Treatment Of Migraine Patients Research Articles

Beyond Vertigo: Vestibular, Aural, and Perceptual Symptoms in Vestibular Migraine.

To review the vestibular, aural, and perceptual symptoms of vestibular migraine (VM) that may present alongside vertigo. Increased research attention to the wide spectrum of symptoms presenting in VM patients has improved understanding of this disorder, with recent identification of five different VM phenotypes. Research into the clinical overlap between VM and other chronic vestibular syndromes such as persistent postural-perceptual dizziness and mal-de-debarquement syndrome reveals a range of vestibular symptoms and hints at pathophysiological connections between migraine and vestibular dysfunction. Studies of migraine treatment for hearing loss suggest patients presenting with aural symptoms may have an underlying diagnosis of migraine and deserve a trial of migraine preventives. Research into the neurologic basis of the perceptual disorder Alice in Wonderland syndrome has revealed brain areas that are likely involved and may help explain its prevalence in VM patients. VM is a sensory processing disorder that presents with more than just vertigo. Understanding the range of potential symptoms improves diagnosis and treatment for migraine patients whose diagnosis may be missed when only the symptoms identified in the diagnostic criteria are considered.

Migraine in multiple sclerosis patients: potential links and treatment approach

ABSTRACT Introduction Migraine has been reported to be twice as prevalent in patients with multiple sclerosis (MS) compared to the non-MS population. However, prospective, controlled studies that could lead to robust conclusions are still lacking. Areas covered Treatment of migraine in patients with MS can be challenging. Comorbidities need to be assessed and managed early, and preventive treatment should be initiated when indicated. Caution is warranted regarding the selection of the preventive medication since certain agents can magnify MS symptoms and particularly cognitive symptoms. This paper aims to discuss the association of MS and migraine, shed light on distinguishing points and red flags, as well as offer practical advice on the selection of treatment according to patients’ characteristics. Expert opinion A holistic approach including pharmacological and non-pharmacological modifications is required to treat migraine in patients with MS effectively. Anti-CGRP monoclonal antibodies are a promising option due to limited drug-to-drug interactions; however, larger prospective studies are required to draw robust conclusions on the concomitant use of anti-CGRPs with MS disease modifying treatments. Early migraine preventive treatment might be needed to reduce the burden of disease in patients with MS.

Impact of anti-CGRP monoclonal antibodies on migraine attack accompanying symptoms: A real-world evidence study.

Clinical trials on anti-calcitonin gene-related peptide monoclonal antibodies poorly investigated their impact on migraine accompanying symptoms. To evaluate the impact of basal accompanying symptoms on anti-CGRP monoclonal antibodies treatment response and their evolution after six months of treatment in migraine patients. Patients with migraine diagnosis seen in the Headache Clinic and treated with erenumab, galcanezumab or fremanezumab were prospectively recruited. They completed a daily eDiary which provided data on headache frequency and the following accompanying symptoms of each day: photophobia, phonophobia, nausea, dizziness, and aura. Patients were classified as responders or non-responders based on 50% or greater reduction in headache days per month at month 6 (≥50% response rate). Accompanying symptoms ratios based on headache days per month were assessed per patient at baseline and after three and six months. Comparisons for basal characteristics, basal accompanying symptoms ratios and their evolution after six months between responders and non-responders were performed. One hundred and fifty-eight patients were included, 44% (69/158) showed ≥50% response rate after six months. A significant reduction in headache days per month in both groups was found at month 6 (-9.4 days/month in ≥50% response rate group; p < 0.001, -2.2 days/month in <50% response rate group; p = 0.004). Additionally, significant decreases in photophobia (-19.5%, p < 0.001), phonophobia (-12.1%, p = 0.010) and aura ratios (-25.1%, p = 0.008) were found in ≥50% response rate group. No statistically significant reductions were found in nausea and dizziness in any group since their reduction was correlated with the decrease in headache days per month. Higher photophobia ratios at baseline were predictive of an increased response between months 3 and 6 (Incidence Risk Ratio = 0.928, p = 0.040). The days per month with photophobia, phonophobia and aura decreased at a higher rate than headache days per month after six months in the ≥50% response group. Higher photophobia ratios were associated with higher response rates between three and six months. It could indicate an involvement of peripheral CGRP in photophobia as well as a central modulation of migraine through these treatments which mainly act on the periphery.

Real-world evidence on the economic implications of CGRP-mAbs as preventive treatment of migraine

BackgroundCalcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) are approved in Europe as preventive treatment of migraine in patients with at least four monthly migraine days. Migraine gives rise to direct healthcare expenditures, but most of the economic burden of migraine is socioeconomic. Evidence on the socioeconomic implications of CGRP-mAbs is, however, limited. There is an increasing interest in supplementing evidence from randomised controlled trials (RCTs) with real-world evidence (RWE) to aid clinical decision making and inform decision making for migraine management. The objective of this study was to generate RWE on the health economic and socioeconomic implications of administering CGRP-mAbs to patients with chronic migraine (CM) and episodic migraine (high-frequency episodic migraine (HFEM), and low-frequency episodic migraine (LFEM)).MethodsReal-world data (RWD) on Danish patients with CM, HFEM, and LFEM were collected via two Danish patient organisations and two informal patient networks and used in a tailored economic model. Treatment effects of CGRP-mAbs on health economic and socioeconomic outcomes were estimated using a sub-sample of patients with CM who receive CGRP-mAb treatment.ResultsA total of 362 patients (CM: 199 [55.0%], HFEM: 80 [22.1%], LFEM: 83 [22.9%]) were included in the health economic model (mean age 44.1 ± 11.5, 97.5% female, 16.3% received treatment with CGRP-mAbs), and 303 patients were included in the socioeconomic model (15.2% received treatment with CGRP-mAbs). Health economic savings from initiating CGRP-mAb treatment totalled €1,179 per patient with CM per year on average (HFEM: €264, LFEM: €175). Socioeconomic gains from initiating CGRP-mAb treatment totalled an average gross domestic product (GDP) gain of €13,329 per patient with CM per year (HFEM: €10,449, LFEM: €9,947).ConclusionOur results indicate that CGRP-mAbs have the potential to reduce both health economic expenditures and the socioeconomic burden of migraine. Health economic savings are used as a basis for health technology assessments (HTAs) of the cost-effectiveness of new treatments, which implies that important socioeconomic gains may not be given enough importance in decision making for migraine management.

Final results of the SPECTRE study: real-world data giving an insight into the treatment of migraine patients with erenumab in Germany (P12-12.011)

Final results of the SPECTRE study: real-world data giving an insight into the treatment of migraine patients with erenumab in Germany (P12-12.011)

Using GON block as a diagnostic block: Investigation of clinical efficacy of GON radiofrequency treatment for migraine patients

Objective: This retrospective study aimed to investigate the clinical efficacy of GON pulsed radiofrequency (PRF) treatment in migraine patients who did not respond adequately to treatment with greater occipital nerve (GON) blockade. Method: Twenty-seven patients with recurrent episodic migraines or chronic migraines were included in the study. GON blockade was performed bilaterally once a week – four times over a one-month duration. PRF treatment was performed once for those patients who did not show an adequate response to GON blockade, and the treatment was directed at the same sites as the GON blockade. The number of migraine attacks in the preceding 30 days, the total number of triptan tablets taken, the average duration of headache and the highest VAS scores at the first, third and sixth-month visits were recorded. Results: The number of severe migraine attacks, total analgesic use and the maximum duration of migraine episodes were recorded in this study. All these parameters showed a significant decrease from the first month after GON PRF treatment as compared to both the baseline as well as to treatment one month after GON block. In addition, this clinical improvement was sustained up to six months after PRF treatment. Conclusion: Our results suggest that GON PRF treatment is a viable treatment approach in the case of migraine patients who do not respond adequately to treatment with GON blockade.

Clinical Observation of Flunarizine Hydrochloride, Aspirin Combined with Flupentixol and Melitracen in the Treatment of Migraine Patients

Clinical Observation of Flunarizine Hydrochloride, Aspirin Combined with Flupentixol and Melitracen in the Treatment of Migraine Patients

Association between sleep quality, migraine and migraine burden.

BackgroundThe relationship between sleep and migraine is well known to be bidirectional. However, few studies have systematically assessed the association between sleep quality and the risk of developing migraine, and its gender and age differences are unclear. And there is currently limited evidence on the associations between sleep quality and migraine-related burdens.ObjectiveThe objectives of this study were to: (1) explore the association between sleep quality and the risk of developing migraine, and its gender and age differences; (2) investigate the associations between sleep quality and the total pain burden, severity, disability, headache impact, quality of life, anxiety, and depression of migraine patients.MethodsThis study consecutively enrolled 134 migraine patients and 70 sex- and age-matched healthy control subjects. Sleep quality was assessed through the Pittsburgh Sleep Quality Index (PSQI). Logistic regression and linear regression analyses were used to explore the associations between sleep quality with the risk of developing migraine and the migraine-related burdens.ResultsThe prevalence of poor sleep quality in migraine patients was significantly higher than that in subjects without migraine (P < 0.001). After adjusting for various confounding factors, the risk of migraine with poor sleep quality remained 3.981 times that of those with good sleep quality. The subgroup analysis showed that there were significant additive interactions between poor sleep quality and the risk of migraine in gender, age, and education level (P for interaction < 0.05), and the stronger correlations were found in females, populations with ages more than 35 years old, and with lower education levels. In addition, multivariate linear regression analysis showed that poor sleep quality was significantly and independently associated with the total pain burden, severity, headache impact, quality of life, anxiety, and depression in migraine patients (P trend < 0.05).ConclusionPoor sleep quality was significantly independently associated with an increased risk of developing migraine and the migraine-related burdens. Strengthening PSQI assessment is valuable for the early prevention and treatment of migraine patients.

Efficacy and safety of ubrogepant for migraine: a meta-analysis of randomized controlled studies

Introduction: The efficacy of ubrogepant 50 mg versus 100 mg daily for migraine remained controversial. We conducted a systematic review and meta-analysis to compare the efficacy and safety of ubrogepant 50 mg versus 100 mg daily on treatment in migraine patients. Methods: We have searched PubMed, EMbase, Web of science, EBSCO, Cochrane library databases and SCOPUS through 21 March 2022 for randomized controlled trials (RCTs) assessing the effect of ubrogepant 50 mg versus 100 mg on treatment efficacy in migraine patients. This meta-analysis was performed using the random-effect model. Results: Three RCTs were included in the meta-analysis. Overall, compared with ubrogepant 100 mg in migraine patients, ubrogepant 50 mg obtained comparable pain freedom at 2 h (OR = 0.86; 95% CI = 0.64–1.15; p = 0.310), sustained pain freedom 2–24 h (OR = 0.76; 95% CI = 0.54–1.07; p = 0.110), photophobia absence at 2 h (OR = 0.80; 95% CI = 0.63–1.02; p = 0.070), phonophobia absence at 2 h (OR = 1.07; 95% CI = 0.82–1.40; p = 0.620) and nausea absence at 2 h (OR = 1.02; 95% CI = 0.79–1.32; p = 0.880). In terms of safety, adverse events were found to be increased in ubrogepant 100 mg as compared to ubrogepant 50 mg (OR = 0.81; 95% CI = 0.67–0.99; p = 0.040), and there was no statistical difference of serious adverse events between two groups (OR = 0.87; 95% CI = 0.40–1.91; p = 0.720). Conclusions: Ubrogepant 50 mg and 100 mg may be equally effective to alleviate migraine, but ubrogepant 100 mg led to increase incidence of adverse events.

PCR3 Real-World Effectiveness of Ubrogepant Among Participants with Prior Treatment Failure: Subgroup Analysis from the Universe Study

The safety and efficacy of ubrogepant have been demonstrated in phase 3 ACHIEVE trials; however, effectiveness of ubrogepant in the real-world setting has yet to be fully characterized. This study aims to examine real-world effectiveness of ubrogepant for the acute treatment of migraine in patients who switched to ubrogepant due to the lack of efficacy of their prior acute treatment.

Palmitoylethanolamide-based nutraceutical Calmux® in preventive treatment of migraine

BackgroundThe aim of this study was to determine the efficacy and tolerability of treatment with a Palmitoylethanolamide (PEA)-based nutraceutical in patients with episodic migraine. MethodsA pilot, prospective, open-label experimental study was designed in which patients with episodic migraine with and without aura seen in the general practice office of a tertiary centre during a period of 6 month were offered the possibility to participate. No control group was included. All included patients were treated with nutraceutical Calmux® taken every 12 h for 3 months. Monthly attack frequency, attack intensity, impact of migraine (HIT-6 and MIDAS scales) and quality of sleep at baseline and after 3 months of treatment were compared. ResultsTwenty-five patients (22 women and 3 men) were included, with a mean age of 36.3 ± 12 years. Headache days per month decreased from 10 ± 2.1 days to 6.6 ± 3.6 days (p < 0.00001). Days of analgesic use decreased from 9.2 ± 2.6 days to 4.1 ± 2.1 (p < 0.0001). None of the patients included suffered from adverse events attributable to treatment. Pain intensity showed a mean reduction of 3.1 points, from 8.1 at baseline to 5 at 3 months of treatment (p < 0.005). ConclusionsPEA nutraceuticals could be useful in migraine prevention. Further studies are necessary, but we consider that PEA-based nutraceutical could be a new approach in the treatment of migraine patients.

Effectiveness of physiotherapeutic treatment interventions on pain intensity, duration, frequency, and quality of life of patients with migraine : Asystematic review

According to the current guidelines preventive treatment of migraine should consist of acombination of pharmacological and nonpharmacological forms of treatment. Physiotherapeutic modalities could be an option for nonpharmacological migraine management. The aim was to assess the efficacy of physiotherapeutic interventions on pain intensity, duration and frequency as well as the quality of life of patients with migraine. Asystematic literature search was carried out in four databases: the Physiotherapy Evidence Database (PEDro), Web of Science, Medline via PubMed and the Cochrane Library. Randomized controlled trials (RCTs) that were published up to the end of July 2021 and examined the effectiveness of physiotherapeutic treatment in migraine patients were eligible for inclusion. Studies that did not examine an adult population, interventions not carried out by aphysiotherapist or not reporting an appropriate outcome were excluded. The assessment of the risk of bias was carried out with the revised version of the Cochrane risk of bias tool 2.0. Adescriptive and quantitative synthesis using mean difference with arandom effects model and 95% confidence intervals were used. The present review included 13RCTs reporting on atotal of 595 patients. The risk of bias was high for four studies, low for two studies and the remaining seven studies had some concerns. The interventions examined were multimodal physiotherapy programs, various mobilization techniques, trigger point therapy, manual lymphatic drainage, massage and various stretching techniques. All interventions examined had asignificantly positive effect on the selected parameters compared to the baseline values. Especially combinations of various physiotherapeutic modalities showed clinically relevant results. The evidence suggests that multimodal physiotherapy treatment is agood supplement to medication and should therefore be considered as anonpharmacological treatment for patients with migraine; however, further RCTs with alow risk of bias are necessary in order to confirm the effectiveness with high quality evidence.

Real-life assessment of erenumab discontinuation following one year of treatment in migraine patients

Monoclonal antibodies (mAbs) against CGRP are first-in-class drugs for migraine prevention, yet studies on treatment discontinuation are currently lacking. Real-life data are warranted to create up-to-date guidelines on migraine prevention with mAbs.

The Efficacy of Memantine for the Treatment of Migraine: A Meta-Analysis of Randomized Controlled Studies.

The efficacy of memantine for migraine remains controversial. We conduct a systematic review and meta-analysis to explore the influence of memantine versus placebo on treatment in migraine patients. We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through February 2020 for randomized controlled trials assessing the effect of memantine versus placebo on treatment efficacy in migraine patients. This meta-analysis is performed using the random-effect model. Three randomized controlled trials are included in the meta-analysis. Overall, compared with control group in migraine patients, memantine treatment is associated with substantially reduced monthly attack frequency (mean difference [MD], -2.14; 95% confidence interval [CI], -2.83 to -1.46; P < 0.00001), number of migraine days (MD, -4.17; 95% CI, -6.40 to -1.93; P = 0.0003) and Migraine Disability Assessment (MD, -5.63; 95% CI, -6.46 to -4.79; P < 0.00001), but demonstrates no obvious influence on acute pain medications (MD, -1.23; 95% CI, -4.63 to 2.17; P = 0.48). Memantine treatment may benefit to the control of migraine.

Effectiveness of a manual therapy protocol based on articulatory techniques in migraine patients. A randomized controlled trial

BackgroundPhysiotherapy is used as a non-pharmacological treatment for migraine. However, controversy exists over whether articulatory manual techniques are effective in some aspects related to migraine. ObjectivesTo assess the effectiveness of a manual therapy protocol based on articulatory techniques in pain intensity, frequency of episodes, migraine disability, quality of life, medication intake and self-reported perceived change after treatment in migraine patients. DesignRandomized controlled trial. MethodsFifty individuals with migraine were randomized into the experimental group, which received manual therapy based on articulatory techniques (n = 25), or the placebo group (n = 25). The intervention lasted 4 weeks and included 4 sessions. Patients were assessed before (T1), after (T2) and at a one-month follow-up following the intervention (T3). The instruments used were the Migraine Disability Assessment (MIDAS) questionnaire, the Short Form-36 Health Survey (SF-36), the medication intake and The Patients’ Global Impression of Change scale. ResultsIn comparison with placebo group, manual therapy patients reported significant effects on pain intensity at T2 (p < 0.001; d = 1.15) and at T3 (p < 0.001; d = 1.13), migraine disability at T3 (p < 0.05; d = 0.69), physical quality of life at T2 (p < 0.05; d = 0.72), overall quality of life at T2 (p < 0.05; d = 0.60), decrease in medication intake at T2 (p < 0.001; d = 1.11) and at T3 (p < 0.05; d = 0.77) and self-reported perceived change after treatment at T2 and T3 (p < 0.001). No serious adverse events were reported. ConclusionsThe application of a manual therapy protocol based on articulatory techniques reduced pain intensity, migraine disability, and medication intake, while improving quality of life in patients with migraine.

Rimegepant for the Acute Treatment of Migraine in Patients with a History of Triptan Treatment Failure: Pooled Results From 3 Phase 3 Clinical Trials (4914)

Rimegepant for the Acute Treatment of Migraine in Patients with a History of Triptan Treatment Failure: Pooled Results From 3 Phase 3 Clinical Trials (4914)

Lasmiditan is Effective in the Acute Treatment of Migraine in Patients with Insufficient Response to Triptans: Findings from the CENTURION Study (1474)

Lasmiditan is Effective in the Acute Treatment of Migraine in Patients with Insufficient Response to Triptans: Findings from the CENTURION Study (1474)

Rimegepant is Safe and Tolerable for the Acute Treatment of Migraine in Patients Using Preventive Migraine Medications: Results from a Long-Term Open-Label Safety Study (2370)

Rimegepant is Safe and Tolerable for the Acute Treatment of Migraine in Patients Using Preventive Migraine Medications: Results from a Long-Term Open-Label Safety Study (2370)

Cost-Effectiveness of Erenumab for the Preventive Treatment of Migraine in Patients with Prior Treatment Failures in Sweden.

Migraine is a common neurological disease that disproportionately affects females and has a peak incidence during productive years, resulting in significant burden. The aim of the study was to determine the cost effectiveness of erenumab for the preventive treatment of migraine. A hybrid decision-tree plus Markov model was developed to evaluate the cost effectiveness of erenumab as a migraine treatment compared with best supportive care only for patients experiencing at least 4 monthly migraine days for whom at least two prior preventive treatments had failed. Clinical efficacy data were based on results from four randomized controlled trials of erenumab against placebo. The primary outcomes were costs, migraine days, and quality-adjusted life-years (QALYs). An incremental cost-effectiveness ratio (ICER) was estimated as the cost per QALY gained. The cost per migraine day avoided was also estimated, as were disaggregated direct and indirect costs. The analysis was conducted from Swedish societal and healthcare system perspectives based on total migraine, chronic migraine and episodic migraine populations, using a discount rate of 3% applied to both costs and health benefits and using year 2019 values. In the base-case deterministic analyses, erenumab treatment resulted in ICERs of Swedish krona (SEK) 34,696 (€3310) and SEK301,565 (€28,769) per QALY gained in the total migraine and episodic migraine populations, respectively. Erenumab was dominant in the chronic migraine population. In the total migraine population, the use of erenumab resulted in a net benefit to society of SEK81,739 (€7773) per patient, assuming a willingness-to-pay threshold of SEK300,000 (€28,528) per QALY. Our analysis suggests that erenumab is a cost-effective treatment for migraine with a willingness-to-pay threshold of SEK300,000 per QALY.

The Efficacy of Vitamin D Supplementation for Migraine: A Meta-Analysis of Randomized Controlled Studies

The efficacy of vitamin D for migraine remains controversial. We conduct a systematic review and meta-analysis to explore the influence of vitamin D versus placebo on treatment in migraine patients. We search PubMed, EMbase, Web of Science, EBSCO, and Cochrane library databases through April 2020 for randomized controlled trials assessing the effect of vitamin D versus placebo on treatment efficacy in migraine patients. This meta-analysis is performed using the random-effect model. Five randomized controlled trials are included in the meta-analysis. Overall, compared with control group in migraine patients, vitamin D treatment is associated with substantially reduced number of headache days (standard mean difference [SMD], -0.53; 95% confidence interval [CI], -0.83 to -0.23; P = 0.0006), frequency of headache attacks (SMD, -1.09; 95% CI, -1.86 to -0.32; P = 0.006), headache severity (SMD, -0.55; 95% CI, -0.91 to -0.19; P = 0.0003), and Migraine Disability Assessment score (SMD, -0.76; 95% CI, -1.11 to -0.40; P < 0.0001). Vitamin D treatment is effective to alleviate migraine.