Genetic polymorphisms related to efficacy and overuse of triptans in chronic migraine

Gentile, Giovanna; Borro, Marina; Lala, Noemi; Missori, Serena; Simmaco, Maurizio; Martelletti, Paolo

doi:10.1007/s10194-010-0241-0

Cited by 38 publications

(39 citation statements)

References 15 publications

(16 reference statements)

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“…The feasible diagnostic setting for a tailored treatment of CM based on the application of pharmacogenomics will allow us to predetermine the efficacy of single old and new drugs by avoiding abuse and chronicization due to nonresponsivity of the abused drug [58].…”

Section: Pharmacogenomics and Chronic Migrainementioning

confidence: 99%

Chronic migraine: comorbidities, risk factors, and rehabilitation

2010

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Migraine is a serious illness with a spontaneous clinical evolution into a chronic form. In some episodic migraines, increase of crises frequency modifies the headache pattern in the chronic form, defined as chronic migraine (CM), with headache frequency of 15 days/month. One-year prevalence of CM includes around 2-4% of the general population. Migraine progression from episodic to chronic form is realized through a period of time involving several months or years, during which an increase of attack frequency occurs. Migraine shows a wide spectrum of comorbidities, including cardiocerebral, vascular, psychiatric, metabolic, neurologic as well as other pathologies. The single/multiple presence of such comorbidities represents a fixed factor in the process of chronicization into CM. Risk factors including medication overuse headache (MOH), obesity, and lifestyle cooperate in the evolution process to CM. MOH is the most severe complication of CM, and similarly to CM its appearance is gradual. Both CM and MOH show particular genetic background able to favor the appearance of chronicity and abuse. Rehabilitation consists of drug withdrawal procedures, re-prophylaxis through administration of innovative drugs, such as OnabotulinumtoxinA and/or topiramate, to avoid relapsing attacks, and behavioral strategies to minimize the role of risk factors. The initial relief step for drug abusers always relies in drug withdrawal. The feasible diagnostic setting for a CM tailored treatment based on the application of pharmacogenomics will allow us to predetermine the efficacy of single old and new drugs by avoiding abuse due to non-responsivity of the acute drug.

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Section: Pharmacogenomics and Chronic Migrainementioning

confidence: 99%

Chronic migraine: comorbidities, risk factors, and rehabilitation

2010

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“…Gentile et al [39] showed that VNTR polymorphism in the MAOA gene is correlated with clinical response to triptans in patients with chronic migraine. However, we did not observe a difference in genomic distribution between consistent and inconsistent responders in migraine patients.…”

Section: Discussionmentioning

confidence: 99%

Negative predictors of clinical response to triptans in patients with migraine

et al. 2011

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Moderate to severe migraine attacks are treated with triptans. However, about 25% of migraineurs fail to respond to triptans. We investigated the involvement of gene polymorphisms, personality traits and characteristics of headache, and made a scoring system for prediction of clinical response to triptans in patients with migraine. Gene polymorphisms including serotonin (5-HT)(1B) receptor G861C and dopamine receptor 2 (DRD2) C939T, personality traits and characteristics of headache were investigated in 46 consistent responders and 14 inconsistent responders to triptans. The multivariate stepwise logistic regression analysis revealed that age, periorbital/deep orbital pain and C/C genotype carrier at DRD2 C939T were significant factors that contributed independently to the negative response to triptans in patients with migraine. Their odds ratios were 6.329 (40-69 vs. 20-39 years, 95% CI 1.441-27.778), 6.772 (no vs. yes, periorbital/deep orbital pain, 95% CI 1.159-39.580) and 14.085 (non-C/C vs. C/C genotype at DRD2 C939T, 95% CI 1.253-166.667), respectively. The predictive index (PI) of clinical response to triptans in patients with migraine was calculated using these three factors. The score in inconsistent responders (1.6 ± 0.6) was significantly higher than that in consistent responders (0.8 ± 0.7, P < 0.001). Sensibility of low-score (RI = 0) group was 100%, and specificity of high-score (PI ≥ 2) group was 87%. The proposed scoring system should in the future be the object of larger studies to confirm its validity.

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“…The mean critical duration of overuse would be shortest for triptans (1.7 years), longer for ergotamine (2.7 years), and longest for simple analgesics (4.8 years) [10][11][12]. In Europe, MOH is rarely caused by overuse of opioids, employment of these compounds for symptomatic headache being largely discouraged in the medical environment [13].…”

Section: Introductionmentioning

confidence: 99%

Update on Medication-Overuse Headache and Its Treatment

Giamberardino

Mitsikostas

Martelletti

2015

Curr Treat Options Neurol

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Medication-overuse headache-i.e., a too-frequent consumption of acute headache medications leading to increased headache frequency and reduced effectiveness of acute and preventive treatments-is a serious medical condition whose pathophysiology still remains incompletely known, which is reflected into a lack of mechanism-based treatments. The first mandatory step in the therapeutic strategy remains withdrawal of the abused drug, preferably abrupt, in concomitance with a detoxification pharmacological regimen to lessen withdrawal symptoms. Intravenous hydration, antiemetics, corticosteroids (prednisone), tranquilizers (benzodiazepine), neuroleptics, and rescue medication (another analgesic than the overused) should be delivered in various combinations, on an inpatient (hospitalization and day hospital) basis or outpatient basis, depending on the characteristics of the specific patient and type of overuse. Inpatient withdrawal should be preferred in barbiturate and opioid overuse, in concomitant depression, or, in general, in patients who have difficulty in stopping the overused medication as outpatients. In contrast, in overuse limited to simple analgesics in highly motivated patients, without high levels of depression and/or anxiety, home detoxification should be chosen. Re-prophylaxis should immediately follow detoxification, ideally with local injections of onabotulinumtoxinA every 3 months or topiramate orally for at least 3 months. Adequate information to patients about the risks of a too-frequent consumption of symptomatic headache medications is essential and should constantly parallel treatment to help preventing relapse after detoxification and re-prophylaxis.

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Genetic polymorphisms related to efficacy and overuse of triptans in chronic migraine

Cited by 38 publications

References 15 publications

Chronic migraine: comorbidities, risk factors, and rehabilitation

Chronic migraine: comorbidities, risk factors, and rehabilitation

Negative predictors of clinical response to triptans in patients with migraine

Update on Medication-Overuse Headache and Its Treatment

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