Consensus of the Brazilian Headache Society (SBCe) for the Prophylactic Treatment of Episodic Migraine: part I

Abstract

The Brazilian Headache Society (Sociedade Brasileira de Cefaleia, SBCe, in Portuguese) nominated a Committee of Authors with the aim of establishing a consensus with recommendations regarding prophylactic treatment for episodic migraine based on articles published in the worldwide literature, as well as personal experience. Migraine affects 1 billion people around the world and more than 30 million Brazilians. In addition, it is an underdiagnosed and undertreated disorder. It is well known within the medical community of neurologists, and especially among headache specialists, that there is a need to disseminate knowledge about prophylactic treatment for migraine. For this purpose, together with the need for drug updates and to expand knowledge of the disease itself (frequency, intensity, duration, impact and perhaps the progression of migraine), this Consensus was developed, following a full online methodology, by 12 groups who reviewed and wrote about the pharmacological categories of the drugs used and, at the end of the process, met to read and establish conclusions for this document. The drug classes studied were: anticonvulsants, tricyclic antidepressants, monoclonal anti-calcitonin gene-related peptide (anti-CGRP) antibodies, beta-blockers, antihypertensives, calcium channel inhibitors, other antidepressants (selective serotonin reuptake inhibitors, SSRIs, and dual-action antidepressants), other drugs, and polytherapy. Hormonal treatment and anti-inflammatories and triptans in minimum prophylaxis schemes (miniprophylaxis) will be covered in a specific chapter. The drug classes studied for part I of the Consensus were: anticonvulsants, tricyclic antidepressants, monoclonal anti-CGRP antibodies, and beta-blockers.

The history and rationale of the development of new drugs for migraine treatment

“…Of these are worth mentioning some phytotherapeutic drugs such as Thanacetum parthenum and Petasites hybridus ; minerals such as magnesium, vitamins such as coenzyme Q10 and riboflavin; the circadian-related hormone melatonin; antihypertensive drugs such as verapamil, enalapril, Olmesartan, and candesartan; antiseizure drugs such as lamotrigine and levetiracetam and NMDA-blockers such as memantine. 74 75 Altogether, with tricyclics, beta-adrenoceptor blockers, flunarizine, topiramate, onabotulinumtoxin A, and valproic acid, drugs mentioned in this “miscellaneous” category have in common the fact that their development was not based on previous and thought basic research on disease mechanisms with specifically pharmacodynamic drug design.…”

Rosemary and its main phytotherapy effects with impact on chronic headache: integrative study of an unconventional therapy for human health

“…A cefaleia crônica (CC) é uma circunstância em que ocorre dor de cabeça constante pelo menos 15 dias por mês em 3 meses consecutivos [1]. Outro aspecto é que a CC é um sintoma que deve ser considerado um alerta, podendo estar relacionado a comprometimentos graves, trazendo ao indivíduo um risco imediato à sua saúde [2].…”

Migraine Preventive Treatment Failure: A Cross-Sectional Study in a Tertiary Center in Brazil

“…Migraine can be divided into episodic, when headaches occur less than 15 days per month, and chronic, when they occur ≥15 days per month for ≥3 months, with ≥8 of these days featuring typical migraine pain.1 Prophylactic treatment is recommended for individuals who experience ≥3 days of pain for a period of ≥3 months or for those who, despite having less frequent pain, are profoundly impacted in their quality of life. 7 The goals of prophylactic treatment extend beyond enhancing the patient's quality of life to also encompass reducing the socioeconomic impact, thus promoting costeffectiveness for both the individual and society at large.…”