Current and emerging evidence-based treatment options in chronic migraine: a narrative review

Agostoni, Elio; Barbanti, Piero; Calabresi, Paolo; Colombo, Bruno; Cortelli, Pietro; Frediani, Fabio; Geppetti, Pietrangelo; Grazzi, Licia; Leone, Massimo; Martelletti, Paolo; Pini, Luigi Alberto; Prudenzano, Maria Pia; Sarchielli, Paola; Tedeschi, Gioacchino; Russo, Antonio

doi:10.1186/s10194-019-1038-4

Cited by 140 publications

(150 citation statements)

References 79 publications

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“…Effects of preventive treatments on migraine frequency. There was only a mild effect on headache frequency in the three months following preventive drugs prescription, in accord to previous studies based on indirect evidence (3,16,20). This could suggest that there is a bias between Randomized…”

Section: Discussionsupporting

confidence: 86%

Failure of Preventive Treatments in Migraine: An Observational Retrospective Study in a Tertiary Headache Center

Delussi¹,

Vecchio²,

Quitadamo

et al. 2020

Preprint

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BACKGROUND Despite the criteria of acute migraine treatment and prevention have been well described , there are still unmet needs, for a general underuse and low benefit of preventive treatments. The aim of the present study was to observe retrospectively the short term effect of preventive treatment in a cohort of migraine patients come at a tertiary headache center, using data from an electronic medical record. METHODS This was an observational retrospective cohort study on data collected in a tertiary headache center. Data were extracted from an electronic dataset collected between January 2009 to December 2019. Main selection criteria were age 18-75, diagnosis of migraine without aura(MO), with aura (MA) and chronic migraine (CM), a control visit after three months from the first access, prescription of preventive treatment with level of evidence 1 as reported by Italian guidelines. As primary outcome measure we considered the change of frequency of headache at follow up , as second outcomes disability scores , intensity of headache, allodynia; as predictive factors age, migraine duration, sex and headache frequency, allodynia, anxiety and depression at baseline; comorbidity with fibromyalgia. RESULTS Among 6430 patients screened,2800 met the selection, 1800 returned to follow up, 550 withdrawn for adverse events, 1100 were introduced into analysis. One hundred thirty four had a frequency reduction of 50% or more. Flunarizine was used in less severe migraine, with a better effect as compared to other drugs (odds ratio 1.48; p 0.022). Low headache frequency and absent or mild allodynia predicted a better outcome. CONCLUSIONSThe mild effect of preventive drugs on migraine features and the number of patients lost to follow up or dropped out for adverse events confirm that in severely and chronic sufferers the first line preventive approach could delay a more focused therapeutic approach.

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Section: Discussionsupporting

confidence: 86%

Failure of Preventive Treatments in Migraine: An Observational Retrospective Study in a Tertiary Headache Center

Delussi¹,

Vecchio²,

Quitadamo

et al. 2020

Preprint

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“…Measures to prevent chronic migraines mainly include orally administered drugs, behavioral management techniques, alternative physical therapies, and nutraceutical therapies (Agostoni and Barbanti, 2019). Orally administered medications, such as betablockers, anticonvulsants, serotonin antagonists, and calciumchannel blockers, are used in the management of chronic migraine (Sarchielli et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…Orally administered medications, such as betablockers, anticonvulsants, serotonin antagonists, and calciumchannel blockers, are used in the management of chronic migraine (Sarchielli et al, 2012). If drug interventions are not found to be effective, other preventive approaches may be used (Agostoni and Barbanti, 2019). These include patient education, substance abuse management, lifestyle changes, and management of comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Impact of the botulinum-A toxin on prevention of adult migraine disorders

Shen

Wang

2020

Journal of Integrative Neuroscience

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A systematic review of the impact of botulinum-A toxin as a therapeutic regimen for the management of adult migraine disorders is shown to that Botulinum-A toxin provides a more significant reduction in the number of headache episodes per month relative to placebo (MD:-0.61, 95% CI:-1.02 to-0.19). In subgroup analysis, botulinum-A toxin significantly reduced headache episodes per month relative to placebo for chronic migraine (MD:-1.68, 95% CI:-3.31 to-0.06), migraine (MD:-2.43, 95% CI:-4.08 to-0.77), and follow-up time in 16 weeks (MD:-2.19, 95% CI:-3.84 to-0.53). Statistical differences were not found in subgroup analyses of data relating to chronic migraine, episodic migraine, and other treatment course durations. An analysis of chronic and episodic migraine, botulinum-A toxin did not significantly differ from placebo in the proportion of patients achieving a fifty percent reduction in the number of headaches per month. In terms of patients' subjective reporting of headaches, botulinum toxin A conferred significant improvements when assessment questionnaires of migraine disability and migraine impact were analyzed. However, differences were not substantial with data from the 6-item headache impact test. This meta-analysis demonstrated that botulinum-A toxin as a therapeutic regimen improved the impact of chronic migraines after 16 weeks of therapy, although this was not the case for episodic migraine.

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“…It is important to note that administration of acute therapy before the onset of migraine attacks is more effective than after migraine symptoms emerge [49]. The use of triptans is limited to acute therapy, since the risk of developing medication overuse headache (MOH) correlates with frequency of triptan use [50]. Additionally, triptans are contraindicated in patients with cardiovascular risk, due to undesirable vasoconstrictive effects [37,51,52].…”

Section: Acute Migraine Headache Therapymentioning

confidence: 99%

“…Unlike the drugs used for acute migraine therapy, migraine preventive therapy aims to reduce the incidence of migraine attacks. Hence, these types of treatments are more suitable for EM and CM with frequent recurrent attacks [50]. These preventive medications were originally designed for other medical conditions including depression, epilepsy, and hypertension before being used for migraine therapy [46].…”

Section: Migraine Headache Preventive Therapymentioning

confidence: 99%

An Evidence-Based Review of Fremanezumab for the Treatment of Migraine

Urits

Clark

et al. 2020

Pain Ther

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Migraine headache is a common, chronic, debilitating disease with a complex etiology. Current therapy for migraine headache comprises either treatments targeting acute migraine pain or prophylactic therapy aimed at increasing the length of time between migraine episodes. Recent evidence suggests that calcium gene-related peptide (CGRP) is a critical component in the pathogenesis of migraines. Fremanezumab, a monoclonal antibody against CGRP, was recently approved by the Food and

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Current and emerging evidence-based treatment options in chronic migraine: a narrative review

Cited by 140 publications

References 79 publications

Failure of Preventive Treatments in Migraine: An Observational Retrospective Study in a Tertiary Headache Center

Failure of Preventive Treatments in Migraine: An Observational Retrospective Study in a Tertiary Headache Center

Impact of the botulinum-A toxin on prevention of adult migraine disorders

An Evidence-Based Review of Fremanezumab for the Treatment of Migraine

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