BACKGROUND Despite the criteria of acute migraine treatment and prevention have been well described , there are still unmet needs, for a general underuse and low benefit of preventive treatments. The aim of the present study was to observe retrospectively the short term effect of preventive treatment in a cohort of migraine patients come at a tertiary headache center, using data from an electronic medical record. METHODS This was an observational retrospective cohort study on data collected in a tertiary headache center. Data were extracted from an electronic dataset collected between January 2009 to December 2019. Main selection criteria were age 18-75, diagnosis of migraine without aura(MO), with aura (MA) and chronic migraine (CM), a control visit after three months from the first access, prescription of preventive treatment with level of evidence 1 as reported by Italian guidelines. As primary outcome measure we considered the change of frequency of headache at follow up , as second outcomes disability scores , intensity of headache, allodynia; as predictive factors age, migraine duration, sex and headache frequency, allodynia, anxiety and depression at baseline; comorbidity with fibromyalgia. RESULTS Among 6430 patients screened,2800 met the selection, 1800 returned to follow up, 550 withdrawn for adverse events, 1100 were introduced into analysis. One hundred thirty four had a frequency reduction of 50% or more. Flunarizine was used in less severe migraine, with a better effect as compared to other drugs (odds ratio 1.48; p 0.022). Low headache frequency and absent or mild allodynia predicted a better outcome. CONCLUSIONSThe mild effect of preventive drugs on migraine features and the number of patients lost to follow up or dropped out for adverse events confirm that in severely and chronic sufferers the first line preventive approach could delay a more focused therapeutic approach.
Background Monoclonal antibodies against calcitonin gene-related peptides (CGRP) are innovative therapies for migraine treatment. Although they are clinically effective, how anti-CGRP treatment reduces migraine attacks still remains unclear. Objective In this observational case–control study, we aimed to apply graph theory to EEG data from 20 migraine patients and 10 controls to investigate the effects of 3 months of galcanezumab on brain connectivity. Methods We analyzed EEG rhythms during black-white pattern reversal stimulation with 0.5 cycle per degree spatial frequency before (T0) galcanezumab injection, as well as after 3 months (T2). EEG recordings made 1 hour after galcanezumab administration served as the control session (T1). Patients’ connectivity patterns obtained at T0, T1 and T2 were compared with normal controls. Results We found that galcanezumab increased network integration (with a 5% significance level corrected with the false discovery rate), changing the intensity of connections between the occipital through the frontal areas. At 3 months follow up, patients with persistent high headache intensity had a minor effect on the strength of connections (evaluated using Kendall’s rank correlation test and p < 0.05). Conclusions The potent anti-nociceptive action that galcanezumab exerts at a peripheral level could restore cortical connections and possibly factors predisposing to attack onset.
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