Unmet Needs in the Acute Treatment of Migraine

Bentivegna, Enrico; Galastri, Silvia; Onan, Dilara; Martelletti, Paolo

doi:10.1007/s12325-023-02650-7

Cited by 7 publications

(3 citation statements)

References 66 publications

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“…The overarching objective is to deliver evidence-based treatments tailored to individual patients, considering disease severity and characteristics, and adapting to the available and affordable medications in each specific country. This approach holds true for both acute and preventive medications, not only in lowand middle-income countries but also in high-income countries lacking an adequate number of headache experts [137][138][139].…”

Section: Future Directionsmentioning

confidence: 99%

Health equity, care access and quality in headache – part 2

Raffaelli,

Rubio-Beltrán,

Cho

et al. 2023

J Headache Pain

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Background Headache disorders are a global public health concern affecting diverse populations. This review examines headache service organizations in low-, middle-, and high-income countries. It addresses global challenges in pharmacological headache treatment, with a focus on safety, tolerability, reproductive and child health, and outlines disparities in accessing innovative treatments worldwide. Main body Organized headache services are essential due to the wide prevalence and varying severity of headache disorders. The tiered headache service model is globally recognized, although its implementation varies based on financial and workforce considerations. Headache burden affects well-being, causing disability, economic challenges, and work limitations, irrespective of location or income. All nations still require improved diagnosis and treatment, and the majority of countries face obstacles including limited access, awareness, economic barriers, and inadequate health policies. Provided adequate internet availability, telemedicine could help improve health equity by expanding access to headache care, since it can offer patients access to services without lengthy waiting times or extensive travel and can provide healthcare unavailable in underserved areas due to staff shortages. Numerous health disparities restrict global access to many headache medications, especially impacting individuals historically excluded from randomized controlled trials, such as those with cardiovascular and cerebrovascular conditions, as well as pregnant women. Furthermore, despite advancements in researching migraine treatments for young patients, the options for treatment remain limited. Access to headache treatment relies on factors like medication availability, approval, financial coverage, and healthcare provider expertise. Inadequate public awareness leads to neglect by policymakers and undertreatment by patients and healthcare providers. Global access discrepancies are exacerbated by the introduction of novel disease-specific medications, particularly impacting Asian, African, and Latin American nations excluded from clinical trials. While North America and Europe experience broad availability of migraine treatments, the majority of countries worldwide lack access to these therapies. Conclusions Healthcare disparities, treatment access, and medication availability are concerning issues in headache medicine. Variations in national healthcare systems impact headache management, and costly innovative drugs are widening these gaps. Healthcare practitioners and experts should acknowledge these challenges and work towards minimizing access barriers for equitable global headache care in the future.

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Section: Future Directionsmentioning

confidence: 99%

Health equity, care access and quality in headache – part 2

Raffaelli,

Rubio-Beltrán,

Cho

et al. 2023

J Headache Pain

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“…The treatment of EM is mainly based on pharmacological interventions, especially now that new drugs with innovative mechanisms of action are available, such as symptomatic treatments (gepants and ditans) and preventive treatments (monoclonal antibodies targeting the calcitonin gene receptor peptide). Despite this, unmet treatment needs remain a reality in patients’ lives ( 9 ). A combination of pharmacological and non-pharmacological approaches has been shown to be more effective than either approach alone in achieving positive outcomes and improving treatment adherence ( 10–12 ).…”

Section: Introductionmentioning

confidence: 99%

Network analysis of negative emotions in patients with episodic migraine: need for a multidisciplinary perspective

Guerra,

Di Giacomo,

Ranieri

et al. 2024

Front. Neurol.

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BackgroundEpisodic migraine (EM) is the second most prevalent neurological disorder worldwide and is responsible for more disability than all other neurological disorders combined. Triggers for the development of migraine include, stress, emotional burden, low blood sugar levels, tobacco, skipped meals, anxious and depressive feelings. Migraine affects both children and adults, occurring three times more frequently in women than in men.ObjectiveThe aim of this study was to evaluate the psychological profile of EM patients and the relationship among negative emotions in EM patients, analyzing self-efficacy measures in pain management.DesignWe performed an observational study in 60 outpatients aged 18–55 years (mean age 33.8; SD ±10.4) with EM.MethodsAll patients have been enrolled at the Headache Center of the San Salvatore Hospital of L’Aquila. The assessment comprised five standardized psychological self-assessments investigating relevant emotional dimensions and pain self-efficacy, along with two questionnaires assessing migraine-related disability. A network analysis of negative emotions was performed to evaluate which emotional traits and relationships play a crucial role in pain coping and management.ResultsOur findings indicate that migraine significantly impairs the quality of life of patients in their daily lives. Over half of the patients reported experiencing severe disability, with negative emotions significantly influencing their ability to cope with pain and maintain productivity during migraine attacks. Dysphoric variables (irritability, interpersonal resentment, and surrender) were correlated with difficulties in emotion regulation ability and with the capacity of engaging in goal-directed behaviors despite experiencing pain. The ability to regulate one’s emotions and manage dysphoria were positively correlated with pain self-efficacy, whereas positive mental health was associated with individuals’ confidence in performing activities despite experiencing pain.ConclusionNegative emotions had a negative correlation with positive mental health and were linked to a lower capacity to carry out daily activities despite experiencing migraine pain. This suggests that psychological interventions could improve mental health and potentially surpassing the effects of pharmacological interventions alone in migraine management. An integrated, patient-centered approach may represent an effective paradigm to address and reduce the burden of migraine, leading to a reduction in healthcare costs.

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“…Various groups of pharmacological drugs are commonly employed in managing migraine attacks, including analgesics, nonsteroidal anti-inflammatory drugs, triptans, ergot alkaloids, opioids, and antidepressants. [7] Preventing these attacks is crucial and mandatory for individuals suffering from migraine. For many patients with chronic migraine headaches, effective preventive treatments such as onabotulinumtoxinA (Onabot-A) and monoclonal antibody agents have shown positive results.…”

mentioning

confidence: 99%

The wear-off phenomenon of repeated botulinum toxin injection for chronic migraine treatment: A retrospective study

Ruşen,

Hafez,

Tunç

2024

Turk J Neurol

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Objectives: This study aimed to evaluate the efficacy, predictors of response, clinical considerations, and analysis of patient-reported wear-off events during injection periods of onabotulinumtoxinA (Onabot-A). Patients and methods: This retrospective study was conducted with 30 adult chronic migraine patients (26 females, 4 males; mean age: 37.9±9.3 years; range, 24 to 72 years) followed between January 2017 and December 2022. All patients received Onabot-A injections at different frequencies throughout their treatment and responded to Onabot-A. The duration between cycles was 3 months in 26 patients, and this period varied in four patients. The Visual Analog Scale scores were measured before and after the injection, all patients responded to Onabot-A. Results: Nine patients stated that they experienced wear-off at least once during their treatment cycles. In some patients, the duration of action lasted less than 12 weeks, resulting in a wear-off phenomenon. Although sex and age were not significant variables in terms of the presence or absence of wear-off phenomenon, the number of Onabot-A injections (Onabot-A treatment cycles) among patients was found to be a statistically significant variable in terms of the presence of wear-off (p<0.011). Conclusion: Repeated treatments using Onabot-A appear to be safe and well-tolerated, but the effectiveness of the drug appears to be affected by wear-off phases that may occur during long-term treatment with Onabot-A.

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Unmet Needs in the Acute Treatment of Migraine

Cited by 7 publications

References 66 publications

Health equity, care access and quality in headache – part 2

Health equity, care access and quality in headache – part 2

Network analysis of negative emotions in patients with episodic migraine: need for a multidisciplinary perspective

The wear-off phenomenon of repeated botulinum toxin injection for chronic migraine treatment: A retrospective study

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