Neuromodulation for the Acute and Preventive Therapy of Migraine and Cluster Headache

Singh, Rashmi B. Halker; Ailani, Jessica; Robbins, Matthew S.

doi:10.1111/head.13586

Cited by 29 publications

(26 citation statements)

References 68 publications

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“…OnabotulinumtoxinA, a preventive therapy for chronic migraine with long-term action, has been shown to have the same rate of birth defects (3%) as in the general population 43 . Finally, neuromodulation devices present a great opportunity for nonpharmacologic treatment of migraine in pregnancy without evidence of adverse effects and are an emerging new option for migraine treatment in pregnancy 44 …”

Section: Headache and Pregnancymentioning

confidence: 99%

Headache in Women

Pavlović¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW: Women are greatly overrepresented among patients seeking treatment for symptoms of headache pain in general and migraine in particular. Understanding the presentation of headache in women in relation to hormonal changes both during the menstrual cycle and throughout the life span is essential for appropriate diagnosis and treatment.RECENT FINDINGS: Although perimenstrual migraine attacks are generally without aura, the diagnosis of migraine with aura has been added to the headache classification for menstrual migraine to account for women with the diagnosis of migraine with aura who experience menstrual migraine attacks. Emerging knowledge regarding the differences between menstrual and nonmenstrual attacks, the variability of attack triggering within and between women, and the response of women with menstrually related migraine to new migraine drug classes is contributing to better understanding and more effective treatment of these particularly burdensome and refractory attacks. Given the burden of migraine, almost one-fourth of women with migraine avoid or delay pregnancy. Women who experience migraine during pregnancy are more likely to have a hypertensive disorder and stroke during pregnancy and/or delivery and the postpartum period. Treatment of headache in general and migraine in particular in pregnancy is challenging because of fetal and maternal risks; however, a 2021 systematic review suggests that triptans and low-dose aspirin may not be associated with fetal/child adverse effects and could be more strongly considered for headache treatment in pregnancy.SUMMARY: Headache in general and migraine in particular are extraordinarily common in women of reproductive age and fluctuate with hormonal changes and phases of life. Improved knowledge of the epidemiology, pathophysiology, and response to treatment of perimenstrual attacks is essential for more effective response to this most burdensome headache type. Treatment of headache in pregnancy remains challenging.

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Section: Headache and Pregnancymentioning

confidence: 99%

Headache in Women

Pavlović¹

2021

CONTINUUM: Lifelong Learning in Neurology

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“…These devices provide electrical stimulation to extracranial sensory afferent fibers above their depolarization thresholds but below the perceived pain threshold, which activates the central descending inhibitory pathways to inhibit pain. These devices typically require patient payment and need to be obtained from the manufacturer directly 22 Remote electrical neuromodulation (REN) device 23 …”

Section: Introductionmentioning

confidence: 99%

Migraine Care in the Era of COVID‐19: Clinical Pearls and Plea to Insurers

et al. 2020

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Objective.-To outline strategies for the treatment of migraine which do not require in-person visits to clinic or the emergency department, and to describe ways that health insurance companies can remove barriers to quality care for migraine.Background.-COVID-19 is a global pandemic causing widespread infections and death. To control the spread of infection we are called to observe "social distancing" and we have been asked to postpone any procedures which are not essential. Since procedural therapies are a mainstay of headache care, the inability to do procedures could negatively affect our patients with migraine. In this manuscript we review alternative therapies, with particular attention to those which may be contra-indicated in the setting of COVID-19 infection.Design/Results.-The manuscript reviews the use of telemedicine visits and acute, bridge, and preventive therapies for migraine. We focus on evidence-based treatment where possible, but also describe "real world" strategies which may be tried. In each section we call out areas where changes to rules from commercial health insurance companies would facilitate better migraine care.Conclusions.-Our common goal as health care providers is to maximize the health and safety of our patients. Successful management of migraine with avoidance of in-person clinic and emergency department visits further benefits the current urgent societal goal of maintaining social distance to contain the COVID-19 pandemic.

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“… 34 Several neuro-regulation devices have been approved by the Food and Drug Administration (FDA) for the treatment of MA. 35 This provides us with the possibility of clinical treatment transformation of this study. According to the clinical manifestations of MwoA patients such as decreased QoL and attention, limitation of social and work activity, and poor mood, the corresponding brain regions could be selected as targets, and different neuro-regulatory techniques could be used to prevent and treat MwoA.…”

Section: Discussionmentioning

confidence: 78%

MRI Evaluation of the Relationship Between Abnormalities in Vision-Related Brain Networks and Quality of Life in Patients with Migraine without Aura

Cui¹,

Zhang²,

Xu³

et al. 2021

NDT

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Objective To evaluate whether migraine without aura (MwoA) can be partly attributed to abnormalities of vision-related brain networks (VBN) and whether these specific regional abnormalities affect the patients’ quality of life (QoL). Methods A total of 40 participants, including 20 MwoA patients and 20 healthy control volunteers, were enrolled. There were no significant differences in sex, age, educational qualifications and dominant hand between the two groups. Headache intensity and QoL were assessed by the Pain Number Evaluation Scale (NRS) and the Migraine-Specific Quality of Life Questionnaire (MSQ 2.1), respectively. Resting state functional magnetic resonance imaging (rs-fMRI) and independent component analysis (ICA) were performed to determine and evaluate the VBN. Results Three components were identified as consistent with the VBN in the template and recorded as N1, N2 and N3, respectively. The functional activity of the left primary visual cortex (N1), left culmen of cerebellum (N1), left lingual gyrus (N2), superior frontal gyrus (N2) and left posterior lateral prefrontal cortex (N3) in the MwoA group enhanced compared with the healthy control group. However, the functional activity of right middle occipital gyrus, left fusiform gyrus, right lingual gyrus, and right primary motor cortex in the N3 network weakened. Pearson correlation analysis showed that decline of attention to work and life (MSQ5) was positively associated with the functional activity of left primary visual cortex and left lingual gyrus. Canceling from work and daily life (MSQ8) was inversely associated with the functional activity of right primary motor cortex. The burden of feeling like others (MSQ13) and the overall decrease in QoL were both positively associated with the functional activity of right lingual gyrus. Conclusion MwoA patients showed abnormal VBN function, which was moderately correlated with decreased QoL. This study provides evidence for the precise prevention and treatment of migraine by neural regulation.

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Neuromodulation for the Acute and Preventive Therapy of Migraine and Cluster Headache

Cited by 29 publications

References 68 publications

Headache in Women

Headache in Women

Migraine Care in the Era of COVID‐19: Clinical Pearls and Plea to Insurers

MRI Evaluation of the Relationship Between Abnormalities in Vision-Related Brain Networks and Quality of Life in Patients with Migraine without Aura

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