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Navigating life with migraine and other headaches
\"Navigating Life with Migraine and Other Headaches focuses on the many myths that exist around headaches and dispels common misperceptions by providing simple explanations on how headaches occur, and, most importantly, how to treat them. The authors give real, practical advice: when and how to manage your headaches, when to seek treatment, and when to be concerned. From vitamins to prescription meds; from when to go to the emergency department to optimizing doctor visits; options for managing headaches are presented in this accessible and easy-to-read resource. The more you know about headache, including the mechanisms that cause pain, the better you and your family can manage this common and chronic condition. Through the use of patient stories, a glossary of terms for easy reference, and key points for quick retention, this book is a high-quality resource for people looking for empowerment and a sense of control\"--Provided by publisher.
Book
Triggers, Protectors, and Predictors in Episodic Migraine
Purpose of Review
A wide variety of triggers prompt attacks in episodic migraine. Although experimental triggers such as glyceryl trinitrate reliably produce migraine, natural triggers are much less predictable and vary in importance between individuals. This review describes the most common triggers in episodic migraine and provides strategies for managing them in clinical practice.
Recent Findings
Multiple migraine attack triggers have been established based on patient surveys, diary studies, and clinical trials. Stress, menstrual cycle changes, weather changes, sleep disturbances, alcohol, and other foods are among the most common factors mentioned. Clinical studies have verified that fasting, premenstrual periods in women, “letdown” after stress, and most likely low barometric pressures are migraine triggers. Premonitory symptoms such as neck pain, fatigue, and sensitivity to lights, sounds, or odors may mimic triggers.
Summary
Multiple studies clearly demonstrate triggers in episodic migraine, often related to change in homeostasis or environment. Many common migraine triggers are not easily modifiable, and avoiding triggers may not be realistic. Healthy lifestyle choices such as exercise, adequate sleep, stress management, and eating regularly may prevent triggers and transformation to chronic migraine over time.
Journal Article
Episodic Migraine With and Without Aura: Key Differences and Implications for Pathophysiology, Management, and Assessing Risks
Purpose of Review
To review the pathophysiologic, epidemiologic, and clinical evidence for similarities and differences between migraine with and without aura.
Recent Findings
The ICHD-3 has recently refined the diagnostic criteria for aura to include positive symptomatology, which better differentiates aura from TIA. Although substantial evidence supports cortical spreading depression as the cause of visual aura, the role (if any) of CSD in headache pain is not well understood. Recent imaging evidence suggests a possible hypothalamic origin for a headache attack, but further research is needed. Migraine with aura is associated with a modest increase in the risk of ischemic stroke. The etiology for this association remains unclear. There is a paucity of evidence regarding treatments specifically aimed at the migraine with aura subtype, or whether migraine with vs without aura responds to treatment differently. Migraine with typical aura is therefore often treated similarly to migraine without aura. Lamotrigine, daily aspirin, and flunarizine have evidence for efficacy in prevention of migraine with aura, and magnesium, ketamine, furosemide, and single-pulse transcranial magnetic stimulation have evidence for use as acute treatments. Although triptans have traditionally been contraindicated in hemiplegic migraine and migraine with brainstem aura, this prohibition is being reconsidered in the face of evidence suggesting that use may be safe.
Summary
The debate as to whether migraine with and without aura are different entities is ongoing. In an era of sophisticated imaging, genetic advancement, and ongoing clinical trials, efforts to answer this question are likely to yield important and clinically meaningful results.
Journal Article
3468 Real-world retrospective safety analysis in patients treated with onabotulinumtoxinA for multiple therapeutic indications over repeat treatment periods
BackgroundLong-term real-world safety and utilization data are limited for onabotA treatment of concomitant multiple indications.MethodsSYNCHRONIZE, a retrospective chart review study conducted at 10 US clinics, evaluated onabotA safety for ≥2 different therapeutic indications within 3-month treatment periods(TPs) in adults. This analysis evaluated safety of onabotA for up to seven repeat TPs within 24months.Results279 patients were treated for ≥2 therapeutic indications across all treatment indication combination groups analyzed (Period1; mean age, 49.2y; 79% female;56% White) with a gradual decrease to 80 patients during the last TP (Period7). Mean onabotA treatments over the study period was9.3 (range 2–48); the most common indications combination was cervical dystonia and chronic migraine (range 34–44%). Compared to baseline, no significant change in comorbidities and concomitant medications were observed over repeat TPs. In total, 28.7%(80/279) patients reported ≥1 treatment-emergent adverse event (TEAE) after Period1; proportion remained consistent; 29.7%, 29.6%, and 31.3% after Periods 3, 5 and 7, respectively.Common TEAEs across all TPs were UTI (range 0.7–5.7%), neck pain (3.7–9.1%), headache (2.9–6.5%), and migraine (2.5–6.4%). Most patients had a dosage interval of ≤24h (62–98%). Most patients received ≥200-<400U of cumulative 3-months onabotA dose (43–50%) with mean total 3-month dose ranging from 232–287U. There was no apparent trend between TEAE incidence and dosage intervals or cumulative 3-month dose. No patients were determined to have lack of effect.ConclusionOnabotA demonstrated consistent safety with no new signals observed in patients treated concomitantly for ≥2 therapeutic indications over repeat treatments up to 24months.
Journal Article
113 Incidence of migraine and treatment patterns in UK primary care
ObjectivesTo estimate the incidence of migraine and describe treatment patterns for an indicative year.MethodsPatients ≥18 years old in the Clinical Practice Research Datalink with an incident diagnosis of migraine between 01/04/2007–31/07/2017. The incidence of migraine was estimated. Treatment groups were categorised as none, acute only, prophylactic only, acute and prophylactic. 12-month treatment patterns amongst patients initiating prophylactic treatment with amitriptyline, propranolol or topiramate were classified as continuous use, augmentation, switching or discontinuation. Treatment adherence was defined as medication possession ratio (MPR); patients were ‘adherent’ if their MPR was ≥0.80.Results89,442 patients with incident migraine were included. Mean age at diagnosis was 40 years [SD 15]; 76.6% were females. The cumulative incidence of migraine rate was 25.8/10,000 person-years [95%CI: 25.6–26.0]. 86.7% of patients received prophylactic and/or acute treatment; 37.6% and 20.1% had received ≥2 and ≥3 prophylactic treatments, respectively.1,636 patients initiated prophylactic treatment in 2015. Propranolol (47.8%) and amitriptyline (47.4%) were most commonly prescribed. Although 80–85% of patients were adherent while on treatment, only 20–30% continued treatment up to 12 months.ConclusionsMigraine treatment remains a challenge. Most patients receive one or more pharmacotherapies but the majority discontinue prophylactic treatment within 12 months of initiation.
Journal Article
Mitochondrial function and oxidative stress markers in higher-frequency episodic migraine
Increasing evidence points towards the role of mitochondrial functioning, energy metabolism, and oxidative stress in migraine. However not all previous research has been conclusive and some mitochondrial function/oxidative stress markers have not yet been examined. To this end, alpha-lipoic acid (ALA), total thiols, total plasma antioxidant capacity (TAC), lipid peroxide (PerOx), oxidised LDL (oxLDL), HbA1c and lactate were determined in the serum of 32 higher frequency episodic migraineurs (5–14 migraine days/ months, 19 with aura, 28 females) in this cross-sectional study. The majority of patients had abnormally low ALA and lactate levels (87.5% and 78.1%, respectively). 46.9% of the patients had abnormally high PerOx values, while for thiols and TAC over one third of patients had abnormally low values (31.2% and 37.5%, respectively). 21.9% of patients had abnormally low HbA1c and none had an HbA1c level above 5.6%. oxLDL was normal in all but one patient. This study provides further evidence for a role of oxidative stress and altered metabolism in migraine pathophysiology, which might represent a suitable therapeutic target. ALA, being too low in almost 90% of patients, might represent a potential biomarker for migraine. Further research is needed to replicate these results, in particular a comparison with a control group.
This study is part of the trial registration: ClinicalTrials.gov: NCT03132233, registered on 27.04.2017,
https://clinicaltrials.gov/ct2/show/NCT03132233
.
Journal Article
A Monoclonal Antibody to PACAP for Migraine Prevention
In adults with migraine and previous preventive treatment failures, a single infusion of a monoclonal antibody to pituitary adenylate cyclase–activating polypeptide led to fewer migraine days per month than placebo over the next 4 weeks.
Journal Article