New Appendix Criteria Open for a Broader Concept of Chronic Migraine

Cephalalgia ◽  
2006 ◽  
Vol 26 (6) ◽  
pp. 742-746 ◽  
Author(s):  
J Olesen ◽  
M-G Bousser ◽  
H-C Diener ◽  
D Dodick ◽  
M First ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Ergot Alkaloids ◽  
Primary Headache ◽  
Scientific Evaluation ◽  
Combined Use ◽  
International Headache Classification ◽  
New Criteria

After the introduction of chronic migraine and medication overuse headache as diagnostic entities in The International Classification of Headache Disorders, Second Edition, ICHD-2, it has been shown that very few patients fit into the diagnostic criteria for chronic migraine (CM). The system of being able to use CM and the medication overuse headache (MOH) diagnosis only after discontinuation of overuse has proven highly unpractical and new data have suggested a much more liberal use of these diagnoses. The International Headache Classification Committee has, therefore, worked out the more inclusive criteria for CM and MOH presented in this paper. These criteria are included in the appendix of ICHD-2 and are meant primarily for further scientific evaluation but may be used already now for inclusion into drug trials, etc. It is now recommended that the MOH diagnosis should no longer request improvement after discontinuation of medication overuse but should be given to patients if they have a primary headache plus ongoing medication overuse. The latter is defined as previously, i.e. 10 days or more of intake of triptans, ergot alkaloids mixed analgesics or opioids and 15 days or more of analgesics/NSAIDs or the combined use of more than one substance. If these new criteria for CM and MOH prove useful in future testing, the plan is to include them in a future revised version of ICHD-2.

scholarly journals Pathophysiology of medication overuse headache: Insights and hypotheses from preclinical studies

Cephalalgia ◽  
2011 ◽  
Vol 31 (7) ◽  
pp. 851-860 ◽  
Author(s):  
Ian D Meng ◽  
David Dodick ◽  
Michael H Ossipov ◽  
Frank Porreca
Keyword(s):  
Migraine Headache ◽  
Potential Role ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Ergot Alkaloids ◽  
Opioid Analgesics ◽  
Primary Headache ◽  
Frequent Use ◽  
Underlying Mechanisms ◽  
Pain Inhibition

Introduction: Medication overuse headache (MOH) is a clinical concern in the management of migraine headache. MOH arises from the frequent use of medications used for the treatment of a primary headache. Medications that can cause MOH include opioid analgesics as well as formulations designed for the treatment of migraine, such as triptans, ergot alkaloids, or drug combinations that include caffeine and barbiturates. Literature review: Gathering evidence indicates that migraine patients are more susceptible to development of MOH, and that prolonged use of these medications increases the prognosis for development of chronic migraine, leading to the suggestion that similar underlying mechanisms may drive both migraine headache and MOH. In this review, we examine the link between several mechanisms that have been linked to migraine headache and a potential role in MOH. For example, cortical spreading depression (CSD), associated with migraine development, is increased in frequency with prolonged use of topiramate or paracetamol. Conclusions: Increased CGRP levels in the blood have been linked to migraine and elevated CGRP can be casued by prolonged sumatriptan exposure. Possible mechanisms that may be common to both migraine and MOH include increased endogenous facilitation of pain and/or diminished diminished endogenous pain inhibition. Neuroanatomical pathways mediating these effects are examined.

The International Classification of Headache Disorders Revised Criteria for Chronic Migraine—Field Testing in a Headache Specialty Clinic

Cephalalgia ◽  
2007 ◽  
Vol 27 (3) ◽  
pp. 230-234 ◽  
Author(s):  
ME Bigal ◽  
AM Rapoport ◽  
FD Sheftell ◽  
SJ Tepper ◽  
RB Lipton
Keyword(s):  
Chronic Migraine ◽  
Medication Overuse ◽  
International Headache Society ◽  
Medication Overuse Headache ◽  
Biological Marker ◽  
International Classification ◽  
Headache Disorders ◽  
Transformed Migraine ◽  
Probable Migraine

In the absence of a biological marker and expert consensus on the best approach to classify chronic migraine (CM), recent revised criteria for this disease has been proposed by the Headache Classification Committee of the International Headache Society. This revised criteria for CM is now presented in the Appendix. Herein we field test the revised criteria for CM. We included individuals with transformed migraine with or without medication overuse (TM+ and TM-), according to the criteria proposed by Silberstein and Lipton, since this criterion has been largely used before the Second Edition of the International Classification of the Headache Disorders (ICHD-2). We assessed the proportion of subjects that fulfilled ICHD-2 criteria for CM or probable chronic migraine with probable medication overuse (CM+), as well as the revised ICHD-2 (ICHD-2R) criteria for CM (≥15 days of headache, ≥8 days of migraine or migraine-specific acute medication use—ergotamine or triptans). We also tested the ICHD-2R vs. three proposals. In proposal 1, CM/CM+ would require at least 15 days of migraine or probable migraine per month. Proposal 2 required ≥15 days of headache per month and at least 50% of these days were migraine or probable migraine. Proposal 3 required ≥15 days of headache and at least 8 days of migraine or probable migraine per month. Of the 158 patients with TM-, just 5.6% met ICHD-2 criteria for CM. According to the ICHD-2R, a total of 92.4% met criteria for CM ( P < 0.001 vs. ICHD-2). The ICHD-2R criterion performed better than proposal 1 (47.8% of agreement, P < 0.01) and was not statistically different from proposals 2 (87.9%) and 3 (94.9%). Subjects with TM+ should be classified as medication overuse headache (MOH), and not CM+, according to the ICHD-2R. Nonetheless, we assessed the proportion of them who had ≥8 days of migraine per month. Of the 399 individuals with TM+, just 10.2% could be classified as CM+ in the ICHD-2. However, most (349, 86.9%) had ≥8 days of migraine per month and could be classified as MOH and probable CM in the ICHD-2R ( P < 0.001 vs. ICHD-2). We conclude that the ICHD-2R addresses most of the criticism towards the ICHD-2 and should be adopted in clinical practice and research. In the population where use of specific acute migraine medications is less common, the agreement between ICHD-2R CM and TM may be less robust.

Chronic Migraine and Medication Overuse Headache: Clarifying the Current International Headache Society Classification Criteria

Cephalalgia ◽  
2009 ◽  
Vol 29 (4) ◽  
pp. 445-452 ◽  
Author(s):  
C Sun-Edelstein ◽  
ME Bigal ◽  
AM Rapoport
Keyword(s):  
Chronic Migraine ◽  
Medication Overuse ◽  
International Headache Society ◽  
Medication Overuse Headache ◽  
Classification Criteria ◽  
Daily Headache ◽  
Considerable Controversy ◽  
Chronic Daily Headaches ◽  
International Headache Society Classification

Despite the recent advances in the understanding and classification of the chronic daily headaches, considerable controversy still exists regarding the classification of individual headaches, including chronic migraine (CM) and medication overuse headache (MOH). The original criteria, published in 2004, were difficult to apply to most patients with these disorders and were subsequently revised, resulting in broader clinical applicability. Nonetheless, they remain a topic of debate, and the revisions to the criteria have further added to the confusion. Even some prominent headache specialists are unsure which criteria to use. We aimed to explain the nature of the controversies surrounding the entities of CM and MOH. A clinical case will be used to illustrate some of the problems faced by clinicians in diagnosing patients with chronic daily headache.

Clinical Features of Probable Medication-Overuse Headache: A Retrospective Study in Japan

Cephalalgia ◽  
2007 ◽  
Vol 27 (9) ◽  
pp. 1020-1023 ◽  
Author(s):  
N Imai ◽  
E Kitamura ◽  
T Konishi ◽  
Y Suzuki ◽  
M Serizawa ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Chronic Migraine ◽  
Clinical Picture ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Primary Headache ◽  
Tension Type Headache ◽  
Headache Type ◽  
Combination Analgesics ◽  
Type Headache

This study examined the clinical picture of probable medication-overuse headache (MOH) and the presence of any features peculiar to Japan. In a retrospective study of 47 patients, type of primary headache, type of medicine overused, method and result of withdrawal were investigated. Among the 47 patients, 80.9% had migraine only, and 85.1% overused combination medications. While 36 patients (76.6%) succeeded in withdrawal, five patients (10.6%) failed. One patient (2.1%) had not improved by 2 months after withdrawal and was diagnosed with chronic migraine and chronic tension-type headache without MOH. The remaining five patients (10.6%) dropped out. All dropout patients were recommended abrupt inpatient withdrawal, but chose abrupt outpatient withdrawal. As features peculiar to Japan, many patients with probable MOH overused combination analgesics, particularly females.

Outcome of Medication Overuse Headache after Abrupt in-Patient withdrawal

Cephalalgia ◽  
2006 ◽  
Vol 26 (5) ◽  
pp. 589-596 ◽  
Author(s):  
G Relja ◽  
A Granato ◽  
A Bratina ◽  
RM Antonello ◽  
M Zorzon
Keyword(s):  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Primary Headache ◽  
Drug Intake ◽  
Patient Withdrawal ◽  
Abrupt Discontinuation ◽  
Medication Abuse ◽  
Daily Headache ◽  
Mean Time

One hundred and one patients suffering from chronic daily headache (CDH) and medication overuse were treated, in an in-patient setting, with abrupt discontinuation of the medication overused, intravenous hydrating, and intravenous administration of benzodiazepines and ademetionine. The mean time to CDH resolution was 8.8 days. The in-patient withdrawal protocol used was effective, safe and well tolerated. There was a trend for a shorter time to CDH resolution in patients who overused triptans ( P = 0.062). There was no correlation between time to CDH resolution and either the type of initial primary headache or duration of medication abuse, whereas time to CDH resolution was related to daily drug intake ( P = 0.01). In multiple regression analysis, daily drug intake, age and type of medication overused were independent predictors of time to CDH resolution. At 3-months' follow-up, no patient had relapsed and was again overusing symptomatic medications.

Case series of sixteen patients with nummular headache

Cephalalgia ◽  
2010 ◽  
Vol 30 (12) ◽  
pp. 1527-1530 ◽  
Author(s):  
Justin Moon ◽  
Kamran Ahmed ◽  
Ivan Garza
Keyword(s):  
Medication Overuse ◽  
Age Of Onset ◽  
Medication Overuse Headache ◽  
Case Series ◽  
Primary Headache ◽  
Headache Disorder ◽  
Therapeutic Interventions ◽  
Nummular Headache ◽  
Primary Headache Disorder ◽  
History Of

Introduction: Nummular headache is a rare primary headache disorder described by a focal circumscribed area of pain (2–6 cm in diameter). Literature on this disorder is sparse. Patients and methods: Here, we describe a case series of 16 patients (6 men, 10 women) seen at the Mayo Clinic. Results: Mean age of onset was 50 years (range, 19–79 years) and mean duration of headache was 7.9 years (range, 0.33–40 years). Location of headache varied and was found to be an average of 3.9 cm in diameter (range, 2–10 cm). Headache was episodic (<15 days/month) in four patients and chronic (>15 days/month) in 12 patients. Attention was paid to therapeutic interventions. Resolution was seen in 38% of patients. Migraine was present in the history of 56% of patients and medication overuse headache was found in 25%. Conclusions: Our series results support previous findings. In our population, no specific therapy was identified to be effective in more than one patient.

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

Cephalalgia ◽  
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.

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

Cephalalgia ◽  
2019 ◽  
Vol 39 (8) ◽  
pp. 988-999 ◽  
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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