The journey from genetic predisposition to medication overuse headache to its acquisition as sequela of chronic migraine

Martelletti, Paolo

doi:10.1186/s10194-017-0830-2

Cited by 21 publications

(23 citation statements)

References 27 publications

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“…However, the quality of the data is limited due to the fact that it is based on post hoc analysis [ 158 ]. A future role for monoclonal antibodies targeting the CGRP pathway is to be awaited [ 159 ]. Ultimately, the identification of proper prophylaxis should be driven by clinical history, comorbidity, contraindications and side effects of the possible drugs [ 126 ].…”

Section: Treatmentmentioning

confidence: 99%

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Medication-overuse headache: a widely recognized entity amidst ongoing debate

et al. 2018

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Medication overuse in primary headache disorders is a worldwide phenomenon and has a role in the chronification of headache disorders. The burden of disease on individuals and societies is significant due to high costs and comorbidities. In the Third Edition of the International Classification of Headache Disorders, medication-overuse headache is recognized as a separate secondary entity next to mostly primary headache disorders, although many clinicians see the disease as a sole complication of primary headache disorders. In this review, we explore the historical background of medication-overuse headache, its epidemiology, phenomenology, pathophysiology and treatment options. The review explores relevant unanswered questions and summarizes the current debates in medication-overuse headache.

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Section: Treatmentmentioning

confidence: 99%

“…Furthermore, the results from neuroimaging suggest that neuroplasticity exists and that specific imaging findings can be predictive for the outcome after withdrawal. Lastly, the field of genetics in MOH is in development, reaching out to a more personalized approach for MOH [ 159 ].…”

Section: Debates In Mohmentioning

confidence: 99%

Medication-overuse headache: a widely recognized entity amidst ongoing debate

et al. 2018

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“…The employment of multiple treatments, often decided on an empirical basis, could be avoided if the precision medicine approach [ 42 ] was implemented in the management of primary headache. Unfortunately, there have been no specific genetic or epigenetic abnormalities associated with a particular type of headache to assist with determining optimal treatment [ 43 ]. In clinical practice, acute and preventive headache treatments are prescribed on the basis of diagnosis, taking into account the comorbidity of the patient and the safety profile of the drug [ 16 ], but without the possibility of efficient and optimal individualized treatment for the patient.…”

Section: Discussionmentioning

confidence: 99%

Polypharmacy Among Headache Patients: A Cross-Sectional Study

et al. 2018

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BackgroundPolypharmacy can appropriately treat multiple chronic conditions, but it can also increase potential harm. Polypharmacy information for primary headaches is minimal, despite drugs being the main tools to manage headaches.ObjectiveThe aim was to evaluate the prevalence, characteristics and risk factors of polypharmacy in patients with primary headaches and examine whether these variables differ between episodic and chronic headache patients.MethodsWe analysed polypharmacy (simultaneous use of five or more medications), medication type, comorbidity, and risk factors in 300 patients (mean age 42.81 ± 13.21 years) with primary headaches, divided into episodic and chronic, afferent to a headache centre.ResultsPatients took an average of 4.37 medications. Polypharmacy was common in 40.7% of patients, and among chronic patients, it reached 58.8%. Most patients used medications (mainly nonsteroidal anti-inflammatory drugs; 73.5%) to treat acute headaches, and 30.4% of episodic and 64.7% of chronic sufferers underwent prophylactic treatment (P < 0.0001), mostly using antidepressants (77.3%). Up to 76.7% of the cohort was taking other medications, primarily for acid-related disorders (21.7%). Comorbidities were present in 59.7% of the cohort. Variables significantly associated with polypharmacy were comorbidities, prophylactic treatment, and triptans (P < 0.001).ConclusionsPatients with primary headaches, mainly young adults, are exposed to high polypharmacy, comparable to that of the elderly. Because increased numbers of drugs increase the risk of adverse reactions, the many medications concomitantly taken by primary headache sufferers should be frequently reviewed.Electronic supplementary materialThe online version of this article (10.1007/s40263-018-0522-8) contains supplementary material, which is available to authorized users.

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“…This finding is consistent with a review that showed high headache frequency to be an important modifiable risk factor in migraine chronification progression [ 44 ] and with previous studies stating that headache frequency in particular may be a risk factor for onset MOH [ 8 , 45 ]. Martelletti shows that MOH must be considered as sequela of chronic migraine and in light of that, it is beneficial to focus on how to reduce headache frequency among migraine patients to avoid MOH as a consequence [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

The role of personality, disability and physical activity in the development of medication-overuse headache: a prospective observational study

et al. 2018

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BackgroundFactors associated with development of medication-overuse headache (MOH) in migraine patients are not fully understood, but with respect to prevention, the ability to predict the onset of MOH is clinically important. The aims were to examine if personality characteristics, disability and physical activity level are associated with the onset of MOH in a group of migraine patients and explore to which extend these factors combined can predict the onset of MOH.MethodsThe study was a single-center prospective observational study of migraine patients. At inclusion, all patients completed questionnaires evaluating 1) personality (NEO Five-Factor Inventory), 2) disability (Migraine Disability Assessment), and 3) physical activity level (Physical Activity Scale 2.1). Diagnostic codes from patients’ electronic health records confirmed if they had developed MOH during the study period of 20 months. Analyses of associations were performed and to identify which of the variables predict onset MOH, a multivariable least absolute shrinkage and selection operator (LASSO) logistic regression model was fitted to predict presence or absence of MOH.ResultsOut of 131 participants, 12 % (n=16) developed MOH. Migraine disability score (OR=1.02, 95 % CI: 1.00 to 1.04), intensity of headache (OR=1.49, 95 % CI: 1.03 to 2.15) and headache frequency (OR=1.02, 95 % CI: 1.00 to 1.04) were associated with the onset of MOH adjusting for age and gender. To identify which of the variables predict onset MOH, we used a LASSO regression model, and evaluating the predictive performance of the LASSO-mode (containing the predictors MIDAS score, MIDAS-intensity and –frequency, neuroticism score, time with moderate physical activity, educational level, hours of sleep daily and number of contacts to the headache clinic) in terms of area under the curve (AUC) was weak (apparent AUC=0.62, 95% CI: 0.41-0.82).ConclusionDisability, headache intensity and frequency were associated with the onset of MOH whereas personality and the level of physical activity were not. The multivariable LASSO model based on personality, disability and physical activity is applicable despite moderate study size, however it can be considered as a weak classifier for discriminating between absence and presence of MOH.

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The journey from genetic predisposition to medication overuse headache to its acquisition as sequela of chronic migraine

Cited by 21 publications

References 27 publications

Medication-overuse headache: a widely recognized entity amidst ongoing debate

Medication-overuse headache: a widely recognized entity amidst ongoing debate

Polypharmacy Among Headache Patients: A Cross-Sectional Study

The role of personality, disability and physical activity in the development of medication-overuse headache: a prospective observational study

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