Therapy For Chronic Migraine Research Articles

Onabotulinumtoxina reduce visual cortical excitability in chronic migraine: Preliminary results of a study with sound induced flash illusions

The number of sound-induced flash illusions (SIFI) perceived are related with the level of visual cortex (V1) excitability. In episodic migraineurs, in response to visual-acoustic illusions, V1 is hyperexcitable. The injection of botulinum toxin type A was approved as a therapy for chronic migraine (CM). Recent studies have correlated the action of botulinum toxin with the release of CGRP and cortical excitability. We used SIFI to evaluate the V1 excitability in CM at baseline and 3 months after treatment with botulinum toxin.

Manual therapy for chronic migraine: a pragmatic randomised controlled trial study protocol

IntroductionChronic migraine is a largely refractory condition affecting between 1 and 2.2% of the overall population worldwide, with females more affected than males. There are also high health and socioeconomic costs associated both for the individual and society. The mainstay of chronic migraine management is pharmacological, but the options available have limited efficacy and there are often unwanted side effects. There is some evidence for manual therapy as a treatment option for migraine, but its effectiveness for chronic migraine is unknown. Therefore, we have designed a pragmatic randomised control trial to investigate whether adding manual therapy to the tertiary specialist treatment of chronic migraine improves patient-reported outcomes.MethodsA pragmatic, randomised controlled trial in a hospital tertiary headache clinic. Participants will be randomised into one of two groups: treatment as usual or treatment as usual plus manual therapy. The primary outcome measure will be a change in the Headache Impact Test score. Secondary outcomes will also be measured over the 12-week study period including changes in headache frequency, migraine specific quality of life and reductions in relevant medicine consumption. The manual therapy group will have five treatment sessions each lasting 30 min. The recruitment target of 64 participants will allow power at 80% with p = 0.05 using minimal clinical difference for Headache Impact Test of 3.7 and includes provision for a 10% dropout rate. Recruitment will take place between August 2018 and February 2019. The results will form part of a doctoral study and be published in peer-reviewed journals and presented at national/international conferences.DiscussionCurrent pharmacological approaches have limited effects in the management of chronic migraine and there is a requirement to improve treatment options and reduce the health and economic burden of the condition. Manual therapy has been shown to be effective in other chronic pain conditions as well as other primary headaches. This study will explore the effectiveness of manual therapy as an adjunctive approach to the management of chronic migraine.Trial registrationThe trial has received a favourable opinion from the UK Health Research Authority (IRAS 228901) and is registered at ClinicalTrials.gov.number NCT03395457. Registered 1st March 2018.

Oscillating Mechanical Stimulation of the Craniocervical Region as Physical Therapy for Chronic Migraine: A Pilot Trial

Objective: We conducted a prospective trial of oscillating mechanical stimulation (OS) of the craniocervical region as treatment for drug-refractory chronic migraine (CM). Methods: Ten patients (8 women, 2 men; mean age 47.0 ± 15.1 years) were enrolled. The treatment was administered over an 8-week period to 13, 4, and 9 sites on the face and head, neck, and upper back, respectively, at 5- to 15-pound intensity. The primary outcome measure was the number of days patients suffered a migraine (hereafter “number of migraine days”), and the secondary outcome measures were the six-item Headache Impact Test (HIT-6) and Visual Analog Scale (VAS) scores for migraine pain intensity and the nine-item Patient Health Questionnaire (PHQ-9) and the seven-item Generalized Anxiety Disorder (GAD-7) scale scores. Results: Nine patients completed treatment. The number of migraine days remained unchanged, from a mean 21.7 ± 11.6 days/month before treatment to 19.3 ± 7.3 days/month upon completion of treatment. However, the HIT-6 scores improved from 67.0 ± 8.2 to 61.4 ± 7.1 (p = 0.007) after 3 weeks, 61.1 ± 11.5 (p = 0.01) after 6 weeks, and 59.9 ± 11.6 (p = 0.035) upon completion of treatment. Similarly, the VAS scores improved significantly from 7.3 ± 1.7 to 5.7 ± 3.1 (p = 0.018) at 6 weeks and 4.8 ± 2.8 (p = 0.011) upon completion of treatment. The GAD-7, PHQ-9, and allodynia scale scores remained unchanged. Conclusion: Our data suggest that OS is well tolerated and may become a feasible form of treatment for drug-resistant CM.

57. Botulinum toxin type-A therapy in cluster headache: Two clinical cases

Cluster headache (CH) is a primary chronic disabling form with autonomic symptoms, that often does not respond satysfactorily to prophylactic treatment. Botulinum toxin type A is an effective therapy for chronic migraine. We describe 2 clinical cases of CH examining the role of Onabotulinum-toxin-A on this form of primary headache. We treated with Onabotulinum-toxin-A two men (46 and 65 years-old) with refractory CH, with a periodicity of 3–4 months, in the muscles of the head and neck following a Blumenfeld treatment paradigm. The first patient has undergone six applications of Onabotulinum-toxin-A (total dosage of 155 U-31 sites) with a follow-up of two years. The second patient has undergone ten applications of Onabotulinum-toxin-A (total dosage between 105 and 195 U-31-39 sites), with a follow-up of three years. Symptoms improvement appeared after the second infiltrative treatment in both case with persistence of effectiveness until seven treatment, with intensity and frequency attack reduction. The first patient reported rare episodes of temporo-mandibular joint tension. The second case showed a total cessation of attacks. Interleukin-1 is a potent prototypical pro-inflammatory cytochine implicated in the pathogenesis of CH, and botulinum toxin inactivate interleukin-1.Onabotulinum-toxin-A can represent a valid alternative prophylactic therapy in CH.

P054. Chronic migraine and onabotulinumtoxinA: results from clinical practice

Background OnabotulinumtoxinA injection according to PREEMPT protocol is a second-line therapy for chronic migraine (CM)[1]. While its efficacy on frequency of headache has been demonstrated[2], our current clinical experience indicates that patients report benefits regardless of reduction of frequency of attacks, as Lipton et al previously showed[3]. The present study aimed at assessing the impact of botulin injection on intensity, quality and perception of pain in patients with CM.

Botulinumtoxin-Injektionen bei chronischer Migräne im Jugendalter – eine frühzeitige Therapieoption in der Transition von der Neuropädiatrie zur Neurologie

The prevalence of chronic headaches in children and adolescents is up to 2 % resulting in the beginning of the later typical headache careers of adults. The therapy for chronic migraine with botulinum toxin is now established in adults. However, there is only limited experience in the use of botulinum toxin in paediatric patients. 10 patients aged 13 - 17 years who suffered from chronic migraine according to the IHS criteria were injected at 31 specific injection points of the head and neck muscles with a total amount of 150 IE of botulinum toxin A (Botox®) according to the approved scheme. The number of headache days per month over the following 9 months was recorded and side effects were retrospectively determined. The responder rate (that is reduction of headache days per month more than 50 %) was 7/10 at three months after the injection. On average the number of headache days per month was reduced from 19.2 days to a minimum of 10.1 days. After three to six months the number of headache days increased again in all responders. Slight local side effects such as redness or temporary pain were observed in all patients, but severe side effects such as infections, fever, ptosis or allergic reactions did not occur. This small case series shows that the therapy for chronic migraine with botulinum toxin A can also be effective and safe in adolescents. As many adolescents still suffer from headaches later as adults a link between neuropaediatricians and neurologists is justifiable. An early botulinum toxin therapy followed by the transition of the adolescents would be helpful.

Zonisamide is effective in the preventive therapy of chronic migraine

Zonisamide is effective in the preventive therapy of chronic migraine

Adding Propranolol to Topiramate is Innefective in Chronic Migraine: In Search of a Better Combination Therapy for Chronic Migraine

Methods: This was a double-blind, placebo-controlled, randomized clinical trial conducted through the National Institute of Neurological Disorders and Stroke Clinical Research Collaboration, expected to randomize 250 chronic migraine subjects inadequately controlled (≥10 headaches/month) with topiramate (50–100 mg/day) to either propranolol LA (long acting) (240 mg/day) or placebo. Primary outcome was 28day moderate to severe headache rate reduction at 6 months (weeks 16 to 24), compared with baseline (weeks -4 to 0).

Insights Into the Mechanism of OnabotulinumtoxinA in Chronic Migraine

OnabotulinumtoxinA has recently been approved by regulatory agencies in the UK and United States for treatment of chronic migraine based on data generated from the PREEMPT studies. As such, onabotulinumtoxinA is the only prophylactic therapy specifically approved for chronic migraine. Most headache clinicians would agree that acute episodic migraine and chronic migraine differ in their pathophysiology, etiology, diagnosis, and response to pharmacological as well as nonpharmacological therapies. Of the 7 botulinum neurotoxin serotypes, botulinum neurotoxin type A (onabotulinumtoxinA) has been the most thoroughly investigated in preclinical and clinical studies. Based on preclinical studies, onabotulinumtoxinA is known to inhibit the release of excitatory neurotransmitters from both motor and sensory neurons by preventing vesicle fusion to the cell membrane. In addition to the well-documented myorelaxant effects of this neurotoxin, onabotulinumtoxinA can exert a direct analgesic effect that likely involves inhibition of primary and secondary nociceptive neurons. The inhibitory effects of onabotulinumtoxinA are also likely to involve suppressing the activity of myogenic trigger points and decreasing the persistent nociceptive barrage that promotes and maintains central sensitization. This article describes possible mechanisms to explain how onabotulinumtoxinA functions as a therapy for chronic migraine and considers why treatment with the neurotoxin is not effective in some chronic migraineurs.

Use of a Pine Bark Extract and Antioxidant Vitamin Combination Product as Therapy for Migraine in Patients Refractory to Pharmacologic Medication

To evaluate the potential benefit of a pine bark extract and antioxidant vitamin combination product in the treatment of migraine headache. This was an uncontrolled preliminary study to investigate the potential of an antioxidant formulation as therapy for migraine headache. Twelve patients with a long-term history of migraine with and without aura who had failed to respond to multiple treatments with beta-blockers, antidepressants, anticonvulsants, and 5-hydroxytryptamine receptor agonists were selected for the study. They were treated with 10 capsules of an antioxidant formulation of 120 mg pine bark extract, 60 mg vitamin C, and 30 IU vitamin E in each capsule daily for 3 months. Following enrollment patients completed a migraine disability assessment (MIDAS) questionnaire to give a baseline measure of migraine impact on work, school, domestic, and social activities over the previous 3 months. Patients were then treated for 3 months with the antioxidant formulation while continuing to receive existing pharmacologic medications. A second MIDAS was given at the conclusion of the treatment period. There was a significant mean improvement in MIDAS score of 50.6% for the 3-month treatment period compared with the 3 months prior to baseline (P < .005). The treatment was also associated with significant reductions in number of headache days and headache severity score. Mean number of headache days was reduced from 44.4 days at baseline (95% CI 28.9 to 59.8) to 26.0 days (95% CI 5.3 to 46.7; P < .005) after 3 months' therapy and mean headache severity was reduced from 7.5 of 10 (95% CI 6.7 to 8.4) to 5.5 (95% CI 4.1 to 7.0; P < .005). These data suggest that the antioxidant therapy used in this study may be beneficial in the treatment of migraine possibly reducing headache frequency and severity. Further clinical investigation into the efficacy of antioxidant as therapy for chronic migraine is warranted.