32664898 PMCID: PMC7362418 DOI: 10.1186/s10194-020-01135-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/25/2020] [Indexed: 12/11/2022] Open
Abstract
Background According to the International Classification of Headache Disorders 3, post-traumatic headache (PTH) attributed to traumatic brain injury (TBI) is a secondary headache reported to have developed within 7 days from head injury, regaining consciousness following the head injury, or discontinuation of medication(s) impairing the ability to sense or report headache following the head injury. It is one of the most common secondary headache disorders, and it is defined as persistent when it lasts more than 3 months. Main body Currently, due to the high prevalence of this disorder, several preclinical studies have been conducted using different animal models of mild TBI to reproduce conditions that engender PTH. Despite representing a simplification of a complex disorder and displaying different limitations concerning the human condition, animal models are still a mainstay to study in vivo the mechanisms of PTH and have provided valuable insight into the pathophysiology and possible treatment strategies. Different models reproduce different types of trauma and have been ideated in order to ensure maximal proximity to the human condition and optimal experimental reproducibility. Conclusion At present, despite its high prevalence, PTH is not entirely understood, and the differential contribution of pathophysiological mechanisms, also observed in other conditions like migraine, has to be clarified. Although facing limitations, animal models are needed to improve understanding of PTH. The knowledge of currently available models is necessary to all researchers who want to investigate PTH and contribute to unravel its mechanisms.
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Affiliation(s)
- Silvia Benemei
- Health Sciences Department, University of Florence and Headache Centre, Careggi University Hospital, Florence, Italy
| | - Alejandro Labastida-Ramírez
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Dr Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
| | - Ekaterina Abramova
- Pain Clinic Unit, Department of Anesthesiology, Pirogov City Clinical Hospital, Moscow, Russia
| | | | - Edoardo Caronna
- Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Paola Diana
- Child Neuropsychiatry Unit, Department of PROMISE, University of Palermo, Palermo, Italy
| | - Roman Gapeshin
- Department of Neurology and Manual Medicine, Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg, Russia
| | - Maxi Dana Hofacker
- Department of Neurology, Headache Centre, Charité Universitatsmedizin Berlin, Berlin, Germany
| | - Ilaria Maestrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Enrique Martínez Pías
- Neurology Department, Hospital Clínico Universitario of Valladolid, Valladolid, Spain
| | - Petr Mikulenka
- Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Olga Tikhonova
- Department of neurology, Kazaryan Clinic of Epileptology and Neurology, Moscow, Russia
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Dr Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands.
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