Topiramate: A Case Series Study in Migraine Prophylaxis

Cephalalgia ◽  
2002 ◽  
Vol 22 (8) ◽  
pp. 659-663 ◽  
Author(s):  
WB Young ◽  
MM Hopkins ◽  
AL Shechter ◽  
SD Silberstein
Keyword(s):  
Chronic Migraine ◽  
Case Series ◽  
Total Body Weight ◽  
Episodic Migraine ◽  
Headache Frequency ◽  
Transformed Migraine ◽  
Cognitive Difficulties ◽  
Headache Severity ◽  
Case Series Study ◽  
Total Body

We reviewed the electronic records of 74 migraine patients treated with topiramate for more than 6 weeks. Twenty-four patients had episodic migraine and 50 had chronic (transformed) migraine. Most (81%) started treatment at 25 mg per day and reached a dose of 100 mg twice a day (mean dose on the last follow-up visit was 208 mg). The mean headache frequency decreased from 20.6 days to 13.6 days per month ( P < 0.0001) for all headaches (9.9-5.1 ( P < 0.0001) and 25.7-17.7 ( P < 0.001) for episodic migraine and chronic migraine, respectively). The percentage of patients whose headache frequency was reduced by ≥ 50% was 44.6% for all patients; 58.3 for episodic migraine and 38.0 for chronic migraine. For all patients mean headache severity (10-point scale) was reduced from 6.2 to 4.8 ( P < 0.0001). Patients on monotherapy (20%) and polytherapy (80%) had similar reductions in headache frequency. Adverse events were usually mild to moderate and were seen in 58.1% (paresthesias in 25%, cognitive difficulties 14.9%). Mean weight loss was 3.1 ± 4 kg (3.8% of total body weight).

scholarly journals 1151 Is Timing Of Light Exposure Different In Women With Chronic Migraine?

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A438-A439
Author(s):  
S C Dawson ◽  
M Kim ◽  
K Reid ◽  
H J Burgess ◽  
J K Wyatt ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Light Exposure ◽  
Pearson Correlation ◽  
Significant Trend ◽  
Headache Frequency ◽  
Healthy Controls ◽  
Start Time ◽  
Headache Severity ◽  
Wrist Actigraphy ◽  
Daily Headache

Abstract Introduction Light avoidance is a common coping behavior of individuals with migraine headaches. It is not known whether timing of light exposure is different in individuals with chronic migraine (CM) compared to those without migraine and how this may relate to headache frequency and severity. We tested this by examining timing of the brightest and darkest light and headaches in women with chronic migraines and healthy controls. Methods Sixteen women with CM (mean age = 33.07) and 18 female healthy controls (HC; mean age = 32.22) completed daily ratings of headache severity (0-10, severity &gt; 2 classified as headache) concurrent with light exposure measured by wrist actigraphy for approximately one month (M=28.00 days, range=21-36). Start time of each day’s 10-hour periods of maximum light (M10) and 5-hour periods of lowest light (L5) were calculated and averaged for each participant. T-tests and Cohen’s d effect sizes were used to compare groups. Pearson correlation coefficients were calculated to examine associations between M10/L5 timing and headache frequency and severity. Results M10 was earlier in the CM group compared to the HC group (07:42±00:47 vs. 08:50±00:58, t(32)=3.69, p=0.0008, d=1.08). The CM group exhibited non-significant trend towards earlier L5 compared to the HC group (12:26±00:48 vs. 01:07±01:03, t(32)=1.89, p=0.0723, d=0.62). Among individuals with CM, later M10 timing was associated with more severe average daily headache (r=0.60, p=0.0136) and more frequent headaches (r=0.55, p=0.0257). Later L5 timing was significantly associated with more severe average daily headache (r=0.66, p=0.0052) and showed a non-significant trend toward association with more frequent headaches (r=0.47, p=0.0686). Conclusion Timing of the greatest light exposure period was earlier in CM compared to HC. Within the CM group, those who had earlier light and dark periods reported lower headache severity and fewer days with headaches. These findings suggest the possibility of a role for the circadian system in chronic migraine. Support This study was supported by grant R21NS081088 from the National Institutes of Health.

scholarly journals Endoscopic Sleeve Gastroplasty for Obesity – First Indian Experience: Case Series and Review of Literature

2018 ◽  
Vol 09 (04) ◽  
pp. 165-167
Author(s):  
Nitin Jagtap ◽  
Rakesh Kalapala ◽  
Abhishek Katakwar ◽  
Santosh Darishetty ◽  
D Nageshwar Reddy
Keyword(s):  
Weight Loss ◽  
Adverse Events ◽  
Case Series ◽  
Body Weight Loss ◽  
Total Body Weight ◽  
Procedural Time ◽  
Sleeve Gastroplasty ◽  
Total Body ◽  
Total Body Weight Loss

ABSTRACT Introduction: In India, obesity affects >135 million and leads to nearly 5.8 million deaths per year. Some of the unmet need in the management of obesity can be fulfilled by endoscopic therapies such as endoscopic sleeve gastroplasty (ESG). Methods: In this case series, we report our preliminary experience of ESG in three obese patients. We recorded baseline demographic data, total procedural time, adverse events, and percentage total body weight loss (%TBWL) up to 20 weeks. Results: All three patients were male with a median age of 29 years (range 26–39) with a median body mass index of 34.28 kg/m2 (range 32.60–37.13). A total of four full‑thickness and additional three submucosal sutures were applied in each patient. There were no adverse events. The median total procedural time was 105 min (range 90–150). All patients were discharged within 48 h. The median percentage total body weight loss (%TBWL) at 12 weeks was 12.02 (range 10.85–13.33) and at 16 weeks was 14.23 (range 13.84–14.62). The maximum follow‑up so far is 20 weeks (one patient) with %TBWL of 16.38. Conclusion: In our preliminary experience, we conclude that ESG is safe, effective and requires shorter hospital stay. In short‑term follow‑up, there is adequate weight loss without major adverse events.

The clinical and public health implications and risks of widening the definition of chronic migraine

Cephalalgia ◽  
2019 ◽  
Vol 40 (4) ◽  
pp. 407-410 ◽  
Author(s):  
Martina Guglielmetti ◽  
Alberto Raggi ◽  
Raffaele Ornello ◽  
Simona Sacco ◽  
Domenico D’Amico ◽  
...  
Keyword(s):  
Public Health ◽  
Chronic Migraine ◽  
High Frequency ◽  
Episodic Migraine ◽  
Headache Frequency ◽  
Allocation Of Resources ◽  
Independent Entity ◽  
Definition Of ◽  
The Impact

Background The definition of chronic migraine has long been debated. Recently, it was suggested to define subjects with at least 8/migraine days as chronic migraine; that is, incorporating so-called high frequency episodic migraine (eight or more migraine days but less than 15 headache days per month). Methods We addressed the possible problems that might arise based on this proposal accounting for clinical, pathophysiological, impact and public health aspects. Results and conclusions Defining chronic migraine on the basis of headache frequency alone does not account for clinical and pathophysiological aspects, as well as for the impact of chronic migraine in terms of disability and quality of life. Moreover, it is potentially harmful for patients in terms of allocation of resources. These issues are discussed in the present manuscript, and we support the idea of defining high frequency episodic migraine as an independent entity as a viable path to follow.

scholarly journals Assessment of peripheral biomarkers potentially involved in episodic and chronic migraine: a case-control study with a focus on NGF, BDNF, VEGF, and PGE2

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Mohammad Mozafarihashjin ◽  
Mansoureh Togha ◽  
Zeinab Ghorbani ◽  
Abolfazl Farbod ◽  
Pegah Rafiee ◽  
...  
Keyword(s):  
Growth Factor ◽  
Chronic Migraine ◽  
Case Control Study ◽  
Demographic Data ◽  
Serum Levels ◽  
Episodic Migraine ◽  
Case Control ◽  
Blood Levels ◽  
Headache Frequency ◽  
Control Study

Abstract Background Several inflammatory and vascular molecules, and neurotrophins have been suggested to have a possible role in the development of migraine. However, pathophysiological events leading to migraine onset and transformation of episodic migraine (EM) to chronic migraine (CM) are not fully understood. Thus, we aimed to assess peripheral levels of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and prostaglandin E2 (PGE2) in EM and CM patients, and controls. Methods From September 2017 to June 2020, 89 subjects were enrolled in a case-control study; 23 and 36 EM and CM patients, respectively, and 30 age and sex-matched controls. Demographic data and medical history were obtained from all patients. Headache characteristics were recorded at baseline visit and ensuing 30 days for persons with migraine disease. Serum levels of NGF, BDNF, VEGF, and PGE2 were measured once for controls and EM and CM patients, and adjusted for age, sex, and body mass index. Results Serum levels of NGF were significantly lower in EM patients compared to controls and CM patients (P-value=0.003 and 0.042, respectively). Serum levels of BDNF were significantly lower in EM and CM patients as opposed to controls (P-value<0.001), but comparable between EM and CM patients (P-value=0.715). Peripheral blood levels of VEGF were significantly higher in EM and CM patients as opposed to controls (P-value<0.001), but not different between EM and CM patients (P-value=0.859). Serum levels of PGE2 were significantly lower in EM patients compared to controls (P-value=0.011), however similar between EM and CM patients (P-value=0.086). In migraine patients, serum levels of NGF and PGE2 positively correlated with headache frequency (NGF: ρ = 0.476 and P-value<0.001; PGE2: ρ = 0.286 and P-value=0.028), while corresponding levels of BDNF and VEGF did not correlate with headache frequency (BDNF: ρ = 0.037 and P-value=0.778; VEGF: ρ= -0.025 and P-value=0.850). Conclusions Our findings suggest that NGF, BDNF, PGE2, and VEGF may play a significant role in migraine pathogenesis and/or chronification, and therefore might bear potential value for novel targeted abortive and prophylactic migraine therapy. Further prospective cohort studies with larger sample sizes can more robustly evaluate the implications of these findings.

Disability, burden, and symptoms related to sensitization in migraine patients associate with headache frequency

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Stefano Di Antonio ◽  
Matteo Castaldo ◽  
Marta Ponzano ◽  
Francesca Bovis ◽  
Paola Torelli ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Migraine ◽  
High Frequency ◽  
Low Frequency ◽  
Episodic Migraine ◽  
Headache Frequency ◽  
Headache Attack ◽  
Burden Of Headache ◽  
The Difference

Abstract Objectives This observational study aimed to assess the difference in disability, burden, and sensitization between migraine patients with low-frequency headache attack (1–8 headache days/month), high-frequency headache attack (9–14 headache days/months), and patients with chronic migraine (>14 headache days/months). Methods Migraine patients with or without aura were divided into three groups according to headache frequency (low-frequency episodic migraine; high-frequency episodic migraine; chronic migraine). Questionnaires were used to assess the burden of headache, quality of life, phycological burden, and symptoms related to sensitization (estimated by the Central Sensitization Inventory). Differences among migraine groups were assessed using Chi-Quadro test, ANOVA, or Kruskal–Wallis as appropriate. Results 136 patients were included (68 low-frequency episodic migraine, 45 high-frequency episodic migraine, 23 chronic migraine). Patients with high frequency episodic migraine and chronic migraine differed from patients with low frequency episodic migraine showing a worse burden of headache (p=0.002; p=0.002), worse level of physical (p=0.001; p<0.001) and mental (p=0.002; p=0.001) quality of life, worse level of depression (p=0.008; p=0.003), and increase presence of symptoms related to sensitization (p<0.001; p=0.003). No differences were found in any variables between patients with high-frequency episodic migraine and patients with chronic migraine (p>0.05). Conclusions Patients with high-frequency episodic migraine and chronic migraine could be considered in the same segment of the migraine population, with similar degrees of disability and sensitization related symptoms.

Field Testing Alternative Criteria for Chronic Migraine

Cephalalgia ◽  
2006 ◽  
Vol 26 (4) ◽  
pp. 477-482 ◽  
Author(s):  
ME Bigal ◽  
SJ Tepper ◽  
FD Sheftell ◽  
AM Rapoport ◽  
RB Lipton
Keyword(s):  
Chronic Migraine ◽  
Chronic Daily Headache ◽  
Medication Overuse ◽  
Field Testing ◽  
Episodic Migraine ◽  
Headache Disorders ◽  
Transformed Migraine ◽  
Daily Headache ◽  
Probable Migraine

The criteria for chronic migraine (CM), as proposed by the Second Edition of the International Classification of Headache Disorders (ICHD-2) is very restrictive, excluding most patients that evolve from episodic migraine. In this study we empirically tested three recent proposals for revised criteria for CM. We included individuals with transformed migraine (TM) with or without medication overuse, according to the criteria proposed by Silberstein and Lipton. All individuals had headache calendars for at least three consecutive months. We assessed the proportion of subjects that fulfilled ICHD-2 criteria for CM or probable chronic migraine with probable medication overuse (CM+). We also tested three proposals for making the CM criteria more inclusive. In proposal 1, CM/CM+ would require at least 15 days of migraine or probable migraine per month. Proposal 2 suggests that CM/CM+ would be classified in those with ≥15 days of headache per month, where at least 50% of these days are migraine or probable migraine. Proposal 3 suggests that CM/CM+ would be classified in those with chronic daily headache and at least 8 days of migraine or probable migraine per month. Among TM sufferers, 399 (62.5%) had TM with medication overuse, and just 10.2% were classified as CM+ 158 (37.5%) had TM without medication overuse; just nine (5.6%) met current ICHD-2 criteria for CM. Using the alternative criteria, proposal 1 included 48.7% of patients with TM without medication overuse; proposal 2 captured 88%, and proposal 3 classified 94.9% of these patients. For TM with medication overuse, the proportions for proposals 1-3 were, respectively, 37%, 81% and 91%. The differences were statistically significant, favouring proposal 3. Consistently, criteria for CM and CM+ should be revised to require at least 8 days of migraine or probable migraine per month, in individuals with 15 or more days of headache per month.

scholarly journals Mechanical punctate pain threshold is associated with headache frequency and phase in patients with migraine

Cephalalgia ◽  
2020 ◽  
Vol 40 (9) ◽  
pp. 990-997
Author(s):  
Li-Ling Hope Pan ◽  
Yen-Feng Wang ◽  
Kuan-Lin Lai ◽  
Wei-Ta Chen ◽  
Shih-Pin Chen ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Quantitative Sensory Testing ◽  
Pain Threshold ◽  
Episodic Migraine ◽  
Headache Frequency ◽  
Healthy Controls ◽  
Sensory Testing ◽  
Dynamic Changes ◽  
Cold Pain ◽  
Pain Thresholds

Objective Previous studies regarding the quantitative sensory testing are inconsistent in migraine. We hypothesized that the quantitative sensory testing results were influenced by headache frequency or migraine phase. Methods This study recruited chronic and episodic migraine patients as well as healthy controls. Participants underwent quantitative sensory testing, including heat, cold, and mechanical punctate pain thresholds at the supraorbital area (V1 dermatome) and the forearm (T1 dermatome). Prospective headache diaries were used for headache frequency and migraine phase when quantitative sensory testing was performed. Results Twenty-eight chronic migraine, 64 episodic migraine and 32 healthy controls completed the study. Significant higher mechanical punctate pain thresholds were found in episodic migraine but not chronic migraine when compared with healthy controls. The mechanical punctate pain thresholds decreased as headache frequency increased then nadired. In episodic migraine, mechanical punctate pain thresholds were highest ( p < 0.05) in those in the interictal phase and declined when approaching the ictal phase in both V1 and T1 dermatomes. Linear regression analyses showed that in those with episodic migraine, headache frequency and phase were independently associated with mechanical punctate pain thresholds and accounted for 29.7% and 38.9% of the variance in V1 ( p = 0.003) and T1 ( p < 0.001) respectively. Of note, unlike mechanical punctate pain thresholds, our study did not demonstrate similar findings for heat pain thresholds and cold pain thresholds in migraine. Conclusion Our study provides new insights into the dynamic changes of quantitative sensory testing, especially mechanical punctate pain thresholds in patients with migraine. Mechanical punctate pain thresholds vary depending on headache frequency and migraine phase, providing an explanation for the inconsistency across studies.

scholarly journals The impact of chronic migraine: The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study methods and baseline results

Cephalalgia ◽  
2014 ◽  
Vol 35 (7) ◽  
pp. 563-578 ◽  
Author(s):  
Aubrey Manack Adams ◽  
Daniel Serrano ◽  
Dawn C Buse ◽  
Michael L Reed ◽  
Valerie Marske ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Episodic Migraine ◽  
Family Burden ◽  
Headache Frequency ◽  
Cross Sectional ◽  
The Core ◽  
Related Quality ◽  
Health Related ◽  
One Year ◽  
The Impact

Background Longitudinal migraine studies have rarely assessed headache frequency and disability variation over a year. Methods The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study is a cross-sectional and longitudinal Internet study designed to characterize the course of episodic migraine (EM) and chronic migraine (CM). Participants were recruited from a Web-panel using quota sampling in an attempt to obtain a sample demographically similar to the US population. Participants who passed the screener were assessed every three months with the Core (baseline, six, and 12 months) and Snapshot (months three and nine) modules, which assessed headache frequency, headache-related disability, treatments, and treatment satisfaction. The Core also assessed resource use, health-related quality of life, and other features. One-time cross-sectional modules measured family burden, barriers to medical care, and comorbidities/endophenotypes. Results Of 489,537 invitees, we obtained 58,418 (11.9%) usable returns including 16,789 individuals who met ICHD-3 beta migraine criteria (EM (<15 headache days/mo): n = 15,313 (91.2%); CM (≥15 headache days/mo): n = 1476 (8.8%)). At baseline, all qualified respondents ( n = 16,789) completed the Screener, Core, and Barriers to Care modules. Subsequent modules showed some attrition (Comorbidities/Endophenotypes, n = 12,810; Family Burden (Proband), n = 13,064; Family Burden (Partner), n = 4022; Family Burden (Child), n = 2140; Snapshot (three months), n = 9741; Core (six months), n = 7517; Snapshot (nine months), n = 6362; Core (12 months), n = 5915). A total of 3513 respondents (21.0%) completed all modules, and 3626 (EM: n = 3303 (21.6%); CM: n = 323 (21.9%)) completed all longitudinal assessments. Conclusions The CaMEO Study provides cross-sectional and longitudinal data that will contribute to our understanding of the course of migraine over one year and quantify variations in headache frequency, headache-related disability, comorbidities, treatments, and familial impact.

scholarly journals Suppression of Menstrual-Related Migraine Attack Severity Using Pyridoxine, Thiamine, and Cyanocobalamin: A Quasi-Experimental Within-Subject Design

2020 ◽  
Vol 7 (3) ◽  
Author(s):  
Mansoureh Togha ◽  
Reza Rahmanzadeh ◽  
Shiva Nematgorgani ◽  
Zahra Yari ◽  
Soodeh Razeghi Jahromi ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Large Scale ◽  
Final Analysis ◽  
Episodic Migraine ◽  
Headache Severity ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Quasi Experimental ◽  
The Mean

Background: B-group vitamins can potentially contribute to migraine prophylaxis through various mechanisms. We conducted a quasi-experimental study to assess the efficacy and tolerability of a combination of vitamins B1, B6, and B12 (Neurobion) for prophylaxis of menstruation-related migraine attacks. Methods: Women diagnosed with menstrual-related migraine, both chronic and episodic headaches, were enrolled. The patients began Neurobion therapy one week before the menstruation cycle, and repeated the injection for three consecutive months; each ampoule contained 100 mg of vitamins B1 and B6 as well as 1000 μg of vitamin B12. Neurobion was used as an add-on therapy for patients receiving the same prophylactic therapy during the last two months before the start of the study. The outcome parameter examined the severity of menstrual-related migraine attacks on a 10-point visual analog scale (VAS). Results: Three hundred eighty-three patients (169 with chronic migraine and 214 with episodic migraine) were included in the final analysis. The patients received treatment with a combination of vitamins B1, B6, and B12 with positive results. The mean intensity of menstrual-related migraine attacks was reduced from 6.7 on the 10-point VAS to 3.2 (P < 0.001) in patients with chronic migraine. The mean severity of menstrual-related migraine attacks was also reduced from 7.2 to 3.7 in patients with episodic migraine (P < 0.001). There was no significant difference in the reduction of headache severity between the two groups of migraineurs (P = 0.985). Conclusions: Neurotropic vitamins, including pyridoxine, thiamine, and cyanocobalamin yielded significant reductions in the severity of menstrual-related migraine attacks. Neurobion as a combination of vitamins B1, B6, and B12 appears to be well-tolerated and beneficial as an adjuvant in treatment and prophylaxis of menstrual-related migraine attacks. Further large-scale trials with long-term follow-up will be required to confirm our results.

Episodic status migrainosus: A novel migraine subtype

Cephalalgia ◽  
2017 ◽  
Vol 38 (2) ◽  
pp. 304-311 ◽  
Author(s):  
Tarun D Singh ◽  
F Michael Cutrer ◽  
Jonathan H Smith
Keyword(s):  
Chronic Migraine ◽  
Age Of Onset ◽  
Case Series ◽  
Episodic Migraine ◽  
Attack Frequency ◽  
High Tendency ◽  
Migraine Headaches ◽  
High Conversion Rate ◽  
Status Migrainosus ◽  
Nosologic Entity

Objective To report a case series of a novel migraine subtype, which we term as episodic status migrainosus (ESM), characterized by attacks of migraine exclusively lasting more than 72 hours. We hypothesized that this would represent a novel nosologic entity, possibly an unstable migraine phenotype with a high conversion rate to chronic migraine (CM). Methods We conducted a retrospective review of patients diagnosed with status migrainosus at the Mayo Clinic, Rochester, between January 2005 and December 2015. All the records were then manually reviewed for patients with migraine headaches exclusively lasting more than 72 hours. Results We identified 18 patients with ESM, with a female predominance (15(83.3%)) and a median age of onset of 16.5 (IQR 13–19) years. The median monthly attack frequency was two (IQR 1–3), with each attack lasting a median duration of seven (IQR 4–12.5) days. Stress was the most commonly reported precipitant (11 (61.1%)). Migraine with aura was common (10 (55.6%)), as was comorbid depression (10 (55.6%)). Fifteen (83.3%) patients developed CM at a median of 7.8 (IQR 2.6–21.9) years from their first attack. There was no significant association between the time to the development of chronic migraine with either attack frequency or duration. Conclusions and relevance We report the existence of a novel migraine subtype, episodic status migrainosus. This migraine subtype appears to have similar clinical characteristics to episodic migraine with or without aura, except for a notably high tendency to progress to chronic migraine.

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