1
|
Seebadri-White C, Yuan H, Young WB, Arca KN. Advocacy Connection Team-Now educational program for headache fellows and patients/caregivers: Assessment of educational objectives. Headache 2024; 64:374-379. [PMID: 38523478 DOI: 10.1111/head.14705] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/19/2024] [Accepted: 02/23/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE To assess for improvement in comfort in participating in advocacy for migraine and headache disorders and knowledge needed for successful advocacy. BACKGROUND The Advocacy Connection Team (ACT)-Now program is an educational program offered through Miles for Migraine, a non-profit advocacy organization. It is designed to teach headache fellows and patients advocacy skills. METHODS In a cross-sectional pre-test-post-test design, the 2021 ACT-Now cohort of 98 participants were administered a set of 11 pre-course survey questions identifying their role (healthcare provider/headache fellow or patient/caregiver), baseline knowledge of migraine-related disability and stigma, and baseline engagement and comfort with advocating. The post-course survey questions were the same as the pre-course questions, with the addition of one question assessing knowledge of migraine-related disability, additional questions addressing comfort levels advocating with insurance and policymakers, as well as creating an advocacy plan. RESULTS For the pre-course survey, 69 participants responded and for the post-course survey, 40 participants responded. Compared to the pre-course survey, participants were able to correctly identify epidemiological data about migraine following the ACT-Now course (pre-course 46% correct, post-course 58% correct, p = 0.263). There was also an increase in the comfort level of participants in advocacy activities, including the creation of an advocacy action plan (pre-course 23% were "very comfortable" advocating, post-course 63%, p < 0.05). CONCLUSION These results demonstrate that ACT-Now is effective at improving advocacy skills in a mixed cohort of patients and headache fellows, giving them the skills to create advocacy plans and engage with other patients and physicians, payers, and policymakers to create a more understanding, equitable and compassionate world for persons with migraine and other headache diseases.
Collapse
Affiliation(s)
- Courtney Seebadri-White
- Department of Neurology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Hsiangkuo Yuan
- Department of Neurology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - William B Young
- Department of Neurology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Karissa N Arca
- Department of Neurology, Mayo Clinic Scottsdale, Scottsdale, Arizona, USA
| |
Collapse
|
2
|
Abstract
PURPOSE OF REVIEW Migraine and other primary headache disorders do not receive adequate research funding, medical resources, or other forms of structural support relative to their prevalence and the disability they cause. In recent research, scholars have argued that stigma associated with headache disorders explains some of this discrepancy. This review will discuss (1) the factors contributing to stigma toward migraine and other primary headache disorders, (2) how structural and enacted stigma may perpetuate individual disability, (3) the impact of internalized stigma, and (4) interventions to mitigate stigma toward headache disorders with an emphasis on outcome monitoring. The review will also propose new areas of stigma research in need of further investigation. RECENT FINDINGS Recent research shows that discrimination can exacerbate chronic pain. Stigma profoundly affects everything from the allocation of federal research funds and healthcare resources to individual patients' self-efficacy and ability to care for themselves. Understanding the stigma of migraine and learning how to develop effective interventions to mitigate this stigma will increase access to appropriate migraine care, improve healthcare providers' ability to care for their migraine patients, and help advocates reverse policies that discriminate against those with migraine. It is important to closely monitor outcomes of anti-stigma efforts for both positive and negative consequences and take note of outcomes and "lessons learned" from anti-stigma campaigns for other diseases.
Collapse
Affiliation(s)
- Simy K. Parikh
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Joanna Kempner
- Department of Sociology, Institute of Health, Health Care Policy, and Aging Research, Rutgers University, The State University of New Jersey, New Brunswick, NJ 08901 USA
| | - William B. Young
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107 USA
| |
Collapse
|
3
|
Dodick DW, Shewale AS, Lipton RB, Baum SJ, Marcus SC, Silberstein SD, Pavlovic JM, Bennett NL, Young WB, Viswanathan HN, Doshi JA, Weintraub H. Migraine Patients With Cardiovascular Disease and Contraindications: An Analysis of Real-World Claims Data. J Prim Care Community Health 2020; 11:2150132720963680. [PMID: 33095099 PMCID: PMC7585888 DOI: 10.1177/2150132720963680] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction: Triptans, the most commonly prescribed acute treatments for migraine attacks are, per FDA labeling, contraindicated in cardiovascular (CV) disease patients and have warnings and precautions for those with CV risk factors. Methods: Headache specialists, cardiologists, and health economics and outcomes researchers convened to identify diagnostic codes for: (1) CV diseases contraindicating triptans based on FDA labeling; (2) conditions comprising “other significant underlying CV disease”; and (3) CV risk factors included as warnings and precautions for triptans. A retrospective, cross-sectional analysis of commercially insured adult US migraine patients in the 2017 Optum® Clinformatics® Data Mart (CDM) and the 2017 IBM® Watson Health MarketScan® Commercial Claims database was used to estimate the proportion of migraine patients with CV contraindications and warnings and precautions to triptans. Results: Of the 56,662 migraine patients analyzed from Optum CDM, 13.5% had ≥1 CV disease as specified in triptan labeling and an additional 8.5% had ≥1 “other CV disease” judged by the panel to constitute a “significant underlying CV disease” (total: 22.0% migraine patients). Of 176 724 migraine patients analyzed from MarketScan, 12.2% had ≥1 CV disease as specified in the labeling and an additional 8.0% had ≥1 “other significant underlying CV disease” (total: 20.2% of migraine patients). An additional 25.4% and 25.1% of migraine patients had ≥2 CV risk factors in Optum CDM and MarketScan. In total, 47.4% and 45.3% of migraine patients in both databases had a CV disease specified as a contraindication, an “other CV disease” endorsed as significant, or ≥2 CV risk factors identified as warnings and precautions to triptans. Conclusions: Analyses of more than 230,000 people with migraine showed that ≥20% of commercially insured US migraine patients have a CV condition that specifically contraindicates triptan treatment, and an additional 25% have ≥2 CV risk factors identified as warnings and precautions to triptans.
Collapse
Affiliation(s)
| | - Anand S. Shewale
- AbbVie, Irvine, CA, USA
- Anand S. Shewale, Global Health Economics & Outcomes Research (GHEOR), AbbVie, 2525 Dupont Drive (T2-#237), Irvine, CA 92612, USA.
| | - Richard B. Lipton
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Headache Center, Bronx, NY, USA
| | | | | | | | - Jelena M. Pavlovic
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Headache Center, Bronx, NY, USA
| | | | | | | | | | | |
Collapse
|
4
|
Marcus SC, Shewale AR, Silberstein SD, Lipton RB, Young WB, Viswanathan HN, Doshi JA. Comparison of healthcare resource utilization and costs among patients with migraine with potentially adequate and insufficient triptan response. Cephalalgia 2020; 40:639-649. [PMID: 32223301 PMCID: PMC7273744 DOI: 10.1177/0333102420915167] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 12/14/2022]
Abstract
Background Triptans are the most commonly prescribed acute treatments for migraine;
however, not all triptan users experience adequate response. Information on
real-world resource use and costs associated with triptan insufficient
response are limited. Methods A retrospective claims analysis using US commercial health plan data between
2012 and 2015 assessed healthcare resource use and costs in adults with a
migraine diagnosis newly initiating triptans. Patients who either did not
refill triptans but used other non-triptan medications or refilled triptans
but also filled non-triptan medications over a 24-month follow-up period
were designated as potential triptan insufficient responders. Patients who
continued filling only triptans (i.e. triptan-only continuers) were
designated as potential adequate responders. All-cause and migraine-related
resource use and total (medical and pharmacy) costs over months 1–12 and
months 13–24 were compared between triptan-only continuers and potential
triptan insufficient responders. Results Among 10,509 new triptan users, 4371 (41%) were triptan-only continuers, 3102
(30%) were potential triptan insufficient responders, and 3036 (29%) did not
refill their index triptan or fill non-triptan medications over 24 months’
follow-up. Opioids were the most commonly used non-triptan treatment (68%)
among potential triptan insufficient responders over 24 months of follow-up.
Adjusted mean all-cause and migraine-related total costs were $5449 and
$2905 higher, respectively, among potential triptan insufficient responders
versus triptan-only continuers over the first 12 months. Conclusions In a US commercial health plan, almost one-third of new triptan users were
potential triptan insufficient responders and the majority filled opioid
prescriptions. Potential triptan insufficient responder patients had
significantly higher all-cause and migraine-related healthcare utilization
and costs than triptan-only continuers.
Collapse
Affiliation(s)
| | | | - Stephen D Silberstein
- Jefferson Headache Center, Thomas Jefferson University Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Richard B Lipton
- Montefiore Headache Center, Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - William B Young
- Jefferson Headache Center, Thomas Jefferson University Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | |
Collapse
|
5
|
|
6
|
Young WB, Ivan Lopez J, Rothrock JF, Orejudos A, Manack Adams A, Lipton RB, Blumenfeld AM. Effects of onabotulinumtoxinA treatment in chronic migraine patients with and without daily headache at baseline: results from the COMPEL Study. J Headache Pain 2019; 20:12. [PMID: 30709333 PMCID: PMC6734507 DOI: 10.1186/s10194-018-0953-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 10/01/2018] [Accepted: 12/19/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND OnabotulinumtoxinA is effective in preventing chronic migraine (CM); however, the benefit of onabotulinumtoxinA in patients with CM with daily headache is unknown because these patients are typically excluded from clinical trials. This subanalysis of the COMPEL Study assessed the efficacy and safety of onabotulinumtoxinA in people with CM with and without daily headache. METHODS In total, 715 patients received onabotulinumtoxinA 155 U with or without concomitant oral preventive treatment. Patients who had complete daily diary records for the 28 days of the baseline period were stratified based on daily headache status. The primary outcome variable was reduction in headache-day frequency per 28-day period at 108 weeks (after 9 treatment cycles) relative to baseline. Exploratory outcomes included moderate to severe headache days, migraine disability (using the Migraine Disability Assessment [MIDAS] questionnaire), and health-related quality of life (Migraine-Specific Quality-of-Life Questionnaire v2 [MSQ]). Adverse events and their relatedness were recorded. RESULTS Overall, 641 patients had complete daily diary records at baseline. In patients with daily headache (n = 138) versus without (n = 503), treatment with onabotulinumtoxinA was associated with a significant mean (SD) reduction in 28-day headache-day frequency relative to baseline at week 108 (- 10.5 [9.2] vs - 12.2 [6.7], respectively; both P < 0.001) with no significant between-group difference (P = 0.132). The mean (SD) reduction in moderate to severe headache days at week 108 was significant in patients with and without daily headache (- 11.5 [9.4] and - 9.9 [6.4]; P < 0.001) with no significant between-group difference (P = 0.153). Mean (SD) MIDAS scores significantly improved from baseline at week 108 (- 43.3 [73.4] and - 43.6 [46.7]; both P < 0.001), with no significant between-group difference (P = 0.962). Similarly, mean (SD) MSQ subscale scores significantly improved from baseline at week 108 for patients with and without daily headache. OnabotulinumtoxinA was well tolerated in patients with and without daily headache. CONCLUSION Results indicate that onabotulinumtoxinA is associated with reductions from baseline in headache-day frequency and improvements in disability and quality of life for up to 108 weeks in people with CM with daily headache; however, a longer duration of treatment was required to fully realize the treatment effect on headache. No new safety concerns were identified.
Collapse
Affiliation(s)
- William B Young
- Jefferson Hospital for Neuroscience, 900 Walnut Street, Second Floor, Suite #200, Philadelphia, PA, 19107, USA.
| | - J Ivan Lopez
- University of South Alabama College of Medicine, Mobile, AL, USA
| | | | | | | | - Richard B Lipton
- Montefiore Headache Center, Department of Neurology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew M Blumenfeld
- Headache Center of Southern California, The Neurology Center, Carlsbad, CA, USA
| |
Collapse
|
7
|
Young WB, Ivan Lopez J, Rothrock JF, Orejudos A, Manack Adams A, Lipton RB, Blumenfeld AM. Effects of onabotulinumtoxinA treatment in patients with and without allodynia: results of the COMPEL study. J Headache Pain 2019; 20:10. [PMID: 30669961 PMCID: PMC6734222 DOI: 10.1186/s10194-018-0952-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/01/2018] [Accepted: 12/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background OnabotulinumtoxinA is effective in treating chronic migraine (CM), but there are limited data assessing how allodynia affects preventive treatment responses. This subanalysis of the 108-week, multicenter, open-label COMPEL Study assessed the efficacy and safety of onabotulinumtoxinA in people with CM with and without allodynia. Methods Patients (n = 715) were treated with onabotulinumtoxinA 155 U every 12 weeks for 9 treatment cycles. The Allodynia Symptom Checklist was used to identify patients with allodynia (scores ≥3). The primary outcome for this subanalysis was reduction in monthly headache days from baseline for weeks 105 to 108 in groups with and without allodynia. Other outcomes included assessments of moderate to severe headache days, disability (using the Migraine Disability Assessment [MIDAS] questionnaire), and health-related quality of life (Migraine-Specific Quality-of-Life Questionnaire [MSQ] v2). Adverse events and their relation to treatment were recorded. Results OnabotulinumtoxinA was associated with a significant mean (SD) reduction in headache day frequency at week 108 relative to baseline in patients with (n = 289) and without (n = 426) allodynia (− 10.8 [7.1] and − 12.5 [7.4], respectively; both P < 0.001) that was significantly greater in patients without allodynia (P = 0.044 between-subgroup comparison). Moderate to severe headache days were significantly reduced at week 108 in patients with and without allodynia (− 9.6 [6.9] and − 10.5 [7.2]; both P < 0.001); reduction was similar between groups. MIDAS scores improved significantly at week 108 (− 53.0 [50.3] and − 37.7 [53.0]; both P < 0.001), with a significant between-group difference in favor of those with allodynia (P = 0.005). Similarly, MSQ subscale scores (Role Function Preventive, Role Function Restrictive, Emotional Function) significantly improved at week 108 for patients with and without allodynia: 20.6 (21.9) and 16.9 (20.7), 28.0 (23.3) and 24.7 (22.7), and 27.6 (26.5) and 24.9 (26.1), respectively (all P < 0.001). OnabotulinumtoxinA was well tolerated in patients with and without allodynia. Conclusion Results indicate that onabotulinumtoxinA is associated with reductions from baseline in multiple efficacy outcomes for up to 108 weeks whether or not allodynia is present. The allodynia group showed a smaller treatment response for reduction in headache days, but a similar or greater treatment response for improvement in other measures. No new safety concerns were identified. Electronic supplementary material The online version of this article (10.1186/s10194-018-0952-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- William B Young
- Jefferson Hospital for Neuroscience, 900 Walnut Street, Second Floor, Suite #200, Philadelphia, PA, 19107, USA.
| | - J Ivan Lopez
- University of South Alabama College of Medicine, Mobile, AL, USA
| | | | | | | | - Richard B Lipton
- Montefiore Headache Center, Department of Neurology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew M Blumenfeld
- Headache Center of Southern California, The Neurology Center, Carlsbad, CA, USA
| |
Collapse
|
8
|
Young WB. The Effect of Onabotulinum Toxin on Aura Frequency and Severity in Patients With Hemiplegic Migraine - A Comment. Headache 2018; 59:110. [PMID: 30575970 DOI: 10.1111/head.13445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 10/27/2022]
Affiliation(s)
- William B Young
- Thomas Jefferson University Hospital - Neurology, 900 Walnut Street, Suite 200, Philadelphia, PA, 19107, USA
| |
Collapse
|
9
|
Schroeder RA, Brandes J, Buse DC, Calhoun A, Eikermann-Haerter K, Golden K, Halker R, Kempner J, Maleki N, Moriarty M, Pavlovic J, Shapiro RE, Starling A, Young WB, Nebel RA. Sex and Gender Differences in Migraine—Evaluating Knowledge Gaps. J Womens Health (Larchmt) 2018; 27:965-973. [DOI: 10.1089/jwh.2018.7274] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
| | - Jan Brandes
- Nashville Neuroscience Group, Nashville, Tennessee
- Department of Neurology, Vanderbilt University, Nashville, Tennessee
| | - Dawn C. Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Anne Calhoun
- Carolina Headache Institute, Durham, North Carolina
| | | | | | - Rashmi Halker
- Department of Neurology, Mayo Clinic, Phoenix, Arizona
| | - Joanna Kempner
- Department of Sociology, Rutgers University, New Brunswick, New Jersey
| | - Nasim Maleki
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Maureen Moriarty
- Department of Nursing, Marymount University, Arlington, Virginia
| | - Jelena Pavlovic
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Robert E. Shapiro
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont
| | | | - William B. Young
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rebecca A. Nebel
- Society for Women's Health Research, Washington, District of Columbia
| |
Collapse
|
10
|
Affiliation(s)
- William B Young
- Thomas Jefferson University, Jefferson Hospital for Neuroscience, Philadelphia 19107, PA, USA
| |
Collapse
|
11
|
Abstract
Allodynia has been described in migraine but has not been fully investigated for the different sensory modalities. The aim of this study was to compare the prevalence of dynamic (brush) and static (pressure) mechanical allodynia in migraine patients and to suggest a practical method of testing them in a clinical setting. Patients with International Headache Society-defined episodic migraine (EM) or with transformed migraine (TM) as defined by Silberstein and Lipton were prospectively recruited from the Jefferson Headache Center out-patient clinic. A questionnaire of migraine features and symptoms of allodynia was administered. Brush allodynia (BA) was tested by cutaneous stimulation with a gauze pad and pressure allodynia (PA) was tested using von Frey hairs (VFH). The prevalence of BA and PA in all patients and in the different subgroups was calculated and correlated with migraine features. We recruited 55 migraine patients. Twenty-five had EM and 30 had TM. BA was present in 18 (32.7±) patients and PA in 18–24 (32.7–43.6±). Allodynia to both brush and pressure was found in 13–17 (23.6–30.9±) patients. If a patient had allodynia to one modality only, it was more likely to be PA than BA. Both BA and PA were more common in patients with TM compared with those with EM [BA 46.7± vs. 16.0±; PA (differences significant for the medium and thick VFHs) 50± vs. 20± and 50± vs. 12±, respectively]. Both types of allodynia were also more common in patients with migraine with aura compared with those with migraine without aura (BA 57.1± vs. 17.6±; PA 57.1–61.9± vs. 17.6–32.7±). There was a positive correlation between allodynia score (as obtained by examination) and allodynia index (as obtained by history) for both BA and PA. The incomplete, although considerable, overlap between BA and PA suggests that allodynia to different sensory modalities is associated with sensitization of different neuronal populations. Because PA was more common than BA, it may be a more sensitive indicator of allodynia in migraine. PA can be tested clinically in a practical and systematic manner.
Collapse
Affiliation(s)
- C LoPinto
- New York University School of Medicine, New York, NY, USA
| | | | | |
Collapse
|
12
|
Affiliation(s)
| | - M Alan Stiles
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA and
| | - Hua Charles Siow
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA and
| | - William B. Young
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA and
| | | | - Todd D. Rozen
- Michigan Head-Pain and Neurological Institute, Ann Arbor, MI, USA
| |
Collapse
|
13
|
Abstract
Weight gain is a side-effect commonly associated with drugs used for headache prophylaxis. Weight gain can adversely affect patient health, exacerbate comorbid metabolic disorders and encourage noncompliance. Few studies have been conducted specifically on the effect of headache medications on weight, and it is important for physicians to have accurate information about weight-gain side-effects when identifying appropriate pharmacological regimens. This review discusses the potential effects on weight of the more common headache medications.
Collapse
Affiliation(s)
- W B Young
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
| | | |
Collapse
|
14
|
Abstract
Cutaneous allodynia has been described in migraine. We report on a 39-year-old woman with migraine with aura who had cutaneous allodynia to both dynamic (brush) and static (pressure) mechanical stimulation between attacks. For both sensory modalities, the evoked pain on allodynia testing was located to the right frontal area (the location of her usual migraine headache), contralaterally to the stimulated skin area. There was no allodynia when the right frontal area was stimulated directly. We suggest the term ‘referred allodynia’ for this phenomenon and discuss possible mechanisms for its occurrence.
Collapse
Affiliation(s)
- A Ashkenazi
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | | | | |
Collapse
|
15
|
Affiliation(s)
- S N Malik
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | |
Collapse
|
16
|
Clark SW, Wu C, Boorman DW, Chalouhi N, Zanaty M, Oshinsky M, Young WB, Silberstein SD, Sharan AD. Long-Term Pain Reduction Does Not Imply Improved Functional Outcome in Patients Treated With Combined Supraorbital and Occipital Nerve Stimulation for Chronic Migraine. Neuromodulation 2016; 19:507-14. [DOI: 10.1111/ner.12400] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/23/2015] [Accepted: 12/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Shannon W. Clark
- Department of Neurosurgery; Thomas Jefferson University Hospital; Philadelphia PA USA
| | - Chengyuan Wu
- Department of Neurosurgery; Thomas Jefferson University Hospital; Philadelphia PA USA
| | - David W. Boorman
- Department of Neurosurgery; Thomas Jefferson University Hospital; Philadelphia PA USA
| | - Nohra Chalouhi
- Department of Neurosurgery; Thomas Jefferson University Hospital; Philadelphia PA USA
| | - Mario Zanaty
- Department of Neurosurgery; Thomas Jefferson University Hospital; Philadelphia PA USA
| | - Michael Oshinsky
- Department of Neurology; Thomas Jefferson University Hospital; Philadelphia PA USA
| | - William B. Young
- Department of Neurology; Thomas Jefferson University Hospital; Philadelphia PA USA
| | | | - Ashwini D. Sharan
- Department of Neurosurgery; Thomas Jefferson University Hospital; Philadelphia PA USA
| |
Collapse
|
17
|
St Cyr A, Chen A, Bradley KC, Yuan H, Silberstein SD, Young WB. Efficacy and Tolerability of STOPAIN for a Migraine Attack. Front Neurol 2015; 6:11. [PMID: 25699012 PMCID: PMC4316718 DOI: 10.3389/fneur.2015.00011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 04/01/2014] [Accepted: 01/18/2015] [Indexed: 11/25/2022] Open
Abstract
Objective: To determine whether topical menthol 6% gel will relieve a migraine attack. Materials and Methods: A single-center, open-label pilot trial of 25 patients with at least 1 year of diagnosed episodic migraine and <15 headache days per month. Patients treated one migraine attack with STOPAIN topical menthol 6% gel to skull base within 2 h of headache onset. Headache pain severity was assessed prior to and after gel application. Results: Thirty-two patients enrolled and 25 completed the study. Prior to treatment, 7 patients had mild pain, 13 moderate pain, and 5 severe pain. Two hours following gel application, 7 (28%) patients had no pain, 7 (28%) mild pain, 6 (25%) moderate pain, and 5 (20%) severe pain. The majority of patients had similar pain intensity (8; 32%) or improvement (13; 52%). At 24-h, only two non-rescued patients still had mild headache. Of the 25 completers, 2 patients took rescue medication prior to the 2-h period, and an additional 10 patients rescued between 2 and 24 h. Conclusion: Study results showed a significant improvement in headache intensity by 2 h after gel application. This pilot study shows STOPAIN gel may be effective in treating an acute migraine attack.
Collapse
Affiliation(s)
- Andrea St Cyr
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University , Philadelphia, PA , USA
| | - Ashley Chen
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University , Philadelphia, PA , USA
| | - Kathleen C Bradley
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University , Philadelphia, PA , USA
| | - Hsiangkuo Yuan
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University , Philadelphia, PA , USA
| | - Stephen D Silberstein
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University , Philadelphia, PA , USA
| | - William B Young
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University , Philadelphia, PA , USA
| |
Collapse
|
18
|
Abstract
Occipital nerve stimulation may be effective in treating chronic migraine. Six studies, including three double-blind studies, were performed, with five showing evidence of benefit. However, of the three randomized, controlled trials, none has met a primary endpoint successfully. A separate study suggested a benefit for combined supraorbital and greater occipital nerve stimulation.
Collapse
Affiliation(s)
- William B Young
- Jefferson Hospital for Neuroscience, Headache Center, Thomas Jefferson University, 900 Walnut Street, Second Floor, Suite #200, Philadelphia, PA, 19107, USA,
| |
Collapse
|
19
|
Young WB, Bradley KC, Anjum MW, Gebeline-Myers C. Duloxetine prophylaxis for episodic migraine in persons without depression: a prospective study. Headache 2013; 53:1430-7. [PMID: 24032526 DOI: 10.1111/head.12205] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this pilot study is to evaluate the effects of daily duloxetine, 60-120 mg, on the frequency, duration, and severity of migraine attacks and the level of disability in episodic migraineurs. BACKGROUND There is a need for more proven effective migraine preventive medications. Two antidepressants, both of which block serotonin and norepinephrine reuptake, have been shown to be effective in the preventive treatment of migraine. Neither has earned a level A recommendation in the 2012 guidelines of the American Academy of Neurology. Duloxetine also blocks serotonin and norepinephrine reuptake. METHODS This was a prospective, 5-visit study on duloxetine treatment of episodic migraine headache with 4-10 migraine days, and less than 15 headache days per month. Patients were titrated to a goal dose of 120 mg. They were excluded if they had depression. RESULTS There were 22 completers plus 5 subjects who took at least 1 dose of drug. The mean duloxetine dose was 110 mg. In a modified intent-to-treat analysis, subjects went from 9.2 ± 2.7 headache days per month at baseline to 4.5 ± 3.4 headache days per month (P < .001). There were no significant differences in the average headache duration, average headache severity, maximum headache attack severity, and level of functioning. Fifty-two percent of subjects had a 50% or greater improvement in headache days. CONCLUSIONS Migraine prophylactic treatment with high-dose duloxetine may be effective in a nondepressed individual. The reported treatment response is in line with other commonly used migraine preventives.
Collapse
Affiliation(s)
- William B Young
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | |
Collapse
|
20
|
Young WB. Preventive Treatments for Migraine. Headache 2013. [DOI: 10.1002/9781118678961.ch9] [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: 11/11/2022]
|
21
|
Blumenfeld A, Ashkenazi A, Napchan U, Bender SD, Klein BC, Berliner R, Ailani J, Schim J, Friedman DI, Charleston L, Young WB, Robertson CE, Dodick DW, Silberstein SD, Robbins MS. Expert consensus recommendations for the performance of peripheral nerve blocks for headaches--a narrative review. Headache 2013; 53:437-46. [PMID: 23406160 DOI: 10.1111/head.12053] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe a standardized methodology for the performance of peripheral nerve blocks (PNBs) in the treatment of headache disorders. BACKGROUND PNBs have long been employed in the management of headache disorders, but a wide variety of techniques are utilized in literature reports and clinical practice. METHODS The American Headache Society Special Interest Section for PNBs and other Interventional Procedures convened meetings during 2010-2011 featuring formal discussions and agreements about the procedural details for occipital and trigeminal PNBs. A subcommittee then generated a narrative review detailing the methodology. RESULTS PNB indications may include select primary headache disorders, secondary headache disorders, and cranial neuralgias. Special procedural considerations may be necessary in certain patient populations, including pregnancy, the elderly, anesthetic allergy, prior vasovagal attacks, an open skull defect, antiplatelet/anticoagulant use, and cosmetic concerns. PNBs described include greater occipital, lesser occipital, supratrochlear, supraorbital, and auriculotemporal injections. Technical success of the PNB should result in cutaneous anesthesia. Targeted clinical outcomes depend on the indication, and include relief of an acute headache attack, terminating a headache cycle, and transitioning out of a medication-overuse pattern. Reinjection frequency is variable, depending on the indications and agents used, and the addition of corticosteroids may be most appropriate when treating cluster headache. CONCLUSIONS These recommendations from the American Headache Society Special Interest Section for PNBs and other Interventional Procedures members for PNB methodology in headache disorder treatment are derived from the available literature and expert consensus. With the exception of cluster headache, there is a paucity of evidence, and further research may result in the revision of these recommendations to improve the outcome and safety of these interventions.
Collapse
Affiliation(s)
- Andrew Blumenfeld
- The Headache Center of Southern California - Neurology, Encinitas, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
BACKGROUND People who have a disease often experience stigma, a socially and culturally embedded process through which individuals experience stereotyping, devaluation, and discrimination. Stigma has great impact on quality of life, behavior, and life chances. We do not know whether or not migraine is stigmatizing. METHODS We studied 123 episodic migraine patients, 123 chronic migraine patients, and 62 epilepsy patients in a clinical setting to investigate the extent to which stigma attaches to migraine, using epilepsy as a comparison. We used the stigma scale for chronic illness, a 24-item questionnaire suitable for studying chronic neurologic diseases, and various disease impact measures. RESULTS Patients with chronic migraine had higher scores (54.0±20.2) on the stigma scale for chronic illness than either episodic migraine (41.7±14.8) or epilepsy patients (44.6±16.3) (p<0.001). Subjects with migraine reported greater inability to work than epilepsy subjects. Stigma correlated most strongly with the mental component score of the short form of the medical outcomes health survey (SF-12), then with ability to work and migraine disability score for chronic and episodic migraine and the Liverpool impact on epilepsy scale for epilepsy. Analysis of covariance showed adjusted scores for the stigma scale for chronic illness were similar for chronic migraine (49.3; 95% confidence interval, 46.2 to 52.4) and epilepsy (46.5; 95% confidence interval, 41.6 to 51.6), and lower for episodic migraine (43.7; 95% confidence interval, 40.9 to 46.6). Ability to work was the strongest predictor of stigma as measured by the stigma scale for chronic illness. CONCLUSION In our model, adjusted stigma was similar for chronic migraine and epilepsy, which were greater than for episodic migraine. Stigma correlated most strongly with inability to work, and was greater for chronic migraine than epilepsy or episodic migraine because chronic migraine patients had less ability to work.
Collapse
Affiliation(s)
- William B Young
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
| | | | | | | |
Collapse
|
23
|
Young WB, Silberstein SD. Occipital nerve stimulation for primary headaches. J Neurosurg Sci 2012; 56:307-312. [PMID: 23111291] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Occipital nerve stimulation may be effective for primary headache disorders. Four studies, including two double-blind show, stimulation-controlled studies that were performed for chronic migraine showed evidence of benefit. A separate study suggested a benefit for combined supraorbital and greater occipital nerve stimulation. Anecdotal evidence suggests benefit in hemicrania continua. In chronic cluster headache, several case series have shown improvement, which, combined with the safety of occipital nerve stimulation relative to deep brain stimulation, have led to published reports supporting this as the preferred surgical technique for chronic cluster headache. A few case reports suggest a possible benefit in short-lasting unilateral neuralgiform headache attacks with conjunctival injection tearing and short-lasting unilateral neuralgiform headache.
Collapse
Affiliation(s)
- W B Young
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | | |
Collapse
|
24
|
Affiliation(s)
- Shuu-Jiun Wang
- Neurological Institute, Taipei Veterans General Hospital, Taiwan
- National Yang-Ming University School of Medicine, Taiwan
| | | |
Collapse
|
25
|
Young WB, Kempner J, Loder EW, Roberts J, Segal JZ, Solomon M, Cady RK, Janoff L, Sheeler RD, Robert T, Yocum J, Sheftell FD. Naming migraine and those who have it. Headache 2011; 52:283-91. [PMID: 21929663 DOI: 10.1111/j.1526-4610.2011.01995.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Medical language has implications for both public perception of and institutional responses to illness. A consensus panel of physicians, academics, advocates, and patients with diverse experiences and knowledge about migraine considered 3 questions: (1) What is migraine: an illness, disease, syndrome, condition, disorder, or susceptibility? (2) What ought we call someone with migraine? (3) What should we not call someone with migraine? Although consensus was not reached, the responses were summarized and analyzed quantitatively and qualitatively. Panelists participated in writing and editing the paper. The panelists agreed that "migraine," not "migraine headache," was generally preferable, that migraine met the dictionary definition for each candidate moniker, terms with psychiatric valence should be avoided, and "sufferer" should be avoided except in very limited circumstances. Overall, while there was no consensus, "disease" was the preferred term in the most situations, and illness the least preferred. Panelists disagreed strongly whether one ought to use the term "migraineur" at all or if "person with migraine" was preferable. Panelists drew upon a variety of principles when considering language choices, including the extent to which candidate monikers could be defended using biomedical evidence, the cultural meaning of the proposed term, and the context within which the term would be used. Panelists strove to balance the need for terms to describe the best science on migraine, with the desire to choose language that would emphasize the credibility of migraine. The wide range of symptoms of migraine and its diverse effects may require considerable elasticity of language.
Collapse
Affiliation(s)
- William B Young
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
New daily-persistent headache is a relatively uncommon type of chronic daily headache. The critical features of the original description and the subsequent Silberstein-Lipton description was the onset: daily headache starts abruptly without a background of frequent or worsening headache. In 2004, the International Headache Society classification committee excluded an abundance of migrainous features. The exclusion of patients with too many migrainous features from the International Headache Society classification was contentious from the onset and is a source of consternation for many headache experts. Many contend that the sudden onset of a daily headache raises the same issue of what turned on the headache, irrespective of the headache features. Switch-related questions about predisposing factors or precipitating events are equally valid regardless of how many migrainous features the patient has. The differential diagnosis, treatment response, or prognoses do not vary by the number of migrainous features. The current International Headache Society definition excludes more than half of patients with new onset of daily headache. This exclusion due to migrainous features could have adverse scientific, diagnostic, and treatment consequences.
Collapse
Affiliation(s)
- William B Young
- Thomas Jefferson University, Jefferson Headache Center, 111 South 11th Street, Philadelphia, PA 19107, USA.
| |
Collapse
|
27
|
|
28
|
Conforto AB, Lois LA, Amaro E, Paes AT, Ecker C, Young WB, Gamarra LF, Peres MFP. Migraine and motion sickness independently contribute to visual discomfort. Cephalalgia 2011; 30:161-9. [PMID: 19500116 DOI: 10.1111/j.1468-2982.2009.01867.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The objective of this study was to evaluate, in patients with migraine and healthy volunteers, with and without a history of motion sickness, the degree of discomfort elicited by drifting striped patterns. Eighteen healthy volunteers (HV) and 30 migraine patients participated in the study. Discomfort was greater in migraine patients than in HV, and in individuals with a history of motion sickness than in those without, but the effect of history of migraine was independent of history of motion sickness. Generalized Estimating Equations models for binary correlated data revealed that these differences did not depend on levels of duty cycle, spatial and temporal frequencies. Visual discomfort in migraine patients was associated with worse performance. There was a significant correlation between median degree of discomfort across conditions and number of migraine attacks in the past month. Discomfort to drifting striped patterns may be related to central sensitization in migraine patients.
Collapse
Affiliation(s)
- A B Conforto
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
The aim was to assess the relative frequency of migraine and the headache characteristics of complex regional pain syndrome (CRPS) sufferers. CRPS and migraine are chronic, often disabling pain syndromes. Recent studies suggest that headache is associated with the development of CRPS. Consecutive adults fulfilling International Association for the Study of Pain criteria for CRPS at a pain clinic were included. Demographics, medical history, and pain characteristics were obtained. Headache diagnoses were made using International Classification of Headache Disorders, 2nd edn criteria. Migraine and pain characteristics were compared in those with migraine with those without. anova with Tukey post hoc tests was used to determine the significance of continuous variables and Fisher's exact or χ(2) tests for categorical variables. The expected prevalence of migraine and chronic daily headache (CDH) was calculated based on age- and gender-stratified general population estimates. Standardized morbidity ratios (SMR) were calculated by dividing the observed prevalence of migraine by the expected prevalence from the general population. The sample consisted of 124 CRPS participants. The mean age was 45.5 ± 12.0 years. Age- and gender-adjusted SMRs showed that those with CRPS were 3.6 times more likely to have migraine and nearly twice as likely to have CDH as the general population. Aura was reported in 59.7% (74/124) of participants. Of those CRPS sufferers with migraine, 61.2% (41/67) reported the onset of severe headaches before the onset of CRPS symptoms Mean age of onset of CRPS was earlier in those with migraine (34.9 ± 11.1 years) and CDH (32.5 ± 13.4 years) compared with those with no headaches (46.8 ± 14.9 years) and those with tension-type headache (TTH) (39.9 ± 9.9 years), P < 0.05. More extremities were affected by CRPS in participants with migraine (median of four extremities) compared with the combined group of those CRPS sufferers with no headaches or TTH (median 2.0 extremities), P < 0.05. The presence of static, dynamic and deep joint mechano-allodynia together was reported by more CRPS participants with migraine (72.2%) than those with no headaches or TTH (46.2%), P ≤ 0.05. Migraine may be a risk factor for CRPS and the presence of migraine may be associated with a more severe form of CRPS. Specifically: (i) migraine occurs in a greater percentage of CRPS sufferers than expected in the general population; (ii) the onset of CRPS is reported earlier in those with migraine than in those without; and (iii) CRPS symptoms are present in more extremities in those CRPS sufferers with migraine compared with those without. In addition, as we also found that the presence of aura is reported in a higher percentage of those CRPS sufferers with migraine than reported in migraineurs in the general population, further evaluation of the cardiovascular risk profile of CRPS sufferers is warranted.
Collapse
Affiliation(s)
- B L Peterlin
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA 19102, USA.
| | | | | | | | | |
Collapse
|
30
|
Conforto AB, Amaro E, Young WB, Gamarra L, Peres MFP. Visual pattern responses in migraine with and without motion sickness - A response. Cephalalgia 2010. [DOI: 10.1177/0333102410375627] [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: 11/15/2022]
Affiliation(s)
| | - Edson Amaro
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Brazil
| | | | - Lionel Gamarra
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Brazil
| | | |
Collapse
|
31
|
|
32
|
Abstract
Background: New daily persistent headache (NDPH) is a primary chronic daily headache that is generally considered to be difficult to treat. Migraine has been linked to comorbid psychiatric conditions, mainly mood and anxiety disorders, but NDPH has never been linked to psychiatric conditions, and never studied extensively for such an association. Case: We report nine cases (six women and three men) of patients diagnosed with NDPH and panic disorder who were treated for both conditions. Six of them (66%) had good or excellent responses. Conclusion: The spectrum of anxiety disorders, particularly panic disorder, should be considered in NDPH patients. Simultaneous treatment of both disorders may lead to good outcomes.
Collapse
Affiliation(s)
- Mario FP Peres
- Albert Einstein Hospital, Brazil
- Federal University of São Paulo, Brazil
| | | | | | | |
Collapse
|
33
|
Abstract
Introduction: Cluster headache is characterized by severe attacks of unilateral pain, but many patients experience symptoms more commonly associated with migraine such as persistent pain. Patients and methods: We evaluated cluster headache patients using a questionnaire and chart review to determine clinical characteristics. Results: Twenty-four of 50 subjects reported interictal pain outside of their acute attacks. Sixteen reported persistent pain more than half the time while in cycle. Unlike acute attacks, this pain was generally mild. Conclusions: Subjects with persistent interictal pain were more likely to have chronic cluster, allodynia, and suboptimal response to sumatriptan, suggesting that interictal pain in cluster headache may predict a more severe disease process.
Collapse
|
34
|
|
35
|
Abstract
Many dopamine antagonists are proven acute migraine treatments. Genetic studies also imply that polymorphisms in dopamine genes (DRD2 receptors) in persons with migraine may create dopamine hypersensitivity. However, treatment is limited by the adverse event profiles of conventional neuroleptics including extrapyramidal symptoms, anticholinergic and antihistaminergic effects, hyperprolactinemia, and prolonged cardiac QT interval. Atypical neuroleptics cause less extrapyramial symptoms and some atypical neuroleptics, including olanzapine and quetiapine, may be beneficial as both acute and preventive migraine treatment. The combination of prochlorperazine, indomethacin, and caffeine is effective in the treatment of the acute migraine attack. The mechanism of action by which neuroleptics relieve headache is probably related to dopamine D2 receptor antagonist. Other actions via serotonin (5HT) receptor antagonists may also be important, particularly for migraine prevention. Additional studies to clarify the mechanism of action of neuroleptics in migraine could lead to new drugs and better management of migraine.
Collapse
Affiliation(s)
- Petcharat Dusitanond
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, USA.
| | | |
Collapse
|
36
|
Marmura MJ, Hopkins M, Andrel J, Young WB, Biondi DM, Rupnow MF, Armstrong RB. Electronic Medical Records as a Research Tool: Evaluating Topiramate Use at a Headache Center. Headache 2010; 50:769-78. [DOI: 10.1111/j.1526-4610.2010.01624.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
37
|
Young WB, Marmura M, Ashkenazi A, Evans RW. Expert opinion: greater occipital nerve and other anesthetic injections for primary headache disorders. Headache 2009; 48:1122-5. [PMID: 18687084 DOI: 10.1111/j.1526-4610.2008.01192.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- William B Young
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | |
Collapse
|
38
|
Abstract
Our aim was to determine the prevalence of right-to-left shunt (RtLS) in patients with chronic migraine (CM), and to correlate the presence and grade of RtLS with aura and neurological symptoms, and duration and severity of disease. The prevalence of RtLS in migraine without aura is similar to that of the general population (between 20 and 35%). In migraine with aura, the prevalence is much higher (approximately 50%). The prevalence in CM, with or without aura, is unknown. Consecutive patients between the ages of 18 and 60 years with CM attending a tertiary care specialty headache clinic over an 8-week period were eligible. There were 131 patients in the study. A structured diagnostic interview was performed. Bubble transcranial Doppler with Valsalva manoeuvre determined RtLS presence and grade. Sixty-six percent (86/131) of patients had RtLS, a statistically significantly greater rate than those reported in the general population and in migraine with or without aura ( P < 0.001). There was no difference in RtLS rate or grade between those with and those without aura. Specific headache features and the presence of neurological symptoms were similar between those with and those without RtLS. Compared with both the general population and the episodic migraine population (with and without aura), patients with CM, with or without aura, are more likely to have RtLS. The clinical implications of our findings need to be determined.
Collapse
Affiliation(s)
- SJ Nahas
- Thomas Jefferson University Hospital, Department of Neurology, Philadelphia, PA, USA
| | - WB Young
- Thomas Jefferson University Hospital, Department of Neurology, Philadelphia, PA, USA
| | - R Terry
- Jefferson Medical College, Philadelphia, PA, USA
| | - A Kim
- Jefferson Medical College, Philadelphia, PA, USA
| | - T Van Dell
- Jefferson Medical College, Philadelphia, PA, USA
| | - AJ Guarino
- Massachusetts General Hospital, Institute of Health Professions, Boston, MA, USA
| | - SD Silberstein
- Thomas Jefferson University Hospital, Department of Neurology, Philadelphia, PA, USA
| |
Collapse
|
39
|
Abstract
Cluster headache (CH) is a primary headache syndrome that is classified with the trigeminal autonomic cephalalgias. CH treatment involves three steps: acute attack management, transitional therapy, and preventive therapy. Greater occipital nerve block has been shown to be an effective alternative bridge therapy to oral steroids in CH. Botulinum toxin type A has recently been studied as a new preventive treatment for patients with chronic CH, with limited success.
Collapse
Affiliation(s)
- Jessica Ailani
- Jefferson Headache Center, Gibbon Building, 111 South 11th Street, Suite 8130, Philadelphia, PA 19107, USA.
| | | |
Collapse
|
40
|
Abstract
Weight gain is a common side effect of drugs used for headache prevention. Weight gain can adversely affect patient health, exacerbate comorbid metabolic disorders, and encourage noncompliance. Additionally, obesity may promote the chronification of episodic migraine. Few studies have looked specifically at the effect that headache medications have on weight. The practicing physician needs accurate information about important side effects, including weight gain, when selecting appropriate pharmacologic regimens. This article discusses the potential effects the more common headache medications have on weight.
Collapse
Affiliation(s)
- William B Young
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
| |
Collapse
|
41
|
Young WB. Resident and fellow section. Teaching case presentation: heroic headache. Headache 2009; 49:325-7; discussion 327. [PMID: 19222603 DOI: 10.1111/j.1526-4610.2008.01331.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
42
|
|
43
|
Abstract
Occasionally patients in the stroke age-bracket over 40 years have unexplained transient cerebral ischemic attacks in association with normal cerebral angiograms. From this group, 120 have been collected in whom the transient episodes resembled the neurological accompaniments of migraine. According to symptoms, the patients were categorized as follows: visual accompaniments (patients with only ordinary scintillating scotoma were excluded), 25; visual and paresthesias, 18; visual and speech disturbance, 7; visual, and brain stem symptoms, 14; visual, paresthesias, and speech disturbance, 7; visual, paresthesias, speech disturbance, and paresis, 25; recurrence of old stroke deficit, 9; miscellaneous, 8. In establishing the diagnosis, angiography is advisable in all but classical cases. Typical of migrainous accompaniments are the build-up and migration of visual scintillations, the march of paresthesia, and progression from one accompaniment to another, characteristics that do not occur in thrombosis and embolism. Diagnosis facilitated when 2 or more similar episodes have occurred or migraine-like scintillations are present. Headache occurred in 50% of cases. Other cerebrovascular processes, coagulation disorders, and cerebral seizures must be ruled out.
Collapse
Affiliation(s)
- William B Young
- Department of Neurology and Jefferson Headache Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
44
|
Young WB. Headache Education for the Medical Students – Wolff's Postulates: A Response. Headache 2008. [DOI: 10.1111/j.1526-4610.2008.01062.x] [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: 11/29/2022]
|
45
|
Young WB. Cessation of hemiplegic migraine auras with greater occipital nerve blockade: a comment. Headache 2008; 48:481. [PMID: 18205798 DOI: 10.1111/j.1526-4610.2007.01042.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
46
|
Cuadrado ML, Young WB, Fernández-de-las-Peñas C, Arias JA, Pareja JA. Migrainous Corpalgia: Body Pain and Allodynia Associated with Migraine Attacks. Cephalalgia 2007; 28:87-91. [DOI: 10.1111/j.1468-2982.2007.01485.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cephalic and extracephalic allodynia are recognized as a common sign of sensory sensitization during migraine episodes. However, the occurrence of body pain in migraine has not been thoroughly explored. Here we report three patients presenting with spontaneous body pain in association with migraine attacks. A 41-year-old woman experienced face and limb pain along with migraine headaches; it started before, during or after headache, was usually ipsilateral to head pain, and could last from minutes to days. A 39-year-old woman had pain in her right limbs, back and neck for 30-60 min prior to right-sided migraine headaches. A 30-year-old woman perceived pain in her left upper limb for 24-48 h prior to left-sided migraine headaches. All patients had allodynia to mechanical stimuli over the painful areas. Spontaneous body pain may be associated with migraine attacks. Together with allodynia, this might be a consequence of central sensitization.
Collapse
Affiliation(s)
- ML Cuadrado
- Department of Neurology, Fundación Hospital Alcorcón and Rey Juan Carlos Universit
| | - WB Young
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - JA Arias
- Faculty of Health Sciences, Alfonso X el Sabio University, Madrid, Spain,
| | - JA Pareja
- Department of Neurology, Fundación Hospital Alcorcón and Rey Juan Carlos Universit
| |
Collapse
|
47
|
Gupta MX, Silberstein SD, Young WB, Hopkins M, Lopez BL, Samsa GP. Less Is Not More: Underutilization of Headache Medications in a University Hospital Emergency Department. Headache 2007; 47:1125-33. [DOI: 10.1111/j.1526-4610.2007.00846.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
48
|
Abstract
Osteonecrosis is a bony infarction caused by disruption of blood supply to the bone. Aseptic osteonecrosis should be rare with intermittent use of steroids in disabling and refractory migraine cases. We present 3 cases of patients who had severe migraine and developed aseptic osteonecrosis with short-term, intermittent pulse doses of corticosteroids. Migraine has been mentioned as a possible risk factor for aseptic osteonecrosis, and we speculate that severe migraine may be a risk factor for developing aseptic osteonecrosis. Furthermore, migraineurs who develop aseptic osteonecrosis may or may not have associated white matter changes in the brain. We noted a triad of severe migraine, osteonecrosis, and migraine-related white matter lesions in only 1 case. In severe cases of migraine, steroids should be used cautiously.
Collapse
Affiliation(s)
- Aamir Hussain
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | | |
Collapse
|
49
|
Silberstein SD, Young WB, Hopkins MM, Gebeline-Myers C, Bradley KC. Dihydroergotamine for Early and Late Treatment of Migraine With Cutaneous Allodynia: An Open-Label Pilot Trial. Headache 2007; 47:878-85. [PMID: 17578539 DOI: 10.1111/j.1526-4610.2007.00826.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore whether dihydroergotamine (D.H.E. 45) is equally effective and safe for migraine with allodynia, when administered either early or late in an attack. BACKGROUND Central sensitization may account for the extracranial tenderness and cutaneous allodynia that can occur with migraine. Once allodynia is established, triptans are less effective. Dihydroergotamine is often effective for patients whose refractory headaches have failed prior triptan therapy. METHODS In this single-center, open-label pilot trial, patients with episodic migraine associated with cutaneous allodynia were treated on 2 occasions with dihydroergotamine 1.0 mg intramuscularly. One attack was treated within 2 hours (early) and a second attack at 4 hours (late) after the onset of throbbing pain. Headache pain and any associated symptoms, subjective cutaneous allodynia, and mechanical (brush) allodynia were assessed. All data were analyzed using the Fisher's exact test. RESULTS Thirteen patients met the entry criteria; however, data from only 9 patients, those who completed treatment for 2 migraine attacks, were used to evaluate the efficacy and safety of dihydroergotamine. Whether they took dihydroergotamine early or late in the attack, most patients (>55%) had headache relief within 2 hours, and at least 44% of patients achieved headache-free status by 8 hours postdose. Subjective cutaneous allodynia started to decline after 30 minutes postdose in the early treated group and after 120 minutes postdose in the late-treated group. Brush allodynia began to decline after 15 minutes postdose in the early treated group and after 90 minutes postdose in the late-treated group. Six of 9 patients (67%) reported at least 1 adverse event. CONCLUSIONS The results of this pilot trial provide proof of concept for the headache-relief benefit of dihydroergotamine in patients with migraine headache and allodynia. A large, placebo-controlled trial of dihydroergotamine in allodynic patients is warranted.
Collapse
|
50
|
Abstract
OBJECTIVE To characterise the clinical features of non-familial migraine with unilateral motor symptoms (MUMS) and compare these features with those of migraine without weakness. METHODS 24 patients with MUMS and 48 matched controls were identified from a tertiary care headache centre. Using a structured interview, the migraine symptoms of both groups were characterised. Results of previously administered Beck Depression Inventories (BDI), Minnesota Multiphasic Personality Inventories and psychiatric diagnoses were collected, when available, and compared between groups. RESULTS 9 patients had episodic migraine and 15 had chronic migraine. Patients with MUMS always had weakness involving the arm subjectively, and both arm and leg objectively. A give-way character was always present. Only 17% of patients with MUMS reported facial weakness; 58% reported persistent interictal weakness; 92% reported sensory symptoms. A rostrocaudal march of sensory and motor symptoms was frequently reported. Weakness was ipsilateral to unilateral headache in two thirds of the patients. Compared with controls, patients with MUMS had had similar pain intensities, but were more likely to report other migrainous symptoms, including allodynia. 38% of patients with MUMS were told they had had a stroke, and 17% believed they had had a stroke despite normal brain imaging. Patients with MUMS reported fewer affective disorders and more adjustment disorders than controls, and had similar BDI scores. CONCLUSIONS A syndrome of severe migraine with accompanying give-way weakness is common in tertiary care headache centres. It is accompanied by other neurological symptoms.
Collapse
Affiliation(s)
- William B Young
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | | | | | | |
Collapse
|