Drug–Drug Interactions in Headache Medicine

Ansari, Hossein; Ziad, Sanaz

doi:10.1111/head.12864

Cited by 25 publications

(29 citation statements)

References 17 publications

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“…However, medications are often limited in efficacy and may be associated with significant adverse effects, such as medication overuse headaches 6 and drug interactions. 7 Analgesics, triptans, and ergot derivatives are commonly used for abortive therapy. There is limited evidence for the efficacy of prophylactic agents in the treatment of CM.…”

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confidence: 99%

Anatomical Look Into OnabotulinumtoxinA Injection for Chronic Migraine Headache

Wu-Fienberg

Ansari

Zardouz

et al. 2018

Regional Anesthesia and Pain Medicine

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Background and ObjectivesWhile existing studies about onabotulinumtoxinA for chronic migraines have focused on injection location and appropriate dosing, little consideration has been given to patient body habitus and its potential impact on efficacy. We hypothesized that with increasing patient body mass index (BMI) there would be more subcutaneous fat separating targeted muscle groups from the skin surface, such that standard 0.5-inch needles used in existing protocols may not allow intramuscular injection. This may have implications for treatment planning.MethodsAnatomically normal computed tomography scans of the head, neck, and face were randomly selected. Subjects were stratified into 4 groups based on BMI, with 30 patients in each group. Four standardized locations were chosen to obtain measurements from the skin surface to the underlying muscle fascia, including (1) frontalis, (2) temporalis, (3) semispinalis capitis, and (4) trapezius.ResultsMedian depth for the temporalis was 12.65 mm (Q1 = 9.32 mm, Q3 = 15.08 mm) for the BMI greater than 35 kg/m2 group. Median depth for the semispinalis capitis was 13.77 mm (Q1 = 10.3 mm, Q3 = 15.7 mm) for the BMI 30 to 35 kg/m2 group, and 14.75 mm (Q1 = 11.00, Q3 = 17.00 mm) for the BMI greater than 35 kg/m2 group. Median depth for the trapezius was 13.95 mm (Q1 = 10.18 mm, Q3 = 19.00 mm) for the BMI greater than 35 kg/m2 group. These medians exceeded the length of the standard 0.5-inch (12.-mm) needle used in existing protocols.ConclusionsOur study demonstrates that with increasing BMI there is a greater distance between the skin surface and the muscle fascia of muscles that are targeted for injection in standard chronic migraine botulinum toxin injection protocols. Because of this, patient body habitus may be an important factor in injection technique.

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confidence: 99%

Anatomical Look Into OnabotulinumtoxinA Injection for Chronic Migraine Headache

Wu-Fienberg

Ansari

Zardouz

et al. 2018

Regional Anesthesia and Pain Medicine

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“…►Table 3 lists specific details of triptan formulations and pharmacokinetics along with major pharmacologic interactions. 20 Triptans are solely used for acute treatment, with the exception of frovatriptan, which has a relatively long half-life of more than 24 hours and has been studied as a short-term preventive medication for up to 6 days at a time for the treatment of menstrual migraine. 21,22 Greater occipital nerve blocks with an anesthetic (typically 1-2% lidocaine, or 0.25% bupivacaine) with or without steroids (typically methylprednisolone 20-40 mg) are generally safe and frequently performed by physicians for acute treatment of migraine.…”

Section: Acute Treatmentmentioning

confidence: 99%

Migraine and Tension-Type Headache

Kahriman,

Zhu

2018

Semin Neurol

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Migraine and tension-type headache (TTH) are common primary disorders that carry significant morbidity and socioeconomic effect. In this article, we will review the epidemiology, presentation, and diagnosis of these disorders. First-line acute treatment for migraine consists of analgesics, triptans, and antiemetics, while nonsteroidal anti-inflammatory drugs are the mainstay treatment for TTH. Patients with frequent or chronic headaches warrant prophylactic therapy. For migraine, various classes of preventives can be used (β-blockers, tricyclics, antiepileptics, botulinum toxin), with the choice of therapy tailored to the patient's risk factors and symptoms. For TTH, tricyclics have the most evidence as prophylactic therapy. A new class of medication, monoclonal antibodies to calcitonin gene receptor peptide or its receptor, became available in 2018, and is the first class of medication specifically designed to treat migraine. In addition to pharmacotherapy, we will also review nonpharmacologic interventions as well as neuromodulation for migraine.

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“…Moreover, NIBS can directly aim at the migraine-related neurophysiological abnormalities, so that interventions may be planned on a precise pathophysiological rationale. Lastly, NIBS avoids cumbersome medication-related side effects and drug-drug interactions that limit the use of pharmacological therapies (Blumenfeld et al, 2013; Ansari and Ziad, 2016).…”

Section: Introductionmentioning

confidence: 99%

Treating Chronic Migraine With Neuromodulation: The Role of Neurophysiological Abnormalities and Maladaptive Plasticity

et al. 2019

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Chronic migraine (CM) is the most disabling form of migraine, because pharmacological treatments have low efficacy and cumbersome side effects. New evidence has shown that migraine is primarily a disorder of brain plasticity and migraine chronification depends on a maladaptive process favoring the development of a brain state of hyperexcitability. Due to the ability to induce plastic changes in the brain, researchers started to look at Non-Invasive Brain Stimulation (NIBS) as a possible therapeutic option in migraine field. On one side, NIBS techniques induce changes of neural plasticity that outlast the period of the stimulation (a fundamental prerequisite of a prophylactic migraine treatment, concurrently they allow targeting neurophysiological abnormalities that contribute to the transition from episodic to CM. The action may thus influence not only the cortex but also brainstem and diencephalic structures. Plus, NIBS is not burdened by serious medication side effects and drug–drug interactions. Although the majority of the studies reported somewhat beneficial effects in migraine patients, no standard intervention has been defined. This may be due to methodological differences regarding the used techniques (e.g., transcranial magnetic stimulation, transcranial direct current stimulation), the brain regions chosen as targets, and the stimulation types (e.g., the use of inhibitory and excitatory stimulations on the basis of opposite rationales), and an intrinsic variability of stimulation effect. Hence, it is difficult to draw a conclusion on the real effect of neuromodulation in migraine. In this article, we first will review the definition and mechanisms of brain plasticity, some neurophysiological hallmarks of migraine, and migraine chronification-related (dys)plasticity. Secondly, we will review available results from therapeutic and physiological studies using neuromodulation in CM. Lastly we will discuss the results obtained in these preventive trials in the light of a possible effect on brain plasticity.

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Drug–Drug Interactions in Headache Medicine

Cited by 25 publications

References 17 publications

Anatomical Look Into OnabotulinumtoxinA Injection for Chronic Migraine Headache

Anatomical Look Into OnabotulinumtoxinA Injection for Chronic Migraine Headache

Migraine and Tension-Type Headache

Treating Chronic Migraine With Neuromodulation: The Role of Neurophysiological Abnormalities and Maladaptive Plasticity

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