Pharmacogenomics in migraine: catching biomarkers for a predictable disease control

Simmaco, Maurizio; Borro, Marina; Missori, Serena; Martelletti, Paolo

doi:10.1586/ern.09.80

Cited by 18 publications

(9 citation statements)

References 14 publications

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“…The future in relapse prevention of CM complicated by MOH consists in considering how drugs currently used, such as triptans and emerging therapies present responsivity profiles related to well-defined genetic polymorphisms [54][55][56][57].…”

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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“…The feasible diagnostic setting for 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 due to non-responsivity of the abused drug [9].…”

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confidence: 99%

An emerging problem in clinical practice: how to treat chronic headache patients

Pini

2010

Intern Emerg Med

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In this issue, an interesting article by Farinelli and coworkers [1] debates an important emerging and not yet resolved problem: how to treat the chronic headaches complicated by medication overuse. Headache is the most common neurological disease in clinical practice. In Europe, this affects about 51% of the population, of which 31% are tension-type headache and 14% are migraine sufferers; 2% of these patients become chronic sufferers, more than 15/day/month, and chronic daily headache (CDH). 4-5% of general population suffers from a chronic form (CDH), with prevalence between 1.7 and 2.1% in men and between 2.8 and 6.8% in women [2]; within this group of patients in the US general population ranges around 1.3-2% of chronic migraine (CM).A number of possible pathophysiological mechanisms for the transformation from episodic to chronic headache have been proposed including a progressive damage of the central nociceptive system. One physiopathological hypothesis is the activation of N-methyl-D-aspartate (NMDA) and non-NMDA receptors glutamate, released by central nociceptive terminations, induces calcium entry in dorsal horn neurons, as well as in the trigeminal nucleus caudalis. Calcium entry leads to the activation of nitric oxide (NO) synthetase causing NO synthesis. These neurotransmitters produce the release of sensory neuropeptides, such as CGRP and substance P, which support the development of hyperalgesia and maintain central sensitization [3][4][5].Medication near-daily use and subsequent medication overuse headache (MOH) have been described by the revised International Classification of Headache Disorders (ICHDs)-IIR criteria as the use of each drug for at least 3 months, for a certain number of days per month, and is one of the most critical parameters in the process of becoming chronic.In the past few years, a lot of studies have shed light on potential risk factors for CM such as medication-overuse headache, temporomandibular disorders, obstructive sleep apnea and obesity. Recent clinical trials have started to focus on CM or CDH. Topiramate, onabotulinum toxin type A, gabapentin, pentasites and tizanidine are among the agents that appear to be effective in the treatment of CM. In the treatment of CM, preventive treatment and a better understanding of its risk factors will allow clinicians to better identify individuals at the greatest risk and prevent the development of CM [6].The main problem remains how to treat these patients to avoid a relapse in the daily drug use because recurrence of headaches and the management of CM patients in re-prophylaxis after detoxification of abuses still appears complicated.Regarding abusers, the first step always consists in drug interruption. Only after detoxification can a new prophylaxis therapy be commenced, which will otherwise be useless from the start.Within the possible treatment strategies in the review of Farinelli are examined the use of topiramate and the onabotulinum toxin A, a substance obtained from the grampositive anaerobic bacterium Clostridium bo...

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Section: Discussionmentioning

confidence: 99%

Rehabilitating chronic migraine complicated by medication overuse headaches: how can we prevent migraine relapse?

Farinelli¹,

Dionisi

Martelletti³

2010

Intern Emerg Med

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Headache is among the most common neurological symptoms in clinical practice. In some cases of episodic migraine, the headache intensifies into a chronic form, defined as chronic migraine (CM) and such a condition encompasses a headache frequency of 15 days/month, with features similar to those of migraine attacks. The assessment of CM in the US general population ranges around 1.3-2%. Migraine progression from an episodic into a chronic form is realized through a period of time involving several months or years, during which an increase attack frequency occurs. Both Topiramate and Onabotulinum toxin A can be considered to be safe as well as effective medications, therefore, representing a treatment choice. Regarding drug abusers, the initial relief step always consists of drug interruption. Only after detoxification can a new prophylaxis therapy be commenced, which otherwise would be useless from the start. The feasible diagnostic setting for the tailored treatment of CM based on the application of pharmacogenomics will allow us in predetermining the efficacy of a single old and new drugs by avoiding abuse due to non-responsivity of the abused drug.

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Pharmacogenomics in migraine: catching biomarkers for a predictable disease control

Cited by 18 publications

References 14 publications

Chronic migraine: comorbidities, risk factors, and rehabilitation

Chronic migraine: comorbidities, risk factors, and rehabilitation

An emerging problem in clinical practice: how to treat chronic headache patients

Rehabilitating chronic migraine complicated by medication overuse headaches: how can we prevent migraine relapse?

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