Orbitofrontal dysfunction predicts poor prognosis in chronic migraine with medication overuse

Gómez-Beldarrain, Marian; Carrasco, M. Angélica; Bilbao, Amaia; García-Moncó, Juan Carlos

doi:10.1007/s10194-011-0340-6

Cited by 34 publications

(40 citation statements)

References 32 publications

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“…We also analyzed the location of the reduced P3a amplitude, which revealed decreases in the frontal area. This result supports previous studies showing frontal lobe dysfunction in migraineurs, such as executive dysfunction,10,11 decre-ased gray-matter density in the frontal cortex shown by VBM,11 and decreased EEG alpha activity in the frontal cortex shown by low resolution brain electromagnetic tomography 31. Pain is known to be modulated by attentional mechanisms during parallel cognitive processing, which involves the frontal cortex.…”

Section: Discussionsupporting

confidence: 91%

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Reduced Frontal P3a Amplitude in Migraine Patients during the Pain-Free Period

Koo

Lee

et al. 2013

J Clin Neurol

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Background and PurposeNeuropsychological and neuroimaging studies both suggest that frontal lobe dysfunction is present in migraineurs. Since P3a abnormalities manifest in other diseases associated with attention problems, such as attention deficit hyperactivity disorder, we hypothesized that migraine patients have P3a abnormalities, particularly in the frontal region.MethodsEvent-related potentials were measured using a passive auditory oddball paradigm in 16 female migraineurs (aged 22.9±2.0 years, mean±SD) during the interictal period and in 16 age-matched healthy females (22.6±2.0 years). The amplitudes and latencies were analyzed independently using repeated-measures analysis of variance. Nonparametric statistical testing using a cluster-level randomization method was performed to localize the abnormalities.ResultsThe mean P3a amplitude at frontal areas during the third trials was significantly lower in migraineurs (1.06 µV) than in controls (1.69 µV, p=0.026). P3a amplitudes were negatively correlated with the duration of the migraine history (r=-0.618, p=0.014). Cluster-based nonparametric statistical analysis showed that the amplitudes over left frontal areas were significantly lower in migraine patients than in controls.ConclusionsA reduced P3a amplitude of migraineurs reflects attentional deficits and frontal dysfunction. The negative correlation between P3a amplitude and the duration of the migraine history suggests that attentional deficits and frontal dysfunction are either the cause or the result of headache.

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Section: Discussionsupporting

confidence: 91%

“…Although the results are controversial, migraineurs were reported to have cognitive dysfunctions in memory and attention,6,7 verbal performance,8 orbitofrontal function,9 and executive function 10,11. The brains of migraineurs are also known to have structural and functional abnormalities.…”

Section: Introductionmentioning

confidence: 99%

Reduced Frontal P3a Amplitude in Migraine Patients during the Pain-Free Period

Koo

Lee

et al. 2013

J Clin Neurol

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“…The partial benefit from detoxification and the severity bias led us to consider this subgroup of chronic-relapsing migraneurs as a separate phenotype, whose features might belong to the substance use disorders spectrum. Recent findings from neuroimaging and neuropsychological studies give strength to this hypothesis [6][7][8]30]. However, this study has a number of limitations.…”

Section: Discussionmentioning

confidence: 82%

“…The underlying neurobiology of MO is not well understood. Although it might come from coping with pain and disability associated with migraine, a persistent dysfunction of the orbitofrontal cortex (OFC) and the relative decision-making deficit have been recently reported [6][7][8]. These deficits might explain the above-mentioned maladaptive behaviors and place MO in the substance use disorders spectrum [6].…”

Section: Introductionmentioning

confidence: 99%

Psychiatric screening for migraine patients

Gambini

Biagianti

Grazzi³

et al. 2013

Neurol Sci

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Psychiatric disorders in migraine patients have a higher prevalence than general population. The presence of psychiatric comorbidities may influence the complexity of the migraine pictures and be related to medication overuse. Severely impaired chronic migraineurs presenting with medication overuse are a challenge for headache clinics. Psychiatric comorbities, such as dependency-like behaviors, anxiety and mood symptoms, might account for headacherelated disability and recurrent relapses into medication overuse after a successful detoxification. Within a sample of 63 chronic migraineurs with medication overuse and severe disability, we investigated to which extent clinical severity, affective states and attitudes about medication impact the overall functioning at time of detoxification. To unravel whether some of these factors could predict their long-term outcome, we followed and retest them 1 year after withdrawal. We hypothesized that the detoxification would have led to a partial improvement and not modified the attitudes toward medication and dependence. Detoxification improves most of the clinical and affective measures, but does not free from significant levels of pain intensity and headache-related disability. The partial benefit from detoxification, the severity bias and the maladaptive cognitive profile led us to believe that subgroups of chronic-relapsing migraineurs deserve a multidisciplinary approach that addresses not only the reduction of clinical severity but also specific cognitive and behavioral impairments.

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“…patientsNo. medication overuse headacheAnalgesicsErgotsOpioidsTriptansAltieri et al 2009 [11]ItalyICHD-2 [7]Clinic2711NRNR4Ayzenberg et al 2008 [12]GermanyICHD-2 [7]Clinic2914NRNR15Biagianti et al 2012 [13]ItalyICHD-2 Revised [8]Clinic5226NRNR20Boe et al 2007 [14]NorwayICHD-2 Appendix [7]Clinic100201NR23Coppola et al 2010 [15]ItalyICHD-2 Appendix [7]Clinic2910NRNR9Cupini et al 2009 [16]ItalyICHD-2 Appendix [7]Clinic33NR1NR4Di Lorenzo et al 2009 [17]ItalyICHD-2 [7]Clinic10718NRNR29Donnet et al 2009 [18]FranceICHD-2 [7]Population320157252964Dousset et al 2013 [19]FranceICHD-2 Appendix [7]Clinic428109Galli et al 2011 [20]ItalyICHD-2Appendix [7]Clinic82212322Gambini et al 2013 [21]ItalyICHD-2 Revised [8]Clinic6333NRNR21…”

Section: Methodsmentioning

confidence: 99%

Risk of medication overuse headache across classes of treatments for acute migraine

et al. 2016

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BackgroundThe most commonly prescribed medications used to treat migraine acutely are single analgesics, ergots, opioids, and triptans. Due to varying mechanisms of action across drug classes, there is reason to believe that some classes may be less likely than others to elicit Medication Overuse Headache (MOH) than others. We therefore aimed to determine whether certain classes of acute migraine drugs are more likely to elicit MOH than others.MethodsA comprehensive systematic literature was conducted to identify studies of varying designs that reported on MOH within the considered treatment classes. Only studies that reported MOH according to the International Classification of Headache Disorders (ICHD) were considered. Since no causal comparative design studies were identified; data from prevalence studies and surveys were retrieved. Prevalence-based relative risks between treatment classes were calculated by integrating both medication overuse and medication use from published studies. For each pair wise comparison, pooled relative risks were calculated as the inverse variance weighted average.ResultsA total of 29 studies informed the relative risk between treatment classes, all of which reported country-specific data. Five studies reported country-specific medication use data. For triptans versus analgesics the study relative risks generally favored triptans. The pooled relative risk was 0.65 (i.e., relative risk reduction of 35 %). For ergots versus analgesics, a similar trend was observed in favor of ergots with a relative risk of 0.41. For triptans versus ergots, the direction of effect was mixed, and the pooled relative risk was 1.07. Both triptans and ergots appeared favorable when compared to opioids, with pooled relative risks of 0.35 and 0.76, respectively. However, the evidence was limited for these comparisons. Analgesics and opioids also appeared to yield similar risk of MOH (pooled relative risk 1.09).ConclusionOur study suggests that in patients receiving acute migraine treatment, analgesics and opioids are associated with a higher risk of developing MOH compared with other treatments. These findings provide incentive for better monitoring of use of analgesics and opioids for treating acute migraine, and suggest possible clinical preference for use of so-called “migraine-specific” treatments, that is, triptans and ergots.Electronic supplementary materialThe online version of this article (doi:10.1186/s10194-016-0696-8) contains supplementary material, which is available to authorized users.

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Orbitofrontal dysfunction predicts poor prognosis in chronic migraine with medication overuse

Cited by 34 publications

References 32 publications

Reduced Frontal P3a Amplitude in Migraine Patients during the Pain-Free Period

Reduced Frontal P3a Amplitude in Migraine Patients during the Pain-Free Period

Psychiatric screening for migraine patients

Risk of medication overuse headache across classes of treatments for acute migraine

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