Preventive treatment in migraine and the new US guidelines

Estemalik, Emad; Tepper, Stewart J.

doi:10.2147/ndt.s33769

Cited by 94 publications

(90 citation statements)

References 71 publications

(80 reference statements)

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“…Consistent with a need for noradrenergic effects, headache reduction with venlafaxine was observed at the 150-mg dose, but not 75-mg dose. The 150-mg dose is required for inhibition of the norepinephrine transporter [27].…”

Section: Discussionmentioning

confidence: 99%

A prospective, open-label study of milnacipran in the prevention of headache in patients with episodic or chronic migraine

2013

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Migraine is a highly prevalent episodic and chronic neurological disorder that impacts otherwise healthy men and women in their most productive years. An anecdotal survey in our clinical practices suggested that milnacipran, a drug indicated for the treatment of fibromyalgia, reduced the incidence of headache in patients with migraine. In this 3-month, open-label, pilot study, 38 patients diagnosed with episodic migraine and 7 patients with chronic migraine maintained headache diaries to assess the effectiveness and tolerability of milnacipran in headache prevention. After a 1-month period to obtain baseline data, milnacipran treatment was initiated and doses were titrated up to 100 mg/day over 1 month. Maintenance therapy continued for an additional 3 months. The primary efficacy end point was change from baseline in the number of all headache days during the last 28 days of maintenance therapy analyzed, using last observation carried forward (LOCF). Change from baseline in migraine days during the last month of the maintenance period using LOCF was a secondary end point. Milnacipran 100 mg daily was associated with a significant reduction in headache (-4.2 days; P < 0.001) and migraine frequency (-2.2 days; P < 0.003). The adverse event profile was consistent with prior reports of milnacipran for the treatment of other conditions. However, compared with the recommended protocol, a more gradual increase in milnacipran dose was required to improve tolerability for some patients. The robust efficacy signal found in this study strongly suggests that a double-blind, placebo-controlled trial of milnacipran in migraine and chronic headache is warranted.

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Section: Discussionmentioning

confidence: 99%

A prospective, open-label study of milnacipran in the prevention of headache in patients with episodic or chronic migraine

2013

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“…Sexual dimorphism is reported in migraine, i.e. prevalence ratio among men and women is 3:7 [13,14].…”

Section: Advantages Of Orodispersible Filmmentioning

confidence: 99%

Application of Quality by Design Approach for the Optimization of Orodispersible Film Formulation

Gupta

Kumar

Verma

et al. 2018

Asian J Pharm Clin Res

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Objective: The present study was done to understand the effect of formulation variables on the quality of orodispersible films using quality by design (QbD) approach as mentioned in ICH Q8 (R 2 ) guideline. Methods:A definitive screening design of experiments (DoE) was used to identify and classify the critical formulation variables affecting critical quality attributes (CQA) using 2×2 factorial design. Based on prescreening study, the critical formulation variables, i.e. concentration of film-forming polymer and plasticizers (propylene glycol and polyethylene glycol 400 [PEG 400]) were kept in the range of 1.5-2.5% w/w and 0.5-1% v/v, respectively. A total of eight laboratory-scale formulations were prepared which were provided by DoE using solvent casting method. These batches were evaluated for CQA's, i.e. mechanical properties such as folding endurance (FD) and disintegration time (DT). Data were analyzed for elucidating interactions between two variables and for providing a predictive model for the process. Finally, the drug was incorporated into optimized batches, and these were evaluated for in vitro dissolution study in simulated saliva (pH 6.8) as well as their mechanical properties. Results:The results suggested that the concentration of film-forming polymer and plasticizer was critical to manufacture orodispersible film with desired CQA, i. Conclusion:From the results, it has been found that the percentage drug release of naratriptan hydrochloride containing propylene glycol as a plasticizer was greater than the formulation containing PEG 400 as plasticizer. From this, we concluded that QbD is very much useful approach to get an optimized formulation in an economic and faster way in comparison to traditional method (hit and trail methods). The futuristic application of the film will involve the management of an acute migraine.

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“…Migren atakları hastaların %90'ında işlevsel fonksiyonlarında bozulmaya ve %50'sinde de yatak istirahatı gerektirecek şekilde şiddetli ağrıya neden olur. [1][2][3] Migren tedavisinde PAIN A RI na devam etmeleri de önerildi. O gün dinlenmeleri tavsiye edilerek taburcu edildi.…”

Section: Introductionunclassified

The Results of Greater Occipital Nerve Block Applied for Migraine Headache

Çatav¹,

Solmaz

Kirdemi̇r³

2017

Agri

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Sonuç: Migren başağrısında GON bloğu 1.5 ml %2 lidokain ile güvenilir, basit ve efektif bir tedavi yöntemidir.Anahtar sözcükler: Büyük oksipital sinir bloğu; lidokain; migren. SummaryObjectives: The aim of this study was to evaluate the efficacy of greater occipital nerve (GON) block in the treatment of migraine patients.Methods: This study included 28 patients diagnosed with migraine between 2014 and 2015. The GON block procedure was applied by administering 1.5 ml of 2% lidocaine 2 cm lateral and 2 cm inferior to the external occipital protuberance. The patients were evaluated in respect of VAS scores, attack frequency, attack duration and the need for analgesia before the procedure. These parameters were evaluated again at 1 week, 1 month and 3 months after the procedure. Results:The mean age of the patients was 42.21±10.13 years. The mean VAS score was 9.28±0.72 before the procedure and 2.96±2.16 at 1 week, 2.60±1.96 at 1 month and 1.75±1.37 at 3 months. The frequency of attacks was 9.42±4.51 before the procedure and, 5.42±3.30 at 1 month and 3.57±3.14 at 3 months.Conclusion: GON block with 1.5 ml of 2% lidocaine is a safe, simple and effective treatment method for migraine headache.Keywords: Greater occipital nerve block; lidocaine; migraine. Migren başağrısında büyük oksipital sinir bloğu uygulama sonuçlarımızThe results of greater occipital nerve block applied for migraine headache Serdar ÇATAV, Filiz ALKAYA SOLMAZ, Pakize KIRDEMIR

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Preventive treatment in migraine and the new US guidelines

Cited by 94 publications

References 71 publications

A prospective, open-label study of milnacipran in the prevention of headache in patients with episodic or chronic migraine

A prospective, open-label study of milnacipran in the prevention of headache in patients with episodic or chronic migraine

Application of Quality by Design Approach for the Optimization of Orodispersible Film Formulation

The Results of Greater Occipital Nerve Block Applied for Migraine Headache

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