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Migrain update

Ping-Kun Chen, Shuu-Jiun Wang
Migraine is one of the most common neurological disorders. In addition to severe headaches, non-headache symptoms associated with migraine attacks as well as co-morbid disorders frequently aggravate the disabling of migraine patients. Some of these symptoms are related to poor outcomes. In this review, we update the advances of studies on certain non-headache symptoms, including visual disturbance, gastrointestinal symptoms, allodynia, vestibular symptoms, and symptoms of co-morbid restless legs syndrome and psychiatric disorders...
2018: F1000Research
Cristina Tassorelli, Hans-Christoph Diener, David W Dodick, Stephen D Silberstein, Richard B Lipton, Messoud Ashina, Werner J Becker, Michel D Ferrari, Peter J Goadsby, Patricia Pozo-Rosich, Shuu-Jiun Wang
Background Quality clinical trials form an essential part of the evidence base for the treatment of headache disorders. In 1991, the International Headache Society Clinical Trials Standing Committee developed and published the first edition of the Guidelines for Controlled Trials of Drugs in Migraine. In 2008, the Committee published the first specific guidelines on chronic migraine. Subsequent advances in drug, device, and biologicals development, as well as novel trial designs, have created a need for a revision of the chronic migraine guidelines...
January 1, 2018: Cephalalgia: An International Journal of Headache
Machaon Bonafede, Sandhya Sapra, Neel Shah, Stewart Tepper, Katherine Cappell, Pooja Desai
OBJECTIVE: The goal of this analysis was to provide a contemporary estimate of the burden of migraine, incorporating both direct and indirect costs, by comparing the costs of migraine patients to a matched group of patients without migraine in a large, nationally representative sample of commercially insured patients in the United States. BACKGROUND: Previous studies have shown that the economic burden of migraine in the United States is substantial for payers, patients, and employers...
February 15, 2018: Headache
Koen Paemeleire, Antoinette MaassenVanDenBrink
PURPOSE OF REVIEW: Monoclonal antibodies (mAbs) targeting the calcitonin-gene-related peptide (CGRP) pathway have been developed for episodic and chronic migraine prevention, either through binding the CGRP ligand (eptinezumab, fremanezumab, galcanezumab) or the CGRP receptor (erenumab). We provide an update on published Phase 2 and Phase 3 trials, safety/tolerability data, pharmacokinetics and mechanism of action of these biologicals. RECENT FINDINGS: The efficacy data from Phase 2 trials are corroborated by those from published Phase 3 trials, with a multitude of publications expected in 2018...
February 9, 2018: Current Opinion in Neurology
Elina Zakin, David Simpson
Botulinum toxin (BoNT) is a neurotoxin produced by the bacteria Clostridium botulinum that has become widely used for various neurologic indications. The four toxin formulations currently available for use in the United States (approved by the Food and Drug Administration) are onabotulinumtoxinA (Botox® ), abobotulinumtoxinA (Dysport® ), incobotulinumtoxinA (Xeomin® ), and rimabotulinumtoxinB (Myobloc® ). While the FDA-approved labels indicate that potency conversions should not be done, literature supports relative dose equivalents of approximately 1:1:2-4:50-100, respectively...
February 3, 2018: Toxicon: Official Journal of the International Society on Toxinology
Amaal J Starling
Headache is a common, disabling neurologic problem in all age groups, including older adults. In older adults, headache is most likely a primary disorder, such as tension-type headache or migraine; however, there is a higher risk of secondary causes, such as giant cell arteritis or intracranial lesions, than in younger adults. Thus, based on the headache history, clinical examination, and presence of headache red flags, a focused diagnostic evaluation is recommended, ranging from blood tests to neuroimaging, depending on the headache characteristics...
February 2018: Mayo Clinic Proceedings
Jonathan Jia Yuan Ong, Milena De Felice
This article was updated to correct an error in figure 1 introduced during the production process.
January 8, 2018: Neurotherapeutics: the Journal of the American Society for Experimental NeuroTherapeutics
Rainer Spiegel, Heiko Rust, Thomas Baumann, Hergen Friedrich, Raoul Sutter, Martina Göldlin, Christiane Rosin, René Müri, Georgios Mantokoudis, Roland Bingisser, Michael Strupp, Roger Kalla
This review provides an update on interdisciplinary treatment for dizziness. Dizziness can have various causes and the treatment offered should depend on the cause. After reading this article, the clinician will have an overview of current treatment recommendations. Recommendations are made for the most prevalent causes of dizziness including acute and chronic vestibular syndromes, vestibular neuritis, benign paroxysmal positional vertigo, endolymphatic hydrops and Menière’s disease, vestibular paroxysmia and vestibular migraine, cardiac causes, transient ischaemic attacks and strokes, episodic ataxia type 2, persistent postural-perceptual dizziness, bilateral vestibulopathy, degenerative, autoimmune and neoplastic diseases, upbeat- and downbeat nystagmus...
December 28, 2017: Swiss Medical Weekly
Cristina Tassorelli, Gioacchino Tedeschi, P Sarchielli, Luigi Alberto Pini, Licia Grazzi, Pierangelo Geppetti, Marina De Tommaso, Marco Aguggia, P Cortelli, Paolo Martelletti
Management of chronic migraine is challenging. OnabotulinumtoxinA (OBT-A) is the only medication licensed for prevention of chronic migraine, and has been widely adopted in clinical practice. Limited data is available on its long-term use. Areas covered: Data from controlled trials are combined with available data on the long-term use of OBT-A in real-life studies, with information obtained in a recent survey among Italian headache centers, and the clinical experience of the authors. Six areas were identified as relevant to patients with chronic migraine: 1) definition of responders to OBT-A; 2) management of responders to OBT-A; 3) optimal timing of prophylaxis with OBT-A; 4) position of OBT-A in prevention of chronic migraine; 5) management of medication overuse, and 6) patient education...
February 2018: Expert Review of Neurotherapeutics
Yung-Chu Hsu, Kao-Chang Lin, Treatment Guideline Subcommittee Of Taiwan Headache Society Taiwan Headache Society
In 2015, the American Headache Society (AHS) amended the treatment guideline of acute migraine based on evidence-based medicine (EBM) that all triptans in any form of preparations, acetaminophen, and non-steroid anti-inflammation drugs-NSAID (aspirin, diclofenac, ibuprofen, naproxen), sumatriptan/naproxen, combined acetaminophen/aspirin/caffeine are considered effective (Level A). Previously effective drugs as prochlorperazine, and dihydroergotamine-DHE (excluded inhaled form) were downrated to probable effective (Level B)...
June 15, 2017: Acta Neurologica Taiwanica
G Allais, Giulia Chiarle, Silvia Sinigaglia, Chiara Benedetto
Migraine is one of the most common neurological disorders in the general population. It affects 18% of women and 6% of men. In more than 50% of women migraineurs the occurrence of migraine attacks correlates strongly with the perimenstrual period. Menstrual migraine is highly debilitating, less responsive to therapy, and attacks are longer than those not correlated with menses. Menstrual migraine requires accurate evaluation and targeted therapy, that we aim to recommend in this review. Areas covered: This review of the literature provides an overview of currently available pharmacological therapies (especially with triptans, anti-inflammatory drugs, hormonal strategies) and drugs in development (in particular those acting on calcitonin gene-related peptide) for the treatment of acute migraine attacks and the prophylaxis of menstrual migraine...
February 2018: Expert Opinion on Pharmacotherapy
Elizabeth J Brown, Prium Deshmukh, Karen Antell
The oral contraceptive pill (OCP) is the most commonly used form of reversible contraception. The two types of OCPs are combination oral contraceptives (COCs), which contain estrogen and progesterone, and progestin-only pills (POPs). Both have failure rates of approximately 7.2% to 9% with typical use, and are safe for most patients. Because estrogen-containing contraceptives can increase the risk of venous thromboembolism, patients with conditions associated with a risk of cardiovascular events should not use COCs...
November 2017: FP Essentials
Asha Hareendran, Sally Mannix, Anne Skalicky, Martha Bayliss, Andrew Blumenfeld, Dawn C Buse, Pooja R Desai, Brian G Ortmeier, Sandhya Sapra
BACKGROUND: Adults with migraine experience substantial reductions in quality of life during and in-between migraine attacks. Clinical and regulatory guidelines encourage the inclusion of patient reported outcomes for the evaluation of benefits of interventions for migraine. METHODS: The conceptual framework and items for a new patient-reported outcome (PRO) instrument, the Migraine Physical Function Impact Diary (MPFID), were developed using scientific methods recommended to ensure content validity of PRO instruments...
November 17, 2017: Health and Quality of Life Outcomes
Roger Haber, Maria El Gemayel
BACKGROUND: Rosacea is linked to abnormalities of cutaneous vasculature and dysregulation of the inflammatory response. Recent reports on rosacea have shown a significant association with cardiovascular, gastrointestinal, and psychiatric diseases, all of which may affect morbidity and mortality among these patients. OBJECTIVE: To review available data regarding comorbidities associated with rosacea, discuss their pathogenesis, and highlight the evaluation of affected patients...
October 26, 2017: Journal of the American Academy of Dermatology
(no author information available yet)
BACKGROUND: As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. METHODS: We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences...
September 16, 2017: Lancet
Peter Kropp, Bianca Meyer, Wolfgang Meyer, Thomas Dresler
Besides pharmacological and interventional treatments a variety of non-medical therapeutic options exist for migraine, which has largely been derived from behavioral therapy. Areas covered: For our update we collected available studies via PubMed searches. This review highlights that already consulting of the patient is able to reduce the frequency of migraine attacks. Relaxation techniques, especially progressive muscle relaxation, and various types of biofeedback are effective, as is the implementation of cognitive behavioral therapy...
November 2017: Expert Review of Neurotherapeutics
Paul Tabet, Issam Saliba
The diagnosis of Meniere's disease (MD) and vestibular migraine (VM) is primarily based on clinical criteria and their differentiation is often difficult. Currently, there are no known definitive diagnostic tests that can reliably distinguish the two conditions. Patients with MD and patients with VM are treated differently, therefore improving the diagnosis of these two pathologies should avoid errors in management. A systematic review was conducted according to PRISMA guidelines. Medline-Ovid and Embase databases were used to conduct a thorough search of English-language publications dating from 1948 to March 2016...
September 2017: Journal of Clinical Medicine Research
Anne H Calhoun, Pelin Batur
Combined hormonal contraceptives are contraindicated in women who have migraine with aura, in whom these drugs can increase the risk of ischemic stroke. However, this contraindication is based on data from the 1960s and 1970s, when oral contraceptives contained much higher doses of estrogen. Stroke risk is not significantly increased with today's preparations, many of which contain less than 30 μg of ethinyl estradiol. Further, in continuous regimens, ultra-low-dose formulations--those that contain less than 20 μg of ethinyl estradiol--may help prevent menstrual migraine and reduce the frequency of aura...
August 2017: Cleveland Clinic Journal of Medicine
Tzu-Chou Huang, Tzu-Hsien Lai, Treatment Guideline Subcommittee Of Taiwan Headache Society Taiwan Headache Society
The Treatment Guideline Subcommittee of the Taiwan Headache Society evaluated the medications currently used for migraine prevention in Taiwan. We assessed the results of new published drug trials, information from medical database and referred to the latest guidelines published. After comprehensive discussion, we proposed Taiwanese consensus about the preventive treatment for migraine including recommendation levels, strength of evidences, and related prescription information regarding dosage and adverse effects...
March 15, 2017: Acta Neurologica Taiwanica
M Mila, M I Alvarez-Mora, I Madrigal, L Rodriguez-Revenga
Fragile X syndrome (FXS) is the most common cause of inherited intellectual disability and the leading form of the monogenic cause of autism. Fragile X mental retardation type 1 (FMR1) gene premutation is the first single-gene cause of primary ovarian failure (Fragile X-associated primary ovarian insufficiency [FXPOI]) and one of the most common causes of ataxia (fragile X-associated tremor/ataxia syndrome [FXTAS]), multiple additional phenotypes such as fibromyalgia, hypothyroidism, migraine headaches, sleep disturbances, sleep apnea, restless legs syndrome, central pain syndrome, neuropathy and neuropsychiatric alterations has been described...
June 15, 2017: Clinical Genetics
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