Headache management: pharmacological approaches

Sinclair, Alexandra J; Sturrock, Aaron; Davies, Brendan; Matharu, Manjit

doi:10.1136/practneurol-2015-001167

Cited by 27 publications

(19 citation statements)

References 42 publications

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“…Further antidepressants were excluded since all patients were already under amitriptyline treatment. Among calcium-channel blockers, flunarizine was chosen as, according to guidelines, it represents the molecule with the highest level of evidence of efficacy [ 35 – 37 ].…”

Section: Methodsmentioning

confidence: 99%

Impact of migraine on fibromyalgia symptoms

et al. 2016

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BackgroundFibromyalgia (FMS) and high frequency episodic/chronic migraine (M) very frequently co-occur, suggesting common pathophysiological mechanisms; both conditions display generalized somatic hyperalgesia. In FMS-M comorbidity we assessed if: a different level of hyperalgesia is present compared to one condition only; hyperalgesia is a function of migraine frequency; migraine attacks trigger FMS symptoms.MethodsFemale patients with fibromyalgia (FMS)(n.40), high frequency episodic migraine (M1)(n.41), chronic migraine (M2)(n.40), FMS + M1 (n.42) and FMS + M2 (n.40) underwent recording of: −electrical pain thresholds in skin, subcutis and muscle and pressure pain thresholds in control sites, −pressure pain thresholds in tender points (TePs), −number of monthly migraine attacks and fibromyalgia flares (3-month diary). Migraine and FMS parameters were evaluated before and after migraine prophylaxis, or no prophylaxis, for 3 months with calcium-channel blockers, in two further FMS + H1 groups (n.49, n.39). 1-way ANOVA was applied to test trends among groups, Student’s t-test for paired samples was used to compare pre and post-treatment values.ResultsThe lowest electrical and pressure thresholds at all sites and tissues were found in FMS + M2, followed by FMS + H1, FMS, M2 and M1 (trend: p < 0.0001). FMS monthly flares were progressively higher in FMS, FMS + M1 and FMS + M2 (p < 0.0001); most flares (86–87 %) occurred within 12 h from a migraine attack in co-morbid patients (p < 0.0001). Effective migraine prophylaxis vs no prophylaxis also produced a significant improvement of FMS symptoms (decreased monthly flares, increased pain thresholds)(0.0001 < p < 0.003).ConclusionsCo-morbidity between fibromyalgia and migraine involves heightened somatic hyperalgesia compared to one condition only. Increased migraine frequency – with shift towards chronicity – enhances both hyperalgesia and spontaneous FMS pain, which is reversed by effective migraine prophylaxis. These results suggest different levels of central sensitization in patients with migraine, fibromyalgia or both conditions and a role for migraine as a triggering factor for FMS.

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Section: Methodsmentioning

confidence: 99%

Impact of migraine on fibromyalgia symptoms

et al. 2016

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“…The trigeminovascular system has a crucial role in head pain. 5 The supraorbital nerve is a branch of the first division of the trigeminal nerve. Transcutaneous supraorbital nerve stimulation has been developed as a potential treatment for headache.…”

Section: Non-invasive Neurostimulation Devicesmentioning

confidence: 99%

Neurostimulation in the treatment of primary headaches

et al. 2016

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There is increasing interest in using neurostimulation to treat headache disorders. There are now several non-invasive and invasive stimulation devices available with some open-label series and small controlled trial studies that support their use. Non-invasive stimulation options include supraorbital stimulation (Cefaly), vagus nerve stimulation (gammaCore) and single-pulse transcranial magnetic stimulation (SpringTMS). Invasive procedures include occipital nerve stimulation, sphenopalatine ganglion stimulation and ventral tegmental area deep brain stimulation. These stimulation devices may find a place in the treatment pathway of headache disorders. Here, we explore the basic principles of neurostimulation for headache and overview the available methods of neurostimulation.

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“…In a word, their applications are still greatly limited by their tolerability and adverse effects. The effective management of headache disorders remains a moving field and a potential challenge to the neurologist (Sinclair et al, 2015 ). Thus, many migraine patients resort to complementary and alternative medicine (CAM).…”

Section: Introductionmentioning

confidence: 99%

Chuanxiong Formulae for Migraine: A Systematic Review and Meta-Analysis of High-Quality Randomized Controlled Trials

Shan

Shi

et al. 2018

Front. Pharmacol.

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Objective: Migraine is a complex, prevalent and disabling neurological disorder characterized by recurrent episodes of headache without ideal treatment. We aim to assess the current available evidence of herbal Chuanxiong (Ligusticum chuanxiong Hort. root) formulae for the treatment of migraine according to the high-quality randomized controlled trials (RCTs).Methods: English and Chinese electronic databases were searched from their inceptions until March 2017. The methodological quality of included study was assessed by the Cochrane Collaboration risk of bias tool. RCTs with Cochrane risk of bias (RoB) score ≥4 were included in the analyses. Meta-analysis was conducted using RevMan 5.3 software. Publication bias was assessed by funnel plot analysis and Egger's test.Results: Nineteen RCTs with 1832 participants were identified. The studies investigated the Chuanxiong formulae vs. placebo (n = 5), Chuanxiong formulae vs. conventional pharmacotherapy (CP) (n = 13 with 15 comparisons), and Chuanxiong formulae plus CP vs. CP (n = 1). Meta-analysis indicated that Chuanxiong formulae could reduce frequency, duration, days and pain severity of migraine and improve the total clinical efficacy rate (P < 0.05). Adverse event monitoring was reported in 16 out of 19 studies and occurrence rate of adverse event was low.Conclusion: The findings of present study indicated that Chuanxiong formulae exerted the symptom reliefs of for migraine.

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Headache management: pharmacological approaches

Cited by 27 publications

References 42 publications

Impact of migraine on fibromyalgia symptoms

Impact of migraine on fibromyalgia symptoms

Neurostimulation in the treatment of primary headaches

Chuanxiong Formulae for Migraine: A Systematic Review and Meta-Analysis of High-Quality Randomized Controlled Trials

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