New therapeutic developments in chronic migraine

Lovell, Brigitte V; Marmura, Michael J.

doi:10.1097/wco.0b013e3283396d6b

Cited by 22 publications

(13 citation statements)

References 53 publications

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“…Different procedures have been suggested for withdrawal namely at home, at the hospital, with or without the use of steroids, with re-prophylaxis performed immediately or at the end of the wash-out period. However, no final agreement has been reached except for withdrawal from abuse in order to reinstate the natural course of CM or highfrequency migraine [44][45][46].…”

Section: Withdrawal From Drug Abuse and CM Reprophylaxismentioning

confidence: 99%

Chronic migraine: comorbidities, risk factors, and rehabilitation

2010

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Migraine is a serious illness with a spontaneous clinical evolution into a chronic form. In some episodic migraines, increase of crises frequency modifies the headache pattern in the chronic form, defined as chronic migraine (CM), with headache frequency of 15 days/month. One-year prevalence of CM includes around 2-4% of the general population. Migraine progression from episodic to chronic form is realized through a period of time involving several months or years, during which an increase of attack frequency occurs. Migraine shows a wide spectrum of comorbidities, including cardiocerebral, vascular, psychiatric, metabolic, neurologic as well as other pathologies. The single/multiple presence of such comorbidities represents a fixed factor in the process of chronicization into CM. Risk factors including medication overuse headache (MOH), obesity, and lifestyle cooperate in the evolution process to CM. MOH is the most severe complication of CM, and similarly to CM its appearance is gradual. Both CM and MOH show particular genetic background able to favor the appearance of chronicity and abuse. Rehabilitation consists of drug withdrawal procedures, re-prophylaxis through administration of innovative drugs, such as OnabotulinumtoxinA and/or topiramate, to avoid relapsing attacks, and behavioral strategies to minimize the role of risk factors. The initial relief step for drug abusers always relies in drug withdrawal. The feasible diagnostic setting for a CM tailored treatment based on the application of pharmacogenomics will allow us to predetermine the efficacy of single old and new drugs by avoiding abuse due to non-responsivity of the acute drug.

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Section: Withdrawal From Drug Abuse and CM Reprophylaxismentioning

confidence: 99%

Chronic migraine: comorbidities, risk factors, and rehabilitation

2010

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“…Topiramate, onabotulinum toxin type A, gabapentin, pentasites and tizanidine are among the agents that appear to be effective in the treatment of CM. In the treatment of CM, preventive treatment and a better understanding of its risk factors will allow clinicians to better identify individuals at the greatest risk and prevent the development of CM [6].The main problem remains how to treat these patients to avoid a relapse in the daily drug use because recurrence of headaches and the management of CM patients in re-prophylaxis after detoxification of abuses still appears complicated.Regarding abusers, the first step always consists in drug interruption. Only after detoxification can a new prophylaxis therapy be commenced, which will otherwise be useless from the start.…”

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confidence: 99%

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confidence: 99%

An emerging problem in clinical practice: how to treat chronic headache patients

Pini

2010

Intern Emerg Med

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In this issue, an interesting article by Farinelli and coworkers [1] debates an important emerging and not yet resolved problem: how to treat the chronic headaches complicated by medication overuse. Headache is the most common neurological disease in clinical practice. In Europe, this affects about 51% of the population, of which 31% are tension-type headache and 14% are migraine sufferers; 2% of these patients become chronic sufferers, more than 15/day/month, and chronic daily headache (CDH). 4-5% of general population suffers from a chronic form (CDH), with prevalence between 1.7 and 2.1% in men and between 2.8 and 6.8% in women [2]; within this group of patients in the US general population ranges around 1.3-2% of chronic migraine (CM).A number of possible pathophysiological mechanisms for the transformation from episodic to chronic headache have been proposed including a progressive damage of the central nociceptive system. One physiopathological hypothesis is the activation of N-methyl-D-aspartate (NMDA) and non-NMDA receptors glutamate, released by central nociceptive terminations, induces calcium entry in dorsal horn neurons, as well as in the trigeminal nucleus caudalis. Calcium entry leads to the activation of nitric oxide (NO) synthetase causing NO synthesis. These neurotransmitters produce the release of sensory neuropeptides, such as CGRP and substance P, which support the development of hyperalgesia and maintain central sensitization [3][4][5].Medication near-daily use and subsequent medication overuse headache (MOH) have been described by the revised International Classification of Headache Disorders (ICHDs)-IIR criteria as the use of each drug for at least 3 months, for a certain number of days per month, and is one of the most critical parameters in the process of becoming chronic.In the past few years, a lot of studies have shed light on potential risk factors for CM such as medication-overuse headache, temporomandibular disorders, obstructive sleep apnea and obesity. Recent clinical trials have started to focus on CM or CDH. Topiramate, onabotulinum toxin type A, gabapentin, pentasites and tizanidine are among the agents that appear to be effective in the treatment of CM. In the treatment of CM, preventive treatment and a better understanding of its risk factors will allow clinicians to better identify individuals at the greatest risk and prevent the development of CM [6].The main problem remains how to treat these patients to avoid a relapse in the daily drug use because recurrence of headaches and the management of CM patients in re-prophylaxis after detoxification of abuses still appears complicated.Regarding abusers, the first step always consists in drug interruption. Only after detoxification can a new prophylaxis therapy be commenced, which will otherwise be useless from the start.Within the possible treatment strategies in the review of Farinelli are examined the use of topiramate and the onabotulinum toxin A, a substance obtained from the grampositive anaerobic bacterium Clostridium bo...

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“…It is used in the treatment of masticatory and facial muscle spasm, severe bruxism, facial tics, orofacial dyskinesias, dystonias, and idiopathic hypertrophy of the masticatory muscles,1 as well as in the treatment of temporomandibular disorders,2 myofascial pain syndrome,3 headaches such as chronic migraine,4 recurrent dislocation of the temporomandibular joint (TMJ), drooling, and Frey's syndrome 5. Application of BTX-A to various orofacial regions in patients often requires injection into masticatory muscles such as the masseter and temporalis muscles, which can cause temporary muscle paralysis, weakness, and atrophy.…”

Section: Introductionmentioning

confidence: 99%

Change of Distribution and Timing of Bite Force after Botulinum Toxin Type A Injection Evaluated by a Computerized Occlusion Analysis System

2014

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PurposeThe aim of this study was to determine the force distribution and pattern of mastication after injection of botulinum toxin type A (BTX-A) into both masseter muscles. The hypothesis to be tested was that the difference between right and left balance of occlusal force diminishes over time following BTX-A injection.Materials and MethodsFifteen patients were submitted to BTX-A injection therapy for subjective masseter hypertrophy. A total of 25 U of BTX-A (50 U in total) was injected into two points located 1 cm apart at the center of the lower one-third of both masseter muscles. All patients were examined using the T-Scan occlusion analysis system before and 4, 8, 12, and 24 weeks after BTX-A injection.ResultsA significant change in force balance was found between the right and left sides over time and the difference between the two sides decreased with the time post-injection, reaching a minimum at 12 weeks. Comparison of the force balance between the anterior and posterior occlusions revealed no significant difference at any of the time points. The occlusion and disclusion times (right and left sides) did not differ significantly with time since BTX-A injection.ConclusionA decline in the difference in the clenching force between the left and right sides was found with increasing time up to 12 weeks following BTX-A injection.

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New therapeutic developments in chronic migraine

Cited by 22 publications

References 53 publications

Chronic migraine: comorbidities, risk factors, and rehabilitation

Chronic migraine: comorbidities, risk factors, and rehabilitation

An emerging problem in clinical practice: how to treat chronic headache patients

Change of Distribution and Timing of Bite Force after Botulinum Toxin Type A Injection Evaluated by a Computerized Occlusion Analysis System

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