Management of chronic migraine with medication overuse by web-based behavioral program during the COVID-19 emergency: results at 12 months

Abstract: Migraine is the most common disabling brain disorder. Chronic migraine, a condition characterized by the experience of migrainous headache on at least 15 days per month, is highly disabling. Patients with chronic migraine present to primary care, are often referred for management to secondary care, and make up a large proportion of patients in specialist headache clinics. Many patients with chronic migraine also have medication overuse, defined as using a compound analgesic, opioid, triptan or ergot derivative on at least 10 days per month. All doctors will encounter patients with chronic headaches. A basic working knowledge of the common primary headaches, and a rational manner of approaching the patient with these conditions, allows a specific diagnosis of chronic migraine to be made quickly and safely, and by making this diagnosis one opens up a substantial number of acute and preventive treatment options. This article discusses the current state of management of chronic migraine.

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Orbitofrontal dysfunction predicts poor prognosis in chronic migraine with medication overuse

The Journal of Headache and Pain ◽

10.1007/s10194-011-0340-6 ◽

2011 ◽

Vol 12 (4) ◽

pp. 459-466 ◽

Cited By ~ 25

Author(s):

Marian Gómez-Beldarrain ◽

María Carrasco ◽

Amaia Bilbao ◽

Juan C. García-Moncó

Keyword(s):

Chronic Migraine ◽

Poor Prognosis ◽

Medication Overuse

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Study of arginine metabolism in medication overuse chronic migraine: possible defect in NO synthesis

Neurological Sciences ◽

10.1007/s10072-021-05672-7 ◽

2021 ◽

Author(s):

Giovanni D’Andrea ◽

Antonina Gucciardi ◽

Giuseppe Giordano ◽

Gennaro Bussone ◽

Alberta Leon

Keyword(s):

Chronic Migraine ◽

Medication Overuse ◽

Arginine Metabolism

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Neck Pain and Other Location Patterns in Episodic and Chronic Migraine: A Cross-Sectional Study

10.21203/rs.3.rs-90824/v1 ◽

2020 ◽

Author(s):

Marco Antonio Takashi Utiumi ◽

João Guilherme Bochnia Küster ◽

Keryn Sporh Godk ◽

Nikolai José Eustátios Kotsifas ◽

Pedro André Kowacs ◽

...

Keyword(s):

Neck Pain ◽

Chronic Migraine ◽

Medication Overuse ◽

Diagnostic Value ◽

Multivariate Logistic Regression Model ◽

Tactile Allodynia ◽

Cross Sectional ◽

Pain Location ◽

Significant Difference ◽

Location Patterns

Abstract Background: The pain location of migraine has limited diagnostic value and has usually been assessed using non-standard verbal descriptors.Methods: This study uses non-verbal descriptors of pain location in episodic and chronic migraineurs seen at 3 centers of different complexities (tertiary-level hospital and outpatient clinics) and from different sectors (public and private). The explicit pain location was recorded by asking patients to indicate in an electronic form 3 points on the anterolateral side and 3 points on the posterolateral side of the head and neck. A multivariate logistic regression model was fitted to assess the association of different pain location patterns with demographic and clinical variables.Results: Ninety-seven episodic migraine and 113 chronic migraine patients were included, with the most commonly affected sites being the frontal (73% and 65%, respectively), temporal (67% and 73%, respectively) and parietal (27% and 34%, respectively) regions. The posterior cervical site was most often involved in the chronic migraine group (21% vs. 33%, p=0.034). No other locations showed a significant difference. The adjusted model showed that diffuse pain (OR=13.74, CI=4.89-49.85) and the presence of medication overuse associated with tactile allodynia (OR=2.65, CI=1.05-6.87) were associated with increased odds of neck pain. Disease duration was marginally relevant (p=0.078).Conclusions: The migraine attacks most commonly involve the fronto-temporal regions, although neck pain can be more often found in chronic migraine. Some features commonly found in this group such as more diffuse pain, tactile allodynia, and medication overuse are associated with this extratrigeminal site of pain.

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Reply: OnabotulinumtoxinA should be considered in medication overuse withdrawal in patients with chronic migraine

Brain ◽

10.1093/brain/awz368 ◽

2019 ◽

Vol 143 (1) ◽

pp. e6-e6 ◽

Cited By ~ 1

Author(s):

Judith A Pijpers ◽

Michel D Ferrari ◽

Gisela M Terwindt

Keyword(s):

Chronic Migraine ◽

Medication Overuse

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Clinic-based characterization of continuous headache in children and adolescents: Comparing youth with chronic migraine to those with new daily persistent headache

Cephalalgia ◽

10.1177/0333102420920644 ◽

2020 ◽

Vol 40 (10) ◽

pp. 1063-1069 ◽

Cited By ~ 1

Author(s):

Brooke L Reidy ◽

Emily J Riddle ◽

Scott W Powers ◽

Shalonda K Slater ◽

Joanne Kacperski ◽

...

Keyword(s):

Chronic Migraine ◽

Functional Disability ◽

Medication Overuse ◽

Clinical Information ◽

Large Data ◽

Data Repository ◽

New Daily Persistent Headache ◽

Headache Patient ◽

Headache Onset ◽

Persistent Headache

Objective To describe the headache characteristics and functional disability of a large sample of treatment-seeking youth with continuous headache and compare these factors across diagnostic subgroups of chronic migraine and new daily persistent headache. Methods This retrospective study utilized clinical information (e.g. diagnosis, headache features, medication overuse, functional disability) from a large data repository of patients initially presenting to a multidisciplinary headache center with continuous headache. Patient inclusion in subgroup analyses for chronic migraine and new daily persistent headache was based on clinician diagnosis using International Classification of Headache Disorders (ICHD) criteria. Results The current sample included 1170 youth (mean age = 13.95 years, 78.8% female) with continuous headache. The overwhelming majority of these youth had headaches with migrainous features, regardless of their clinical diagnosis. Youth with chronic migraine reported a longer history of continuous headache symptoms and earlier age of headache onset than youth with new daily persistent headache and were more likely to have medication overuse. Most youth with continuous headache experienced severe migraine-related functional disability, regardless of diagnostic subgroup. Conclusions Overall, youth with continuous chronic migraine and new daily persistent headache did not have clinically meaningful differences in headache features and associated disability. Findings suggest that chronic migraine and new daily persistent headache may be variants of the same underlying disease.

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An underrepresented majority: A systematic review utilizing allodynic criteria to examine the present scarcity of discrete animal models for episodic migraine

Cephalalgia ◽

10.1177/0333102420966984 ◽

2020 ◽

pp. 033310242096698

Author(s):

Aidan Levine ◽

Todd W Vanderah ◽

Tally M Largent-Milnes

Keyword(s):

Animal Models ◽

Chronic Migraine ◽

Medication Overuse ◽

Episodic Migraine ◽

Non Invasive ◽

The Past ◽

Inflammatory Soup ◽

Distinct Disease ◽

Post Traumatic ◽

Episodic Migraineurs

Background Despite increasing evidence differentiating episodic and chronic migraine, little work has determined how currently utilized animal models of migraine best represent each distinct disease state. Aim In this review, we seek to characterize accepted preclinical models of migraine-like headache by their ability to recapitulate the clinical allodynic features of either episodic or chronic migraine. Methods From a search of the Pu bMed database for “animal models of migraine”, “headache models” and “preclinical migraine”, we identified approximately 80 recent (within the past 20 years) publications that utilized one of 10 different models for migraine research. Models reviewed fit into one of the following categories: Dural KCl application, direct electrical stimulation, nitroglycerin administration, inflammatory soup injection, CGRP injection, medication overuse, monogenic animals, post-traumatic headache, specific channel activation, and hormone manipulation. Recapitulation of clinical features including cephalic and extracephalic hypersensitivity were evaluated for each and compared. Discussion Episodic migraineurs comprise over half of the migraine population, yet the vast majority of current animal models of migraine appear to best represent chronic migraine states. While some of these models can be modified to reflect episodic migraine, there remains a need for non-invasive, validated models of episodic migraine to enhance the clinical translation of migraine research.

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Migraine progression in subgroups of migraine based on comorbidities

Neurology ◽

10.1212/wnl.0000000000008589 ◽

2019 ◽

Vol 93 (24) ◽

pp. e2224-e2236 ◽

Cited By ~ 14

Author(s):

Richard B. Lipton ◽

Kristina M. Fanning ◽

Dawn C. Buse ◽

Vincent T. Martin ◽

Lee B. Hohaia ◽

...

Keyword(s):

Chronic Migraine ◽

Episodic Migraine ◽

Study Data ◽

Continuous Variables ◽

Web Based ◽

Symptom Severity Scale ◽

Hazard Ratios ◽

Cutaneous Allodynia ◽

Risk Of Progression ◽

Relationship Of

ObjectiveTo test the hypothesis that statistically defined subgroups of migraine (based on constellations of comorbidities and concomitant conditions; henceforth comorbidities), previously identified using Chronic Migraine Epidemiology and Outcomes (CaMEO) Study data, differ in prognosis, as measured by rates of progression from episodic migraine (EM) to chronic migraine (CM).MethodsThe onset of CM was assessed up to 4 times over 12 months in individuals with EM and ≥1 comorbidity at baseline, based on constellations of comorbidities (comorbidity classes). The “fewest comorbidities” class served as reference. Individuals completing ≥1 follow-up survey from the web-based CaMEO Study were included. Covariates included sociodemographic variables and headache characteristics. Sex, income, cutaneous allodynia, and medication overuse were modeled as binary variables; age, body mass index, headache-related disability (Migraine Disability Assessment [MIDAS]), and Migraine Symptom Severity Scale as continuous variables. CM onset was assessed using discrete time analysis.ResultsIn the final sociodemographic model, all comorbidity classes had significantly elevated hazard ratios (HRs) for risk of progression to CM from EM, relative to fewest comorbidities. HRs for CM onset ranged from 5.34 (95% confidence interval [CI] 3.89–7.33; p ≤ 0.001) for most comorbidities to 1.53 (95% CI 1.17–2.01; p < 0.05) for the respiratory class. After adjusting for headache covariates independently, each comorbidity class significantly predicted CM onset, although HRs were attenuated.ConclusionsSubgroups of migraine identified by comorbidity classes at cross-section predicted progression from EM (with ≥1 comorbidity at baseline) to CM. The relationship of comorbidity group to CM onset remained after adjusting for indicators of migraine severity, such as MIDAS.Clinicaltrials.gov identifierNCT01648530.

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