scholarly journals Migraine: features of pharmacotherapeutic and drug-free preventive treatment

2021 ◽  
Vol 17 (5) ◽  
pp. 58-66
Author(s):  
A.V. Demchenko ◽  
D.N. Aravitska
Keyword(s):  
Chronic Migraine ◽  
Heart Attack ◽  
Botulinum Toxin Type A ◽  
Preventive Therapy ◽  
Migraine Treatment ◽  
Angiotensin Ii Receptor ◽  
Severe Nausea ◽  
Drug Induced ◽  
Therapeutic Exercises ◽  
Greater Occipital Nerve

Migraine is one of the most common forms of headache, which can lead to a significant reduction in quality of life. There is migraine with aura, migraine without aura, as well as chronic migraine, which significantly reduces the efficiency of patients and is often combined with mental disorders and drug-induced headaches. Complications of migraine include migraine status, persistent aura without a heart attack, migraine heart attack (stroke) and epileptic seizure caused by migraine aura. The diagnosis of migraine is established based on complaints, medical history, objective examination data, and diagnostic criteria of the International Headache Classification of the 3rd revision. Additional research methods are recommended only in the presence of “red flags” — symptoms that alert to the secondary nature of the headache. Migraine treatment is aimed at reducing the frequency and intensity of attacks, reducing the number of pharmatherapeutical analgesics. It includes three main approaches: seizure relief therapy, preventive therapy, and non-drug methods. Non-steroidal anti-inflammatory drugs, simple and combined analgesics, triptans, as well as anti-nausea drugs (for severe nausea or vomiting) are recommended for seizures relief. In case of frequent or severe migraine attacks, as well as in case of chronic migraine, prophylactic therapy is indicated, which includes antidepressants, topiramate, beta-blockers, angiotensin II receptor antagonists, botulinum toxin type A-hemagglutinin complex and monoclonal antibodies to calcitonin gene-related peptide receptors. Pharmacotherapy is recommended to be combined with non-drug methods, which include cognitive-behavioral therapy, the method of transcranial magnetic stimulation, the method of biological feedback, postsphygmic period, acupuncture, therapeutic exercises, block of greater occipital nerve, and stimulation of the first trigeminal nerve.

scholarly journals Diagnosis and treatment of migraine: Russian experts' recommendations

2020 ◽  
Vol 12 (4) ◽  
pp. 4-14
Author(s):  
E. G. Filatova ◽  
V. V. Osipova ◽  
G. R. Tabeeva ◽  
V. A. Parfenov ◽  
E. V. Ekusheva ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Lifestyle Modification ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Behavioral Therapy ◽  
Botulinum Toxin Type A ◽  
Preventive Therapy ◽  
Migraine Treatment ◽  
Therapeutic Exercises ◽  
Greater Occipital Nerve ◽  
Stimulation Of

Migraine is one of the most common types of headache, which can lead to a significant decrease in quality of life. Researchers identify migraine with aura, migraine without aura, and chronic migraine that substantially reduces the ability of patients to work and is frequently concurrent with mental disorders and drug-induced headache. The complications of migraine include status migrainosus, persistent aura without infarction, migrainous infarction (stroke), and a migraine aura-induced seizure. The diagnosis of migraine is based on complaints, past medical history, objective examination data, and the diagnostic criteria as laid down in the International Classification of Headache Disorders, 3 rd edition. Add-on trials are recommended only in the presence of red flags, such as the symptoms warning about the secondary nature of headache. Migraine treatment is aimed at reducing the frequency and intensity of attacks and the amount of analgesics taken. It includes three main approaches: behavioral therapy, seizure relief therapy, and preventive therapy. Behavioral therapy focuses on lifestyle modification. Nonsteroidal anti-inflammatory drugs, simple and combined analgesics, triptans, and antiemetic drugs for severe nausea or vomiting are recommended for seizure relief. Preventive therapy which includes antidepressants, anticonvulsants, beta-blockers, angiotensin II receptor antagonists, botulinum toxin type A-hemagglutinin complex and monoclonal antibodies to calcitonin gene-related peptide or its receptors, is indicated for frequent or severe migraine attacks and for chronic migraine. Pharmacotherapy is recommended to be combined with non-drug methods that involves cognitive behavioral therapy; progressive muscle relaxation; mindfulness; biofeedback; post-isometric relaxation; acupuncture; therapeutic exercises; greater occipital nerve block; non-invasive high-frequency repetitive transcranial magnetic stimulation; external stimulation of first trigeminal branch; and electrical stimulation of the occipital nerves (neurostimulation).

scholarly journals Botulinum Toxin in the Treatment of Headache

Toxins ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 803
Author(s):  
Werner J. Becker
Keyword(s):  
Botulinum Toxin ◽  
Chronic Migraine ◽  
Mechanism Of Action ◽  
Recombinant Dna ◽  
Botulinum Toxin Type A ◽  
Preventive Treatment ◽  
Botulinum Toxin Type ◽  
Preventive Therapy ◽  
Ongoing Research ◽  
Recombinant Dna Techniques

Botulinum toxin type A has been used in the treatment of chronic migraine for over a decade and has become established as a well-tolerated option for the preventive therapy of chronic migraine. Ongoing research is gradually shedding light on its mechanism of action in migraine prevention. Given that its mechanism of action is quite different from that of the new monoclonal antibodies directed against calcitonin gene-related peptide (CGRP) or its receptor, it is unlikely to be displaced to any major extent by them. Both will likely remain as important tools for patients with chronic migraine and the clinicians assisting them. New types of botulinum toxin selective for sensory pain neurons may well be discovered or produced by recombinant DNA techniques in the coming decade, and this may greatly enhance its therapeutic usefulness. This review summarizes the evolution of botulinum toxin use in headache management over the past several decades and its role in the preventive treatment of chronic migraine and other headache disorders.

Cardiovascular Drugs: From Nitroglycerin to Lipitor

2006 ◽  
Author(s):  
Jie Jack Li
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Cardiovascular Diseases ◽  
High Blood Pressure ◽  
Heart Attack ◽  
Angiotensin Ii Receptor ◽  
Cardiac Events ◽  
Drug Induced ◽  
Heart Attacks ◽  
The 1960S

Cardiovascular diseases are the leading cause of death worldwide and are projected to remain in the lead through 2025. Heart-related diseases include angina, arrhythmia, atrial fibrillation, congestive heart failure, hypertension, atherosclerosis, myocardial infarction (heart attack), and sudden cardiac death. More than 300,000 Americans suffer sudden heart attacks each year. In addition, one of the more important recently identified drug-induced cardiac events, which has occasionally resulted in drugs being withdrawn, is drug-induced torsade des pointes. This is a rare, fatal arrhythmia that has been associated with some drugs that prolong the QT interval of the electrocardiogram (ECG). Hypertension is America’s number one chronic disease. Fifty million Americans, one in six, suffer from high blood pressure. Similarly, high blood pressure affects about one-sixth of the world’s population (1 billion people) worldwide—mostly in the developed world. If uncontrolled, it can lead to heart attack, heart failure, stroke, and other potentially fatal events. Great strides have been made during the past 50 years in conquering cardiovascular diseases. Cardiopulmonary resuscitation (CPR) was developed by a group of researchers at the Johns Hopkins University in 1961. The 1960s also saw the emergence of beta-blockers. Calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and statins appeared in the 1980s and the 1990s. Angiotensin II receptor blockers (ARBs) also emerged in the 1990s. The heart, about the size of a person’s fist, beats about 2.8 billion times in a lifetime, pumping blood and oxygen through the body. Although its function was shrouded in mystery for centuries, mankind has come a long way in understanding how the heart works anatomically and physiologically, although we haven’t made much progress in understanding its “emotional” nature. Greek philosopher and anatomist Aristotle (384–322 B.C.) was the founder of biology. He was very interested in human and animal anatomy, especially the cardiovascular systems in higher animals. In his books he described, for the first time, the human blood system with an emphasis on the deeper-lying vessels. He incorrectly believed that the heart was the organ in which emotions were generated, whereas the function of the brain was to cool the blood. More than 500 years later, the German-born Roman physician Galen (130–200 A.D.) made two revolutionary discoveries about the cardiovascular system.

scholarly journals Placebo effect in chronic migraine prevention. A systematic review

2020 ◽  
pp. 42
Author(s):  
Diego Swerts ◽  
Mario Peres
Keyword(s):  
Clinical Trials ◽  
Chronic Migraine ◽  
Placebo Effect ◽  
Meta Analysis ◽  
Botulinum Toxin Type A ◽  
Preventive Treatment ◽  
Botulinum Toxin Type ◽  
Migraine Treatment ◽  
Double Blind ◽  
Routes Of Administration

BackgroundThe preventive management of headaches has different routes of administration (Oral, Subcutaneous, Intravenous, and Application to the head). Placebo effect is a powerful determinant of health outcomes in several disorders, Meta-analysis of clinical trials in pain conditions such as fibromyalgia and osteoarthritis shows placebo effect can contribute to up to 75% of the overall treatment effect. The placebo effect on different routes of administration is poorly described. Thus, we seek to analyze in this meta-analysis the difference between the routes of administration in the placebo effect in the management of chronic migraine.MethodsWe conducted a meta-analysis with 8 randomized , double blind, Placebo Clinical trials, with 2498 persons. Men and Women over 18 who suffer from chronic migraine (over 15 migraine episodes per month for 3 months) without associated comorbidities. We compared those who received placeboadministered agent for preventive treatment of chronic migraine SC, EV or oral against those who received placebo-administered head injection. The primary outcome was reduction in the number of days with migraine in the month assessed at 12 weeks of treatment compared with baseline.ResultsOur study showed that placebo responses were greater when botulinum toxin type A was applied in the head, followed by intravenous injection of an anti-CGRP monoclonal antibody eptinezumab. Oral topiramate and subcutaneous Mabs had no difference, being inferior to other routes of administration. Also, our analysis shows that much of the effect of drugs in the treatment of migraine is still due to the high placebo effect, which contributes about 80% of the therapeutic gain.ConclusionsAdministration route affects placebo responses in CM preventive treatment but not therapeutic gain as much. Elucidating the underlying mechanisms that mediate placebo effect in migraine treatment is beneficial to clinical practice and drug development.

scholarly journals One-day combined botulinum toxin injections and pulsed radiofrequency of greater occipital nerve for treatment refractory chronic migraine

2020 ◽  
Author(s):  
Alexey Voloshin ◽  
I.V. Moiseeva
Keyword(s):  
Botulinum Toxin ◽  
Chronic Migraine ◽  
Botulinum Toxin Type A ◽  
Response To Treatment ◽  
Complete Regression ◽  
Outpatient Basis ◽  
Pulsed Radiofrequency ◽  
Botulinum Toxin Therapy ◽  
Greater Occipital Nerve ◽  
Refractory Chronic Migraine

Abstract Background. The aim of this study was to evaluate the potential of combined the greater occipital nerve’s (GON) pulsed radiofrequency (PRF) with botulinum toxin therapy procedures for treatment the refractory chronic migraine.Methods. We had 6 patients, all female, from 33 to 57 years old suffering from refractory chronic migraine (RCM) according to the European Headache proposed criteria. All patients had migraine from 5 to 44 years and refractory migraine from 1 to 10 years. Simultaneous one-day treatments were undertaken: first step - botulinum toxin type A injections in accordance with the PREEMPT protocol. Second step - the PRF stimulation on the bilateral GONs was performed under the guidance of ultrasound. The follow-up duration after the procedure was 6 months.Results. We had a positive response to treatment from all patients. As a result, we observed a dramatic reduction of pain intensity from 7±1 to 2±2 on NRS scale and, most importantly, a significant decrease in the number of days with headache from 22±5 to 4±4 during first month after treatment, with two patients (30% of patients) recording a complete regression of migraine attacks. None of the patients had any adverse effects.Conclusion. The simultaneous one-day use of PRF GON with botulinum toxin therapy may be a useful option for the treatment of refractory chronic migraine. The combined interventional procedures are effective, minimally invasive, inexpensive, safe, well tolerated and can be performed on an outpatient basis.

scholarly journals Enxaqueca Crónica e Refratária: Como Diagnosticar e Tratar

2020 ◽  
Vol 33 (11) ◽  
pp. 753
Author(s):  
Elsa Parreira ◽  
Isabel Luzeiro ◽  
José Maria Pereira Monteiro
Keyword(s):  
Chronic Migraine ◽  
Medication Overuse Headache ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
Migraine Treatment ◽  
The Novel ◽  
Personal Impact ◽  
Calcitonin Gene ◽  
Migraine Pathogenesis ◽  
Refractory Migraine

Migraine is highly prevalent and carries a significant personal, social and economic burden. It is the second cause of disability (years living with disability) worldwide and the first cause under 50 years of age. Chronic migraine (occurring for more than 15 days a month) and refractory migraine (treatment resistant), especially when there is also analgesic overuse, are the most disabling forms of migraine. These three disorders (chronic migraine, refractory migraine and medication overuse headache) are particularly difficult to treat. This article reviews their epidemiology, clinical presentation, diagnostic criteria, risk factors, comorbidities and social and personal impact. The therapeutic options available are discussed and focused on a multidisciplinary approach, non-pharmacological interventions treatment of comorbidities and avoiding analgesic overuse. Prophylactic treatments are mandatory and include the oral prophylactic treatments (topiramate), botulinum toxin type A and the novel monoclonal antibodies against calcitonin gene related peptide or its receptor, which are the first migraine preventive medicines developed specifically to target migraine pathogenesis. In refractory cases, multiple therapies are required including neurostimulation.

The efficacy of botulinum toxin type-A for intractable chronic migraine patients with no pain-free time

2021 ◽  
pp. 204946372110145
Author(s):  
Dominic Atraszkiewicz ◽  
Rieko Ito ◽  
Anish Bahra
Keyword(s):  
Botulinum Toxin ◽  
Chronic Migraine ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
Free Time ◽  
Phase Iii ◽  
Pharmacological Management ◽  
Sustained Reduction ◽  
New Onset

Aim: This is a retrospective report of the efficacy of botulinum toxin-A, Botox® (Allergan), in intractable chronic migraine patients non-responsive to previous pharmacological management and with largely no pain-free time, including those with new onset daily persistent headache. Methods: Thirty-three patients, all with severe Headache Impact Test (HIT)-6 scores at baseline, received 3-monthly injections of Botox® as per Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PRE-EMPT) protocol over a maximum 33-month period. Response criteria were a sustained reduction of HIT-6 scores below 60. Results: Four patients had headache on at least 20 days a month; the remaining patients had daily headache with no pain-free time, including nine patients with new onset persistent migraine. There was a significant reduction in HIT-6 scores following Botox® therapy ( x̅ = −5.45, p = 0.000920). Twenty-one percent of the cohort exhibited a sustained reduction in HIT-6 scores below 60. The number of headache days and pain-free time did not change in five of the six responders, but disability improved. There was no difference between patients with episodic migraine evolving to chronic as opposed to those with chronic migraine from onset. Conclusion: This report suggests that Botox® treatment is efficacious in intractable chronic migraine without pain-free time. The HIT-6 is a reliable and practical parameter to assess disability in this patient group. Use of such validated parameters should be considered with greater weight in future International Classification of Headache Disorders (ICHD) guidelines for controlled clinical trials.

scholarly journals Migraine Headache : An Overview

2010 ◽  
Vol 23 (1) ◽  
pp. 114-119
Author(s):  
ASM Hasan ◽  
Iftekhar Mahmood ◽  
MR Islam ◽  
MSI Khan ◽  
SM Ali ◽  
...  
Keyword(s):  
Migraine Headache ◽  
Botulinum Toxin Type A ◽  
Antihypertensive Agents ◽  
Opioid Analgesics ◽  
The Elderly ◽  
Botulinum Toxin Type ◽  
The United States ◽  
Treatment Modalities ◽  
Migraine Treatment ◽  
History Of

The history of headache can be traced almost to the beginning of the history of humankind. Among the many causes of it, migraine headache is a debilitating disorder affecting millions of people in the United States and worldwide. The diagnosis of migraine can significantly affect quality of life, health care costs and daily productivity. Hundreds of trials and many guidelines have documented various approaches to migraine management, whether via acute treatment or chronic migraine prophylaxis. Acute or abortive migraine management encompasses specific and nonspecific migraine therapeutics including non-opioid and opioid analgesics, triptans and ergotamines. Prophylactic migraine management data span the pharmacological spectrum from antiepileptic and antihypertensive agents to botulinum toxin type A. Special considerations for migraine management also must be applied in various populations including children, pregnant women and the elderly. Although hundreds of clinical trials are available regarding migraine treatment modalities, this review serves as an introduction to current accepted therapeutics for migraine treatment and an overview of pharmacological prophylaxis in the modern management of migraine. TAJ 2010; 23(1): 114-119

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