Preventive migraine treatment with eptinezumab reduced acute headache medication and headache frequency to below diagnostic thresholds in patients with chronic migraine and medication‐overuse headache

Background: Eptinezumab is a preventive migraine treatment approved in the US. We evaluated the impact of eptinezumab on acute headache medication (AHM) use in patients diagnosed with chronic migraine (CM) and medication-overuse headache (MOH) in PROMISE-2. Methods: PROMISE-2 randomized patients with CM to eptinezumab 100mg, 300mg, or placebo for 2 intravenous doses administered every 12 weeks. Trained investigators diagnosed MOH at screening using 3-month medication history and ICHD-3b criteria. Endpoints included days/month of any AHM use (days of ≥1 medication class), total AHM use (summed days for each medication class), and triptan use over Weeks 1-12 and 13-24. AHM classes included triptan, ergot, opioid, simple analgesic, and combination analgesic. Results: Of 1072 PROMISE-2 patients, 431 (40.2%) were diagnosed with MOH (100mg, n=139; 300mg, n=147; placebo, n=145). During the 28-day baseline period, mean days of any AHM was ~16.4, total AHM was ~20.4, and triptan was ~8.9 across treatment arms. Over Weeks 1-12, mean days/month of any AHM was 8.8 (100mg), 9.9 (300mg), and 11.8 (placebo); total AHM was 10.8, 12.2, and 14.8; triptan was 4.3, 4.4, and 6.4. Similar or lower rates were observed over Weeks 13-24. Conclusions: In patients diagnosed with both CM and MOH, eptinezumab treatment reduced AHM use.

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Chronic Migraine and Medication-Overuse Headache Through the Ages

Cephalalgia ◽

10.1111/j.1468-2982.2005.00868.x ◽

2005 ◽

Vol 25 (5) ◽

pp. 378-390 ◽

Cited By ~ 26

Author(s):

CJ Boes ◽

DJ Capobianco

Keyword(s):

Chronic Migraine ◽

English Language ◽

Medication Overuse ◽

International Headache Society ◽

Medication Overuse Headache ◽

Headache Frequency ◽

Ihs Criteria ◽

Acute Headache

We set out to review early descriptions of chronic migraine and medication-overuse headache. The International Headache Society (IHS) recently gave criteria for chronic migraine and medication-overuse headache. Chronic migraine was absent from the 1988 IHS criteria. Peters and Horton described ergotamine-overuse headache in 1951. In the 1980s it was more fully appreciated that overuse of other acute headache medications could increase headache frequency. We reviewed published English-language papers and book chapters. Willis (1672), Oppenheim (1900), Collier (1922), Balyeat (1933), and von Storch (1937) all described chronic migraine. Lennox (1934), O'Sullivan (1936), Silfverskiöld (1947), Graham (1955), Friedman (1955), and Lippman (1955) wrote about ergotamine-overuse headache. Graham (1955), Friedman (1955), Lippman (1955), and Horton and Peters (1963) outlined withdrawal protocols. Chronic migraine has been mentioned in the literature for centuries, while medication-overuse headache has been written about for decades. Graham, Friedman, and Lippman deserve credit for separately reporting the first ergotamine withdrawal programmes.

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Medication-overuse headache

Practical Neurology ◽

10.1136/practneurol-2018-002048 ◽

2019 ◽

Vol 19 (5) ◽

pp. 399-403 ◽

Cited By ~ 6

Author(s):

Benjamin R Wakerley

Keyword(s):

Preventive Measures ◽

Medication Overuse ◽

Medication Overuse Headache ◽

Treatment Strategies ◽

Primary Headache ◽

Current Treatment ◽

Migraine Treatment ◽

General Neurology ◽

Acute Headache ◽

Acute Migraine Treatment

Medication-overuse headache is defined as headache occurring on more than 15days in a month in people with pre-existing primary headache, and developing as a consequence of regular overuse of acute headache treatments. Medication-overuse headache is common in general neurology clinics and can be difficult to manage. Most patients have a background of migraine, which has slowly transformed over months and years from the episodic to chronic form; with this comes an increased use of acute migraine treatment. This paper identifies who is at risk of developing medication-overuse headache, and reviews preventive measures and current treatment strategies.

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A prospective pilot study of the effect on catecholamines of mindfulness training vs pharmacological prophylaxis in patients with chronic migraine and medication overuse headache

Cephalalgia ◽

10.1177/0333102418801584 ◽

2018 ◽

Vol 39 (5) ◽

pp. 655-664 ◽

Cited By ~ 10

Author(s):

Licia Grazzi ◽

Alberto Raggi ◽

Domenico D’Amico ◽

Emanuela Sansone ◽

Matilde Leonardi ◽

...

Keyword(s):

Treatment Group ◽

Chronic Migraine ◽

Medication Overuse ◽

Medication Overuse Headache ◽

Headache Frequency ◽

Pharmacological Prophylaxis ◽

Prophylaxis Group ◽

Medication Intake ◽

Tyrosine Metabolism ◽

History Of

Aim To address whether, in patients with chronic migraine and medication overuse headache, mindfulness-based treatment is associated with changes in plasma levels of catecholamines and elusive amines that are similar to those observed in patients undergoing pharmacological prophylaxis. Methods In this non-randomized, clinic-based effectiveness study, patients aged 18–65, with a history of chronic migraine ≥ 10 years and overuse of triptans or non-steroidal anti-inflammatory drugs ≥ 5 years, were enrolled. Upon completion of a structured withdrawal program, patients received either pharmacological prophylaxis or six weekly sessions of mindfulness-based treatment and were followed for 12 months. Daily headache diaries were used to record headache frequency and medication intake; catecholamines (noradrenaline, epinephrine and dopamine) and levels of elusive amines were assayed from poor platelet plasma. Results Complete follow-up data were available for 15 patients in the pharmacological prophylaxis-group (14 females, average age 44.1) and 14 in the mindfulness treatment-group (all females, average age 46.4), and all variables were comparable between groups at baseline. At 12 months, significant improvement ( p < .001) was found in the pharmacological prophylaxis group for headache frequency and medication intake (by 51% and 48.7%, respectively), noradrenaline, epinephrine and dopamine (by 98.7%, 120.8% and 501.9%, respectively); patients in the mindfulness treatment-group performed similarly. For elusive amines, no longitudinal changes were found. Conclusions The similar improvement trends observed in the two groups of patients further support the utility of mindfulness-based treatment in migraine care, and reinforce the hypothesis that alteration and normalization of tyrosine metabolism are implicated in migraine chronification and in remission of chronic migraine.

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Headache characteristics and burden from chronic migraine with medication overuse headache: Cross‐sectional observations from the Medication Overuse Treatment Strategy trial

Headache The Journal of Head and Face Pain ◽

10.1111/head.14056 ◽

2021 ◽

Author(s):

Todd J. Schwedt ◽

Joseph G. Hentz ◽

Soma Sahai‐Srivastava ◽

Nicole M. Spare ◽

Vincent T. Martin ◽

...

Keyword(s):

Chronic Migraine ◽

Treatment Strategy ◽

Medication Overuse ◽

Medication Overuse Headache ◽

Cross Sectional

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Discontinuation of Medication Overuse in Headache Patients: Recovery of Therapeutic Responsiveness

Cephalalgia ◽

10.1111/j.1468-2982.2006.01190.x ◽

2006 ◽

Vol 26 (10) ◽

pp. 1192-1198 ◽

Cited By ~ 129

Author(s):

P Zeeberg ◽

J Olesen ◽

R Jensen

Keyword(s):

Drug Withdrawal ◽

Medication Overuse ◽

Medication Overuse Headache ◽

Headache Frequency ◽

Female Ratio ◽

Headache Centre ◽

Before And After ◽

Male Female Ratio ◽

Few Data ◽

Almost All

It is generally accepted that ongoing medication overuse nullifies the effect of prophylactic treatment, although few data support this contention. We set out to describe the treatment outcome in patients withdrawn from medication overuse and relate any improvement to a renewed effect of prophylaxis. For patients with probable medication-overuse headache (pMOH), treated and dismissed from the Danish Headache Centre in 2002 and 2003, we assed, from prospective headache diaries, the headache frequency before and after withdrawal of offending drugs and compared these frequencies with the headache frequency at dismissal. Among 1326 patients, 337 had pMOH. Eligible were 175, mean age 49 years, male/female ratio 1: 2.7. Overall, there was a 46% decrease in headache frequency from the first visit to dismissal ( P < 0.0001). Patients with no improvement 2 months after complete drug withdrawal ( N = 88) subsequently responded to pharmacological and/or non-pharmacological prophylaxis with a 26% decrease in headache frequency as measured from the end of withdrawal to dismissal ( P < 0.0001). At dismissal, 47% were on prophylaxis. Former non-responders to medical prophylaxis had a 49% decrease in headache frequency from first visit to dismissal ( P < 0.0001), whereas those who had never received prophylaxis had a 56% reduction ( P < 0.0001). This difference was not statistically significant ( P = 0.22). Almost all MOH patients benefit from drug withdrawal, either just from the withdrawal or by transformation from therapeutic non-responsiveness to responsiveness. According to the International Classification of Headache Disorders, 2nd edn, the MOH diagnosis requires improvement after drug withdrawal. Our data suggest that these diagnostic criteria are too strict.

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Treatment of medication-overuse headache: A systematic review

Cephalalgia ◽

10.1177/0333102415593088 ◽

2015 ◽

Vol 36 (4) ◽

pp. 371-386 ◽

Cited By ~ 72

Author(s):

Chia-Chun Chiang ◽

Todd J Schwedt ◽

Shuu-Jiun Wang ◽

David W Dodick

Keyword(s):

Medication Overuse ◽

Medication Overuse Headache ◽

Treatment Strategies ◽

Preventive Treatment ◽

Early Discontinuation ◽

Level Of Evidence ◽

Preventive Medication ◽

Long Term Prognosis ◽

Acute Headache

Introduction The objective of this review is to provide an evidence-based discussion of different treatment strategies for medication-overuse headache (MOH). Method We searched PubMed for articles discussing the treatment and prognosis of MOH published between 2004 and August 2014. Titles, abstract and articles were reviewed systematically. The level of evidence provided by each study of the included articles was determined according to the American Academy of Neurology Clinical practice guideline manual. We discuss the level of evidence to support the early discontinuation/withdrawal of overused medications, the level of evidence to support the use of preventive treatment, the short- and long-term prognosis, and the outcome according to the class of drug overused in patients diagnosed with MOH. Results The initial search resulted in 1313 articles; 68 articles met our inclusion criteria and were discussed. The level of evidence to support early discontinuation of overused medications alone is low due to the absence of controlled studies. Adding preventive medication to early discontinuation led to a better outcome than early discontinuation alone. For patients with chronic migraine (CM) and medication overuse (MO), there are large randomized control trials supporting the use of onabotulinumtoxinA and topiramate without early discontinuation of overuse; however, the evidence is limited since data were obtained from post hoc analysis. Conclusion Considering current available evidence and the systemic toxicity of overusing acute headache medication, we suggest discontinuation of the overused medication with the addition of preventive medication. Appropriately sized, randomized controlled trials evaluating the safety and long-term efficacy of preventive medication plus early discontinuation of overuse vs preventive medication alone vs early discontinuation of overuse alone are needed.

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HLA class I alleles are associated with clinic-based migraine and increased risks of chronic migraine and medication overuse

Cephalalgia ◽

10.1177/0333102420902228 ◽

2020 ◽

Vol 40 (5) ◽

pp. 493-502

Author(s):

Claire Huang ◽

Shih-Pin Chen ◽

Yu-Han Huang ◽

Hsuan-Yu Chen ◽

Yen-Feng Wang ◽

...

Keyword(s):

Human Leukocyte Antigen ◽

Chronic Migraine ◽

Medication Overuse ◽

Medical Center ◽

Medication Overuse Headache ◽

Human Leukocyte ◽

Population Based ◽

Class I ◽

Leukocyte Antigen ◽

Antigen B

Objective We aimed to evaluate associations of human leukocyte antigen variants with migraine or headache in hospital and population-based settings. Methods The case-control study population, aged 30–70, included 605 clinic-based migraine patients in a medical center and 8449 population-based participants in Taiwan Biobank (TWB). Clinic-based cases were ascertained by neurologists. Participants in Taiwan Biobank were interviewed by a structured questionnaire including headache and migraine history; among them, 2394 had headache or migraine history while 6055 were free of headache and served as controls. All subjects were genotyped by Axiom Genome-Wide Single Nucleotide Polymorphism Arrays and imputed for eight classical human leukocyte antigen genes. Human leukocyte antigen frequencies were compared between clinic-based and self-reported patients and controls. We utilized likelihood ratio tests to examine human leukocyte antigen-disease associations and logistic regressions to estimate the effect of human leukocyte antigen alleles on migraine. Results Human leukocyte antigen -B and C showed significant associations with clinic-based migraine ( q-value < 0.05). Human leukocyte antigen -B*39:01, human leukocyte antigen -B*51:01, human leukocyte antigen -B*58:01 and human leukocyte antigen -C*03:02 were significantly associated with migraine, with age and sex-adjusted odds ratios (95% CIs) of 1.80 (1.28–2.53), 1.50 (1.15–1.97), 1.36 (1.14–1.62) and 1.36 (1.14–1.62), correspondingly. Clinic-based migraineurs carrying human leukocyte antigen -B*58:01 or human leukocyte antigen -C*03:02 had 1.63 (1.11–2.39) -fold likelihood to have chronic migraine with medication-overuse headache compared to episodic migraine. However, no human leukocyte antigen genes were associated with self-reported headache or migraine in the community. Conclusions Human leukocyte antigen class I genetic variants are positively associated with risk of clinic-based migraine but not self-reported migraine or headache and may contribute to migraine chronification and medication overuse.

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Effectiveness of erenumab in chronic migraine patients with associated medication overuse headache: a prospective observational study

Neurological Sciences ◽

10.1007/s10072-020-04690-1 ◽

2020 ◽

Vol 41 (S2) ◽

pp. 509-510

Author(s):

Marcella Curone ◽

Vincenzo Tullo ◽

Gennaro Bussone

Keyword(s):

Observational Study ◽

Chronic Migraine ◽

Prospective Observational Study ◽

Medication Overuse ◽

Medication Overuse Headache

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Increased cerebral responses to salient transitions between alternating stimuli in chronic migraine with medication overuse headache and during migraine attacks

Cephalalgia ◽

10.1177/0333102418825359 ◽

2019 ◽

Vol 39 (8) ◽

pp. 988-999 ◽

Cited By ~ 2

Author(s):

Volodymyr B Bogdanov ◽

Olena V Bogdanova ◽

Alessandro Viganò ◽

Quentin Noirhomme ◽

Steven Laureys ◽

...

Keyword(s):

Healthy Volunteers ◽

Chronic Migraine ◽

Medication Overuse ◽

Medication Overuse Headache ◽

Blood Oxygenation Level Dependent ◽

Pain Modulation ◽

Blood Oxygenation ◽

Blood Oxygenation Level ◽

Oxygenation Level ◽

Headache Patients

Introduction In a previous study exploring central pain modulation with heterotopic stimuli in healthy volunteers, we found that transitions between sustained noxious and innocuous thermal stimulations on the foot activated the “salience matrix”. Knowing that central sensory processing is abnormal in migraine, we searched in the present study for possible abnormalities of these salient transitional responses in different forms of migraine and at different time points of the migraine cycle. Methods Participants of both sexes, mostly females, took part in a conditioned pain modulation experiment: Migraineurs between (n = 14) and during attacks (n = 5), chronic migraine patients with medication overuse headache (n = 7) and healthy volunteers (n = 24). To evoke the salience response, continuous noxious cold or innocuous warm stimulations were alternatively applied on the right foot. Cerebral blood oxygenation level dependent responses were recorded with fMRI. Results Switching between the two stimulations caused a significant transition response in the “salience matrix” in all subject groups (effect of the condition). Moreover, some group effects appeared on subsequent post-hoc analyses. Augmented transitional blood oxygenation level dependent responses in the motor cortex and superior temporal sulcus were found in two patient groups compared to healthy controls: chronic migraine with medication overuse headache patients and migraineurs recorded during an attack. In chronic migraine with medication overuse headache patients, salience-related responses were moreover greater in the premotor cortex, supplementary motor area, lingual gyrus and dorso-medial prefrontal cortex and other “salience matrix” areas, such as the anterior cingulate and primary somatosensory cortices. Conclusion This study shows salience-related hyperactivation of affective and motor control areas in chronic migraine with medication overuse headache patients and, to a lesser extent, in episodic migraine patients during an attack. The greater extension of exaggerated blood oxygenation level dependent responses to unspecific salient stimuli in chronic migraine with medication overuse headache than during a migraine attack could be relevant for headache chronification.

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