Tackling chronic migraine: current perspectives

Carod-Artal, Francisco Javier

doi:10.2147/jpr.s61819

Cited by 32 publications

(31 citation statements)

References 72 publications

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“…The mean dose of topiramate was 100 mg per day. Sodium valproate efficacy was also proved in smaller trials (mean dose 1000 mg per day) (9). Other antiepileptic drugs with some evidence in preventing CM are: gabapentin, levetiracetam, lacosamide (11).…”

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confidence: 98%

“…The goals of migraine treatment are: reducing or relieving pain, restoration of normal function and reducing attack frequency. Remission in CM was defined as fewer than 10 days of headache per month (9). This goal is difficult to achieve, in a study of 400 patients with , Manack and al.…”

mentioning

confidence: 99%

“…Recommended preventive drugs for chronic migraine are antiepileptic drugs (especially topiramate, but also sodium valproate) and botulinum toxins (Onabotulinumtoxin A). Treatment should be started with topiramate, because the drug has the highest level of evidence in treating CM (9). Several doubleblind, randomized, placebo-controlled clinical trials showed that topiramate cause a significant reduction in migraine days in patients with CM.…”

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confidence: 99%

“…Onabotulinumtoxin A (Botox) injections could be considered when at least two trials with oral medicatins have failed in preventing CM attacks. Botulinum toxin is a neurotoxin which inhibits the release of nociceptive mediators from the peripheral terminals of primary afferents and inhibits sensitization of central trigeminovascular neurons, believed to be key factors in development and progression of migraneous headaches (7), (9). In United States it is the only treatment specifically approved for the prophylaxis of CM, based on the evidence of PREEMPT clinical trials (5).…”

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confidence: 99%

“…Few studies have compared the effect of topiramate and of Onabotulinumtoxin A; they found similar efficacy (9).…”

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confidence: 99%

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Treatment in chronic migraine: choice of reabilitation strategies

Stănescu¹,

Dogaru²

2015

BALNEO

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Migraine is a disabling neurologic condition with a spontaneous clinical evolution into a chronic form. Migraine progression from an episodic into a chronic form is realized through a period of time involving several months or years, during which an increase attack frequency occurs. .According to the International Classification of Headache Disorders (ICHD-3) chronic migraine is a type of primary headache occurring on 15 or more days per month for more than 3 months, in which more than 8 days per month headache meet criteria for migraine with or without aura or respond to specific migraine treatment. The prevalence of chronic migraine is estimated between 1-3% of general population. Persons with chronic migraine are more likely to suffer from severe disability; chronic migraine has an important socio-economic impact.Diagnostic approach in chronic migraine includes exclusion of a secondary headache disorder and confirmation of a primary episodic headache. When a patient is found to overuse pain medication, diagnosis of both chronic migraine and MOH should be considered.Treating episodic migraine early and managing attack frequency using preventive medication and behavioural interventions will be benefic in reducing the risk of chronicisation. Lifestyle changes are important for avoiding triggers for migraine attacks; treatment of comorbidities is equally important because these conditions exacerbate patient's tendency to have headaches. The initial relief step for drug abusers always relies in drug withdrawal. For migraine attacks treatment begins with non-pharmacologic interventions (staying in a quiet, dark room, pressure on painful areas, applying cold compresses ), simple OTC analgetics (NSAIDs, paracetamol, aspirin, acetaminophen). If these are not effective, triptans are the drugs of choice. Preventive treatment is always recommended in patients with chronic migraine because the high frequency of headache attacks. Treatment should be started with topiramate, because the drug has the highest level of evidence in treating CM; Onabotulinumtoxin A reduced the number headache days, headache severity, headache-related disability and improved functioning and quality of life. Additionally, complementary and alternative medicine treatments are available in CM prophylaxis, such as biobehavioral techniques (relaxation training, thermal biofeedback, electromyography feedback and cognitive-behavioral therapy). Invasive and non-invasive neurostimulation techniques have been studied in the treatment and prevention of various types of headaches, including chronic migraine. New treatment options for acute attacks and for prevention include calcitonin generelated peptide (CGRP) antagonists and antibodies.

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confidence: 98%

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confidence: 99%

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confidence: 99%

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confidence: 99%

“…Few studies have compared the effect of topiramate and of Onabotulinumtoxin A; they found similar efficacy (9).…”

mentioning

confidence: 99%

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Treatment in chronic migraine: choice of reabilitation strategies

Stănescu¹,

Dogaru²

2015

BALNEO

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Pharmacological agents for the prevention of vestibular migraine

Valle¹,

Birdi²,

Irving

et al. 2015

Cochrane Database of Systematic Reviews

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Background Vestibular migraine is a common cause of episodic vertigo. Many preventive treatments have been proposed for this condition, including calcium antagonists, beta-blockers, antidepressants, anticonvulsants, selective 5-HT1 agonists, serotonin antagonists and non-steroidal anti-inflammatory drugs (NSAIDs). Objectives To assess the effects of pharmacological agents for the prevention of vestibular migraine.

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