Understanding the nature of psychiatric comorbidity in migraine: a systematic review focused on interactions and treatment implications

Dresler, Thomas; Caratozzolo, Salvatore; Guldolf, Kaat; Huhn, Jana-Isabel; C, Loiacono; Niiberg-Pikksööt, Triinu; Puma, Marta; Sforza, Giorgia; Tobia, Anna; Ornello, Raffaele; Serafini, Gianluca

doi:10.1186/s10194-019-0988-x

Cited by 160 publications

(171 citation statements)

References 186 publications

(230 reference statements)

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“…According to our data, erenumab decreased the intensity, disability and impact of headache and symptoms of depression and anxiety, which were not specifically addressed in the erenumab trials. Migraine and symptoms of anxiety or depression are linked in a bidirectional fashion [28]; in the present case series, the improvement of psychiatric symptoms might be explained by the reduction in recurrent disabling migraine attacks which do not respond to treatment.…”

Section: Discussionmentioning

confidence: 60%

Real-life data on the efficacy and safety of erenumab in the Abruzzo region, central Italy

Casalena²,

et al. 2020

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Background: We aimed to assess the efficacy and safety of erenumab, a fully human monoclonal antibody inhibiting the calcitonin gene-related peptide receptor (CGRPr), for the prevention of migraine in a real-life setting. Main body: We included in our observational study all patients with episodic or chronic migraine treated with erenumab during the year 2019 in the Abruzzo region, central Italy, and with a 6-month follow-up. We included 89 patients; 76 (85.4%) received 6 doses of erenumab, 11 (12.4%) autonomously withdrew the drug due to perceived inefficacy, and 2 (2.2%) due to adverse events. Seventy-eight patients (87.6%) were female, with a mean age of 46.8 ± 11.2 years; 84 (94.4%) had chronic migraine, and 64 (71.9%) medication overuse. All patients had ≥2 prior preventive treatment failures. Fifty-three patients (69.7%) had a 50% decrease in monthly migraine days (MMDs) within the first three doses; 46 (71.9%) of 64 patients withdrew medication overuse. In the 76 patients who completed a 6-dose treatment, erenumab decreased median MMDs from 19 (interquartile range [IQR] 12-27.5) to 4 (IQR 2-9.5; P < 0.001), median monthly days of analgesic use from 10 (IQR 4.5-20) to 2 IQR 0-5; P < 0.001), and median monthly days of triptan use from 5 (IQR 0-15.5) to 1 (IQR 0-4; P < 0.001). We recorded 27 adverse events in 20 (22.5%) patients, the most common being constipation (13.5%). One adverse event, i.e. allergic reaction, led to treatment discontinuation in one patient. Conclusions: Our real-life data confirm the efficacy and tolerability of erenumab for the prevention of migraine in a difficult-to-treat population of patients with a high prevalence of chronic migraine and medication overuse.

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Section: Discussionmentioning

confidence: 60%

Real-life data on the efficacy and safety of erenumab in the Abruzzo region, central Italy

Casalena²,

et al. 2020

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“…Besides, patients received a homogeneous treatment protocol whose response was assessed using standardized criteria. However, the present study is limited by the lack of assessment of migraine comorbidities, especially the psychiatric ones, which negatively affect the course of migraine [43] and might have a negative impact also on BT-A treatment [33]. Data on psychological treatments, including behavioral therapy [44], which might have benefited some patients were not collected in this study.…”

Section: Discussionmentioning

confidence: 97%

Sustained response to onabotulinumtoxin A in patients with chronic migraine: real-life data

et al. 2020

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Background: Treatment with onabotulinumtoxin A (BT-A) is safe and effective for chronic migraine (CM). Several studies assessed possible predictors of response to treatment with BT-A, but there is little knowledge on the frequency and predictors of sustained response. The aim of this study was to evaluate sustained response to BT-A in patients with CM. Main body: In this prospective open-label study, 115 patients with CM and treated with BT-A were consecutively enrolled in two Italian headache centers and followed up for 15 months. Anytime responders were defined as those patients who achieved a ≥ 50% reduction in headache days during any three-month treatment cycle compared with the 3 months prior to initiation of BT-A treatment. Sustained responders were defined as those who achieved a ≥ 50% reduction in headache days within the third treatment cycle and maintained response until the end of follow-up. Non-responders were defined as those patients who never achieved a ≥ 50% reduction in headache days during the follow-up. Headache characteristics prior to BT-A treatment were assessed in order to evaluate their ability in predicting treatment response. The 115 enrolled patients (84.3% female; median age 50 years) had a median migraine duration of 30 years (interquartile range 22-38). At the end of follow-up, 66 patients (57.4%) were classified as anytime responders. Among the 51 patients who achieved a clinical response within the third month of treatment, 33 (64.7%) were sustained responders. Patients with sustained response had a lower CM duration (median 31 vs 65 months; P = 0.030) and a lower number of headache days (median 25 vs 30; P = 0.013) at baseline compared with nonresponders. Conclusions: About two thirds of patients who gain ≥50% response to BT-A within the third cycle of treatment maintain this positive response over time. More recent onset of CM and more headache-free days at baseline are associated with sustained response. We suggest not to delay preventive treatment of CM with BT-A, in order to increase the likelihood to achieve sustained clinical response.

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“…The evidence is mostly based on pairwise comparisons or examination of targeted conditions. A large number of migraine-associated comorbidities have been identified including asthma and allergies, psychiatric, cardiovascular, cerebrovascular, gastrointestinal, musculoskeletal disorders, as well as other neurological and pain-related disorders [9][10][11][12][13][14][15][16][17][18][19]. Moreover, several symptoms related to migraine attacks such as sensitivity to light, sound and odours also occur to some extent between migraine attacks.…”

Section: Introductionmentioning

confidence: 99%

Burden of migraine in Finland: multimorbidity and phenotypic disease networks in occupational healthcare

Korolainen¹,

Tuominen²,

Kurki

et al. 2020

J Headache Pain

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Background: Migraine is a complex neurological disorder with high co-existing morbidity burden. The aim of our study was to examine the overall morbidity and phenotypic diseasome for migraine among people of working age using real world data collected as a part of routine clinical practice. Methods: Electronic medical records (EMR) of patients with migraine (n = 17,623) and age-and gender matched controls (n = 17,623) were included in this retrospective analysis. EMRs were assessed for the prevalence of ICD-10 codes, those with at least two significant phi correlations, and a prevalence >2.5% in migraine patients were included to phenotypic disease networks (PDN) for further analysis. An automatic subnetwork detection algorithm was applied in order to cluster the diagnoses within the PDNs. The diagnosis-wise connectivity based on the PDNs was compared between migraine patients and controls to assess differences in morbidity patterns. Results: The mean number of diagnoses per patient was increased 1.7-fold in migraine compared to controls. Altogether 1337 different ICD-10 codes were detected in EMRs of migraine patients. Monodiagnosis was present in 1% and 13%, and the median number of diagnoses was 12 and 6 in migraine patients and controls. The number of significant phi-correlations was 2.3-fold increased, and cluster analysis showed more clusters in those with migraine vs. controls (9 vs. 6). For migraine, the PDN was larger and denser and exhibited one large cluster containing fatigue, respiratory, sympathetic nervous system, gastrointestinal, infection, mental and mood disorder diagnoses. Migraine patients were more likely affected by multiple conditions compared to controls, even if no notable differences in morbidity patterns were identified through connectivity measures. Frequencies of ICD-10 codes on a three character and block level were increased across the whole diagnostic spectrum in migraine. Conclusions: Migraine was associated with an increased multimorbidity, evidenced by multiple different approaches in the study. A systematic increase in the morbidity across the whole spectrum of ICD-10 coded diagnoses, and when interpreting PDNs, were detected in migraine patients. However, no specific diagnoses explained the morbidity. The results reflect clinical praxis, but also undoubtedly, the pathophysiological phenotypes related to migraine, and emphasize the importance of better understanding migraine-related morbidity.

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Understanding the nature of psychiatric comorbidity in migraine: a systematic review focused on interactions and treatment implications

Cited by 160 publications

References 186 publications

Real-life data on the efficacy and safety of erenumab in the Abruzzo region, central Italy

Real-life data on the efficacy and safety of erenumab in the Abruzzo region, central Italy

Sustained response to onabotulinumtoxin A in patients with chronic migraine: real-life data

Burden of migraine in Finland: multimorbidity and phenotypic disease networks in occupational healthcare

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