Botulinum toxin type A is currently being
|
|
- Dwain Skinner
- 5 years ago
- Views:
Transcription
1 EMERGING PREVENTIVE OPTIONS FOR CHRONIC DAILY HEADACHE * David W. Dodick, MD, FRCP(C), FACP ABSTRACT Approximately 3% to 5% of the population is affected by headaches on a daily or almost daily basis. This often interferes with the quality of life for patients and requires them to take a variety of acute headache medications to manage their acute attacks. Over time, these treatments may wane in efficacy, cause adverse events, lead to their overuse, and ultimately increase the headache burden. Therefore, prevention of acute attacks for these patients is essential. Emerging therapeutic options for the prevention of headache include a variety of pharmacologic and nonpharmacologic agents. This article will focus on some of these agents, including evidence from clinical trials for use of botulinum toxin type A, herbal preparations, and the antiepileptic medication lamotrigine. (Adv Stud Med. 26;6(4D):S336-S342) *This article is based on a roundtable symposium held in New York, New York, on December 3, 25. Professor of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Scottsdale, Arizona. Address correspondence to: David W. Dodick, MD, FRCP(C), FACP, Professor of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, 134 East Shea Boulevard, Scottsdale, AZ dodick.david@mayo.edu. Botulinum toxin type A is currently being studied as an emerging treatment for patients with migraine who suffer from chronic daily headache (CDH). In addition, various antiepileptic medications, vitamins, and herbal remedies are being explored as treatments for migraine. They include lamotrigine, coenzyme Q 1 (CoQ 1 ), and Petasites hybridus (butterbur). This article will focus on evidence from clinical trials for use of botulinum toxin type A, herbal preparations, such as butterbur, and the antiepileptic medication lamotrigine. USE OF BOTULINUM TOXIN TYPE A FOR EPISODIC MIGRAINE AND CHRONIC DAILY HEADACHE Two serotypes of botulinum neurotoxin (BoNT), type A (9 kd) and type B (5 kd), have been approved by the US Food and Drug Administration (FDA) since 1989 for a variety of therapeutic indications. 1 When used clinically, BoNT is delivered through intramuscular or local subcutaneous injection, where it binds preferentially to cholinergic terminals. BoNTs inhibit acetylcholine release at the neuromuscular junction. Specifically, type A cleaves the synaptosome-associated protein at different sites at the carboxyl-terminus, and this can be applied to the treatment of conditions characterized by a hyperfunction of cholinergic nerve terminals. 2 Although not yet US FDA sanctioned, evolving uses of the toxin include treatment of various pain syndromes, including headaches. Phase II studies of botulinum toxin type A for the treatment of episodic migraine and chronic tensiontype headache have been conducted since 2 with mixed results. 3-7 The literature for the use of botulinum toxin type A for CDH is sparse, although recent large randomized placebo-controlled studies by Silberstein et al and Mathew et al have yielded interesting findings in this rarely studied patient population. 8-1 The Silberstein et al study, which used a fixed-site, fixeddose approach, and the Mathew et al study, which used a modified, follow-the-pain approach, failed to achieve significance on their primary endpoints. However, sufficient information was obtained to warrant progressing to phase III investigations of botulinum toxin type A for use in patients with CDH. The late phase II study conducted by Mathew et al for the use of botulinum toxin type A for treatment of CDH was initiated in early The study design S336 Vol. 6 (4D) April 26
2 was an 11-month, randomized, double-blind, placebocontrolled investigation with 3-month treatment cycles. Patients were injected with botulinum toxin type A or placebo every 9 days and assessed every 3 days for 9 months. The primary efficacy measure was the change from baseline in the frequency of headache-free days in a 3-day period at day 18 the primary analysis time point. The secondary efficacy measure was the proportion of patients with a decrease from baseline of 5% or more in the frequency of headache-days per 3-day period at day 18. The change from baseline in the frequency of headaches (ie, per 3-day period), the proportion of patients with a decrease from baseline of at least 5% or greater in the frequency of headaches per 3-day period, days of acute medication use, and adverse events also were assessed (Figure 1). On a daily basis, patients used an electronic telephone diary to report headache characteristics, symptoms, and acute treatments. 9 After a single-blind placebo injection, patients were reassessed 1 month later to determine the responsiveness to placebo. Patients were stratified as placebo responders (ie, >3% reduction in headaches) or placebo nonresponders. These 2 groups were then randomized to receive placebo or botulinum toxin type A in a double-blind fashion. Study subjects then received 2 subsequent double-blind injections of active drug or placebo every 12 weeks. Injection sites were as indicated in Figure 2. All patients received injections into the following muscles: frontal/glabellar, temporalis, occipitalis, trapezius, semispinalis capitis, and splenius capitis. The dosages were modified according to the pain experienced by the patient. Twenty-three to 58 injection sites were used per patient with a total dosage between 15 and 26 U used per treatment in each patient. 9 Demographic characteristics for this patient population were similarly matched between the groups who received botulinum toxin type A and placebo. Most of the subjects were female with a mean age of approximately 43 years (age range, years). These patients were long-term sufferers of CDH, averaging nearly 15 years, with Migraine Disability Assessment questionnaire scores in the severe range (ie, >2) for those patients receiving botulinum toxin type A treatments and those patients receiving placebo (ie, 78% and 72%, respectively). They suffered with headache for 23 days on average, whereas the actual frequency of headache attacks was approximately 13. The discrepancy owes to the fact that 1 attack may last longer than 1 day. There was no significant difference between treatment groups for the headache frequency per 3 days (during baseline) or for migraine/probable migraine frequency per 3 days (during baseline). Every headache reported by the patient during the study was classified into migraine, probable migraine, or nonmigraine (eg, tension-type headache) using the International Criteria of Headache Disorders (second edition). It was determined that 1% of the patients experienced at least 1 migraine or probable migraine headache during the baseline period. 9 Figure 1. Use of in the Treatment of CDH Baseline Single-blind placebo Tx nonresponder responder Late Phase II Studies Common Design Doubleblind Tx Interim analysis Doubleblind Tx Primary analysis Doubleblind Tx Final analysis Day Day -3 Day Day 9 Day 18 Day 27 = botulinum toxin type A; CDH = chronic daily headache; Tx = treatment. Figure 2. Injection Sites for Phase II Clinical Studies of Frontal/ glabellar Masseter reconstituted with 2 ml/vial (5 U/mL) total injection sites = botulinum toxin type A. Semispinalis Temporalis Occipitalis Trapezius MUSCLE AREA # Units Bilateral? Total Dose Frontal/glabellar 25 4 No 25 4 Occipitalis 1 Yes 2 Temporalis 1 25 Yes 2 5 Masseter (optional) 25 Yes 5 Trapezius 1 3 Yes 2 6 Semispinalis 5 1 Yes 1 2 Splenius capitis 5 1 Yes 1 2 TOTAL DOSE RANGE = U Splenius capitis Johns Hopkins Advanced Studies in Medicine S337
3 Half (53%) of the subjects in the botulinum toxin type A group were overusing acute headache medications, whereas 42% in the placebo group were overusing acute headache medications (total use of all headache medications, 1 days/month for >3 months). These patients were permitted to remain in the study at the discretion of the investigator if they believed that the patients were not experiencing medication overuse headaches. Approximately one third of patients (ie, 32% and 39%, respectively for botulinum toxin type A and placebo subjects) were using concurrent preventive headache medications at baseline. 9 A total of 76.9% (273/355) of patients completed the study, including 132 patients who completed the original protocol requiring only 1 postrandomization treatment. Of the 22.8% (81/355) of patients who discontinued early, 5.1% (18/355) of these patients discontinued for lack of efficacy, 1.4% (5/355) for adverse events,.3% (1/355) for inability to follow study instructions, 1.1% (4/355) for personal reasons, and 2.8% (1/355) were lost to follow-up. Of the patients who discontinued because of adverse events, the specific adverse events were neck pain in 2 subjects and neck weakness in 2 other patients. 9 Table 1 lists the primary and secondary endpoints: number of headache-free days and patients with at least a 5% decrease in headache-days per month, respectively. 9 In terms of the primary outcome measure, there was no significant difference between botulinum toxin type A and placebo. The placebo nonresponders and the placebo responders improved, but there was no statistical difference between the 2 groups, and therefore, the data could be pooled for greater statistical power. The secondary endpoint the proportion of patients with at least a 5% decrease in headache-days per month in the placebo-nonresponder group was significantly in favor of botulinum toxin type A treatment at day 18 (32.7% for those receiving botulinum toxin type A and 15% in patients receiving placebo). When examining headache frequency, there was a significant difference at most time points favoring botulinum toxin type A in the pooled population. On average, patients receiving botulinum toxin type A injections had 7 fewer headaches per month compared to approximately 4 fewer headaches per month among those patients receiving placebo injections at day Because patients were experiencing an average of 13.5 headaches per month at baseline, this has true relevance to clinical practice, especially as these patients have traditionally been considered to be largely recalcitrant to treatment. A specific subpopulation of these patients (n = 228) who were not using concurrent headache-preventive medications achieved statistical significance for most study endpoints at day 18, including the number of headache-free days (1 vs 6.7; P =.38), percentage of patients with at least a 5% decrease in headache-days per month (46% vs 22%; P =.5), headache frequency per month (-7.5 vs -3.6; P.5), and days using acute headache medication (-7.8 vs.1; P =.15). Patients with at least a 5% reduction in headaches per Table 1. Outcome Measures for Treatment Versus Efficacy Measures Outcome Measure Day 18 1º Headache-free days/month, n Not significant 2º Percentage of patients with 5% P =.27 decrease headache-days/month (4% vs 25%) Additional Headache frequency/month P =.1 (-7.1 vs -3.7) Additional Patients with 5% decrease P =.46 headaches/month (54% vs 38%) = botulinum toxin type A. Data from Mathew et al. 9 Table 2. : No Prophylaxis Subgroup (228; 64%) Efficacy Measures Outcome Measure Day 18 1º Headache-free days/month, n P <.5 (-1 vs.7) 2º Percentage of patients with 5% P <.5 decrease headache-days/month (46% vs 22%) Additional Headache frequency/month P <.5 (-7.5 vs -3.6) Additional Acute headache medication use P <.5 (-7.8 vs.1) Additional Patients with 5% decrease Not of headaches/month significant (52% vs 37%) = botulinum toxin type A. Data from Dodick et al. 11 S338 Vol. 6 (4D) April 26
4 month did not achieve statistical significance (52% for botulinum toxin type A vs 37% for placebo; Table 2). 11 Specific populations that appear to respond well to botulinum toxin type A treatments include particularly challenging patients, such as those who overuse acute headache medications (Figure 3) 4,12 and patients who experience moderate-to-severe headaches of at least 4 hours in duration (Figure 4). 5,6 For the population of patients who overuse acute headache medications, a significant difference in headache episodes was observed at nearly all time points favoring botulinum toxin type A (P.5). In the population of patients who experienced headaches for more than 4 hours, there was a significant difference favoring botulinum toxin type A at all time points (P <.5). For this study, there was no dose response observed, adverse events were dose and injection-site dependent, there was an incremental response after the second injection, and the duration of response correlated with the biologic activity of the toxin (approximately 3 months). The conclusions from this phase II study were that repeat treatments with botulinum toxin type A are safe and well tolerated at doses up to 26 U and that there were significant, clinically meaningful improvements compared to placebo in headache frequency, responder rates, and days and number of acute headache medication used. Furthermore, these findings were confirmed among patients with headache who did not use concurrent headache prophylaxis and among patients who overused acute headache medications. COENZYME Q 1 AND VITAMIN B 2 (RIBOFLAVIN) Mitochondrial dysfunction resulting in impaired oxygen metabolism may play a role in migraine pathogenesis. 13 Vitamin B 2 (riboflavin) and CoQ 1 are known to improve abnormalities in mitochondrial encephalomyopathies. Vitamin B 2 (randomized controlled trials) and CoQ 1 (open-label) have been studied in migraine prophylaxis Schoenen et al compared riboflavin (4 mg) and placebo in 55 patients with migraine in a randomized trial of 3 months duration. 14 Patients who took riboflavin had significantly fewer attacks and headache-days compared to the placebo group (reduced attack frequency, P =.5; headache-days, P =.12). Furthermore, the proportion of patients who improved by at least 5% was 15% for placebo and 59% for riboflavin (P =.2) and the number-needed-to-treat for effectiveness was 2.3. Three minor adverse events occurred: 2 in the riboflavin group (diarrhea and polyuria) and 1 in the placebo group (abdominal cramps). 14 A randomized controlled trial by Sandor et al of 42 patients reported that significantly more patients taking 1 mg 3 times daily of CoQ 1 had at least a 5% reduction in their migraine than patients who took placebo Figure 3. Late CDH Study: No Prophylaxis and Overusing Acute Pain Medications Mean change in n of headaches -8 * * 47% overusing acute headache pain medications (ICHD-II definitions) Pooled (n = 355) 3.4 * * * * -1 * P < * (n = 173) (n = 182) Baseline: * = 13.5, = Medication Overusers (n = 168) * 4.5 * * * * * * * * P * (n = 91) (n = 77) Baseline: * = 15.2, = 14.9 = botulinum toxin type A; CDH = chronic daily headache; ICHD-II = International Classification of Headache Disorders (second edition). Data from Saper et al. 12 Figure 4. Late CDH Study: Headaches 4 or More Hours Mean change in n of headaches >7% of all headaches were >4 hours in duration Day 18. *.6 vs placebo.2 (P <.5). <4 hours * (n = 173) (n = 182) hours *P.44 * * ** 2.4 * * * * * * (n = 173) (n = 182) Baseline: * = 3.9, = 3.5 Baseline: * = 9.6, = 9.2 = botulinum toxin type A; CDH = chronic daily headache. Data from from Elkind et al 5 and Aurora et al. 6 Johns Hopkins Advanced Studies in Medicine S339
5 Figure 5. Efficacy of CoQ 1 Versus Verum (n = 21) (n = 21) P Value* N of migraine -.9 ± ± attacks/mo N of days with -1.4 ± ± headache/mo Mean severity of.3 ± ± migraine/day N of days with.8 ± ± nausea/vomiting Mean n -.2 ±.5.4 ±.9.71 tablets/day Mean duration -.5 ± ± of migraine/day 5% responder 3 (14.3%) 1 (47.6%).2 rate for attack frequency (47.6% vs 14.3%) after 3 months. 16 Although this is a small study, large-scale clinical trials may be in order to establish whether this is of benefit for patients with chronic migraine (Figure 5). 16 PETASITES HYBRIDUS (BUTTERBUR) 4.4 Petasites hybridus (butterbur) is a perennial shrub used medicinally for 2 years. The active ingredients, petasine and isopetasine, block leukotriene synthesis and have anti-inflammatory effects. An extract of the root stock (Petadolex) is available in Germany where it is sold as an herbal preventative medication for migraine. A small, placebo-controlled trial (n = 6) was positive at dosages of 5 mg twice daily, indicating that butterbur may be effective and well tolerated in the prophylaxis of migraine. Following a 4-week baseline phase, 33 patients were randomized to treatment with 2 capsules of 25-mg butterbur twice a day and 27 patients were randomized to placebo. The mean attack frequency per month decreased from 3.4 at baseline to 1.8 after 3 months (P =.24) in the verum group and from 2.9 to 2.6 in the placebo group. The responder rate (ie, improvement of migraine frequency 5%) was 45% in the verum group and 15% in the placebo group. 17 Lipton et al conducted a larger, 3-arm, parallelgroup, randomized trial comparing Petasites extract 75 mg twice daily, Petasites extract 5 mg twice daily, or Attacks/month (95% CI) CoQ 1 Baseline (1) Months Change from baseline (month 1) to month 4. Values are means ± SD. *Mann-Whitney U test; 2 test for responder rate. CI = confidence interval; CoQ 1 = coenzyme Q 1. Reprinted with permission from Sandor et al. Neurology. 25;64: placebo to be taken twice daily in 245 patients with migraine. 18 The main outcome measure was the decrease in migraine attacks per month calculated as percentage change from baseline over a 4-month treatment period. The authors found that migraine attack frequency was reduced by 48% for Petasites extract 75 mg twice daily (P =.12 vs placebo), 36% for Petasites extract 5 mg twice daily (P =.127 vs placebo), and 26% for the placebo group. The proportion of patients with at least a 5% reduction in attack frequency after 4 months was 68% for patients in the 75-mg arm and 49% for the placebo arm (P <.5; Figure 6). 18 Results also were significant in favor of Petasites 75 mg as early as 1 month into therapy, but lower dosages (ie, 5 mg twice daily) did not seem effective. Secondary endpoints also achieved statistically significant improvements over baseline, including at least a 5% reduction in attack frequency, reduction in attack intensity, and mean number of attackdays per month. Petasites extract was well tolerated with 87% of participants reporting good/excellent tolerability. The most frequently reported adverse reactions considered possibly related to treatment were mild gastrointestinal events (ie, burping, nausea, or vomiting) and, rarely, neurologic symptoms (ie, exacerbation of migraine attacks or sleep interruption). 18 Figure 6. Efficacy of Petasites Versus Mean change from baseline 1% % -1% % -3% % -5% % Reduction in Migraine Attack Count (3 months) (n = 63) Petasites 5 mg (n = 71) Petasites 75 mg (n = 68) 6% P =.7-34% P <.1 P =.4 8% Reprinted with permission from Lipton et al. Neurology. 24;63: S34 Vol. 6 (4D) April 26
6 LAMOTRIGINE Lamotrigine inhibits voltage-gated sodium channels and prevents release of glutamate. Glutamate is considered pivotal for the initiation and propagation of cortical spreading depression the underlying physiological substrate for migraine aura. Evidence in favor of lamotrigine for the prevention of migraine with aura is conflicting. For example, there have been 3 open-label trials suggesting efficacy in patients with migraine with aura, 191 including a trial by D Andrea et al that studied the effects of 1 mg of lamotrigine per day in 24 patients affected by migraine with aura and a high frequency of attacks. 19 Following a 1-month run-in period, the patients took lamotrigine for 3 months. Mean attack number per month was reduced from 6.1 ± 4.1 during the run-in period to.7 ± 1.3 at the third month of treatment (P <.1). According to the authors, in 13 out of 21 patients who completed the study the attacks were completely abolished, whereas only 1 patient was completely unresponsive to the drug. 19 However, a randomized controlled study demonstrated no difference in reducing migraine frequency in 77 patients who had migraine with aura. 22 In this study, Steiner et al compared the safety and efficacy of lamotrigine and placebo for migraine prophylaxis in a double-blind randomized parallel-groups trial; 37 patients were treated with lamotrigine and 4 were treated with placebo for up to 3 months. 22 Initially, lamotrigine therapy was commenced at the full dosage of 2 mg per day, but because of the development of rashes in study patients, a gradually increasing dosage schedule was introduced as follows: 25 mg per day for 2 weeks, 5 mg per day for 2 weeks, and then 2 mg per day. Migraine attack rates were reduced from baseline means of 3.6 per month on lamotrigine and 4.4 on placebo to 3.2 and 3. respectively during the last month of treatment. Improvements were greater on placebo and these changes, although not statistically significant, indicated that lamotrigine was ineffective for migraine prophylaxis. CONCLUSIONS Chronic daily headache is a condition that continues to plague millions of individuals worldwide. Treatments to date include mainly analgesics to cope with acute attacks, and these may wane in their efficacy or cause adverse effects over time. Efforts also have been focused on developing therapeutic options for prophylaxis, including nontraditional pharmaceutical agents and alternative therapies. There is now evidence from randomized, double-blind, placebo-controlled clinical trials that botulinum toxin type A may be an effective treatment for patients with migraine suffering with CDH. Furthermore, the antiepileptic medications lamotrigine and vitamins and herbs (eg, CoQ 1 and butterbur) also have demonstrated efficacy in small studies. In the future, the goal will be to gain a better understanding of the pathophysiology underlying headache pain to develop strategies to target and bring relief to those patients who suffer from this disabling condition. REFERENCES 1. Fishman P. Clinical uses of botulinum toxin. Adv Stud Med. 25;5: Pellizzari R, Rossetto O, Schiavo G, Montecucco C. Tetanus and botulinum neurotoxins: mechanism of action and therapeutic uses. Philos Trans R Soc Lond B Biol Sci. 1999;354: Silberstein S, Mathew N, Saper J, Jenkins S. Botulinum toxin type A as a migraine preventive treatment. Headache. 2;4: Saper JR, Mathew NT, Loder EW, et al. A double-blind, randomised, placebo-controlled exploratory study comparing injection sites with low doses of botulinum toxin type A in the prevention of episodic migraine. J Neurol. 25;252:58 (P26). 5. Elkind AH, O Carroll CP, Blumenfeld R, et al. A randomised, controlled, 3-study series of multiple treatments with low doses of botulinum toxin type A for the prophylaxis of episodic migraine. J Neurol. 25;252:13-14 (P39). 6. Aurora SK, Gawel M, Brandes J, et al. Botulinum toxin type A prophylactic treatment for episodic migraine using a modified follow-the-pain treatment paradigm: a randomized, double-blind, placebo-controlled, phase II study. Headache. 25;45:766-84, S Relja M, Poole AC, Schoenen J, et al. A multicenter, double-blind, randomised, placebo-controlled, parallel group study of multiple treatments of botulinum toxin type A () for the prophylaxis of migraine headaches. J Neurol. 25;252:62 (P222). 8. Silberstein SD, Gobel H, Jensen R, et al. The safety and efficacy of a single treatment of botulinum toxin type A in the prophylactic treatment of chronic tension-type headache (CTTH): a multicenter, double-blind, randomized, placebo-controlled, parallel-group study. Headache. 25;45: Mathew NT, Frishberg BM, Gawel M, et al. Botulinum toxin type A (BOTOX) for the prophylactic treatment of chronic daily headache: a randomized, double-blind, placebo-controlled trial. Headache. 25;45: Silberstein SD, Stark S, Lucas S, et al. Botulinum toxin type A (BOTOX) for the prophylaxis of chronic daily headache in migraineurs using a fixed-site, fixed-dose treatment paradigm: a randomized, double-blind, placebo controlled trial. Headache. 25;45:766-84, S Dodick DW, Mauskop A, Elkind AH, et al. Botulinum toxin Johns Hopkins Advanced Studies in Medicine S341
7 type A for the prophylaxis of chronic daily headache:subgroup analysis of patients not receiving other prophylactic medications: a randomized, double-blind, placebo controlled study. Headache. 25;45: Saper JR, Brandes J, Wrubel B, et al. Efficacy of prophylactic treatment with Botulinum Toxin Type A in migraineurs with chronic daily headache who overuse acute headache pain medications. Headache. 25;45: Watanabe H, Kuwabara T, Ohkubo M, et al. Elevation of cerebral lactate detected by localized 1H-magnetic resonance spectroscopy in migraine during the interictal period. Neurology. 1996;47: Schoenen J, Jacquy J, Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology. 1998;5: Rozen TD, Oshinsky ML, Gebeline CA, et al. Open label trial of coenzyme Q1 as a migraine preventive. Cephalalgia. 22;22: Sandor PS, Di Clemente L, Coppola G, et al. Efficacy of coenzyme Q1 in migraine prophylaxis: a randomized controlled trial. Neurology. 25;64: Diener HC, Rahlfs VW, Danesch U. The first placebo-controlled trial of a special butterbur root extract for the prevention of migraine: reanalysis of efficacy criteria. Eur Neurol. 24;51: Lipton RB, Gobel H, Einhaupl KM, et al. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology. 24;63: D Andrea G, Granella F, Cadaldini M, Manzoni GC. Effectiveness of lamotrigine in the prophylaxis of migraine with aura: an open pilot study. Cephalalgia. 1999;19: D Andrea G, Allais G, Grazzi L, Fumagalli L. Migraine with aura from pathophysiology to treatment: therapeutic strategies. Neurol Sci. 25;26:s14-s Lampl C, Katsarava Z, Diener HC, Limmroth V. Lamotrigine reduces migraine aura and migraine attacks in patients with migraine with aura. J Neurol Neurosurg Psychiatry. 25;76: Steiner TJ, Findley LJ, Yuen AW. Lamotrigine versus placebo in the prophylaxis of migraine with and without aura. Cephalalgia. 1997;17: S342 Vol. 6 (4D) April 26
Chronic daily headache (CDH), defined
FINDING A FIT: STRATEGIES FOR CHRONIC MIGRAINE PROPHYLAXIS David W. Dodick, MD, FRCP(C), FACP ABSTRACT Chronic daily headache (CDH) affects approximately 4% to 5% of the population and is responsible for
More information10/17/2017 CHRONIC MIGRAINES BOTOX: TO INJECT OR NOT INJECT? IN CHRONIC MIGRAINE PROPHYLAXIS OBJECTIVES PATIENT CASE EPIDEMIOLOGY EPIDEMIOLOGY
BOTOX: TO INJECT OR NOT INJECT? IN CHRONIC MIGRAINE PROPHYLAXIS OBJECTIVES JENNIFER SHIN, PHARMD PGY2 AMBULATORY CARE PHARMACY RESIDENT COMMUNITYCARE HEALTH CENTERS PHARMACOTHERAPY ROUNDS OCTOBER 20, 2017
More informationLong-term benefits of botulinum toxin type A (BOTOX) in chronic daily headache: a five-year long experience
J Headache Pain (26) 7:47 412 DOI 1.17/s1194-6-344-9 RAPID COMMUNICATION Ivano Farinelli Gabriella Coloprisco Sergio De Filippis Paolo Martelletti Long-term benefits of botulinum toxin type A (BOTOX) in
More informationResearch Submission. Accepted for publication December 14, 2004.
Research Submission Botulinum Toxin Type A for the Prophylaxis of Chronic Daily Headache: Subgroup Analysis of Patients Not Receiving Other Prophylactic Medications: A Randomized Double-Blind, Placebo-Controlled
More informationDavid W. Dodick M.D. Professor Director of Headache Medicine Department of Neurology Mayo Clinic Phoenix Arizona USA
Headache Masters School 2013 in Asia Sunday March 24, 2013 Procedural Medicine Workshop Onabotulinumtoxin A: Evidence, Injection Technique, and Mechanism of Action David W. Dodick M.D. Professor Director
More informationOnabotulinumtoxinA 155 U in medication overuse headache: a two years prospective study
OnabotulinumtoxinA 155 U in medication overuse headache: a two years prospective study The Harvard community has made this article openly available. Please share how this access benefits you. Your story
More informationPetasites hybridus root (butterbur) is an effective preventive treatment for migraine
Petasites hybridus root (butterbur) is an effective preventive treatment for migraine R.B. Lipton, MD; H. Göbel, MD, PhD; K.M. Einhäupl, MD; K. Wilks, MD; and A. Mauskop, MD Abstract Objective: To evaluate
More information2 nd Resubmission. 13 January 2017
2 nd Resubmission botulinum toxin A, 50 Allergan units, 100 Allergan units, 200 Allergan units, powder for solution for injection (Botox ) SMC No. (692/11) Allergan Limited 13 January 2017 The Scottish
More informationA one-year prospective costing study of botulinum toxin type A treatment of chronic tension headache
J Headache Pain (2004) 5:192 196 DOI 10.1007/s10194-004-0100-3 ORIGINAL Fabio Palazzo Francesco S. Mennini Laura Fioravanti Laura Piasini Gabriella Coloprisco Paolo Martelletti A one-year prospective costing
More informationNational Institute for Health and Clinical Excellence. Single Technology Appraisal (STA)
National Institute for Health and Clinical Excellence Comment 1: the draft remit Single Technology Appraisal (STA) Botulinum toxin type A for the prophylaxis of headaches in adults with chronic migraine
More informationThe frequency with which migraine attacks
STRATEGIES TO PREVENT MIGRAINE * Sheena K. Aurora, MD ABSTRACT Patients who suffer from daily or near-daily headaches may experience significant disability and interference in all aspects of their professional
More informationChronic Migraine in Primary Care. December 11 th, 2017 Werner J. Becker University of Calgary
Chronic Migraine in Primary Care December 11 th, 2017 Werner J. Becker University of Calgary Disclosures Faculty: Werner J. Becker Relationships with commercial interests: Grants/Research Support: Clinical
More informationPrednisone vs. placebo in withdrawal therapy following medication overuse headache
doi:10.1111/j.1468-2982.2007.01488.x Prednisone vs. placebo in withdrawal therapy following medication overuse headache L Pageler 1,2, Z Katsarava 2, HC Diener 2 & V Limmroth 1,2 1 Department of Neurology,
More informationDoes analgesic overuse matter? Response to OnabotulinumtoxinA in patients with chronic migraine with or without medication overuse
DOI 10.1186/s40064-015-1386-8 RESEARCH Open Access Does analgesic overuse matter? Response to OnabotulinumtoxinA in patients with chronic migraine with or without medication overuse Fayyaz Ahmed *, Hassan
More informationMEASURE #3: PREVENTIVE MIGRAINE MEDICATION PRESCRIBED Headache
MEASURE #3: PREVENTIVE MIGRAINE MEDICATION PRESCRIBED Headache Measure Description Percentage of patients age 18 years old and older diagnosed with migraine headache whose migraine frequency is 4 migraine
More informationMedication overuse headache: a critical review of end points in recent follow-up studies
J Headache Pain (2010) 11:373 377 DOI 10.1007/s10194-010-0221-4 REVIEW ARTICLE Medication overuse headache: a critical review of end points in recent follow-up studies Knut Hagen Rigmor Jensen Magne Geir
More informationA Multi-Center Double-Blind Pilot Comparison of OnabotulinumtoxinA and Topiramate for the Prophylactic Treatment of Chronic Migrainehead_
Headache 2010 American Headache Society ISSN 0017-8748 doi: 10.1111/j.1526-4610.2010.01796.x Published by Wiley Periodicals, Inc. Research Submission A Multi-Center Double-Blind Pilot Comparison of OnabotulinumtoxinA
More informationGiorgio Sandrini Armando Perrotta Cristina Tassorelli Paola Torelli Filippo Brighina Grazia Sances Giuseppe Nappi
J Headache Pain (2011) 12:427 433 DOI 10.1007/s10194-011-0339-z ORIGINAL Botulinum toxin type-a in the prophylactic treatment of medication-overuse headache: a multicenter, double-blind, randomized, placebo-controlled,
More informationBotulinum Neurotoxin for Chronic Migraine and Trigeminal Neuralgia
Botulinum Neurotoxin for Chronic Migraine and Trigeminal Neuralgia David W. Dodick, MD Professor Department of Neurology, Mayo Clinic Phoenix Arizona, USA Onabotulinumtoxin A is the only botulinum toxin
More informationPROCEEDINGS MANAGEMENT OF CHRONIC DAILY HEADACHE: CHALLENGES IN CLINICAL PRACTICE * Constance J. Johnson, MD ABSTRACT
MANAGEMENT OF CHRONIC DAILY HEADACHE: CHALLENGES IN CLINICAL PRACTICE * Constance J. Johnson, MD ABSTRACT Chronic daily headache (CDH) is a chronic disease that presents challenges related to patient and
More informationMark W. Green, MD, FAAN
Mark W. Green, MD, FAAN Professor of Neurology, Anesthesiology, and Rehabilitation Medicine Director of Headache and Pain Medicine Icahn School of Medicine at Mt Sinai New York Pain-sensitive structures
More informationNew generation anti-epileptics for facial pain and headache
Acta neurol. belg., 2001, 101, 42-46 New generation anti-epileptics for facial pain and headache Valérie DELVAUX and Jean SCHOENEN University Department of Neurology, University of Liège, Liège, Belgium
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
CGRP Page 1 of 13 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: CGRP (calcitonin gene-related peptide) Prime Therapeutics will review Prior Authorization requests
More informationUpdate on Diagnosis and Management of Migraines
Update on Diagnosis and Management of Migraines Joel J. Heidelbaugh, MD, FAAFP, FACG Clinical Professor Departments of Family Medicine and Urology University of Michigan Learning Objectives To distinguish
More informationPreventive treatment of migraine. Rebecca Burch, MD Brigham and Women s Faulkner Hospital Harvard Medical School Boston, MA
Preventive treatment of migraine Rebecca Burch, MD Brigham and Women s Faulkner Hospital Harvard Medical School Boston, MA No disclosures Disclosures Many preventive treatments for migraine are not FDA-approved
More informationMigraine headache incurs estimated. The Cost of Migraine and Its Treatment REPORTS. Lawrence D. Goldberg, MD, MBA
REPORTS The Cost of Migraine and Its Treatment Lawrence D. Goldberg, MD, MBA Abstract Migraine headache incurs estimated annual costs totaling as much as $17 billion in the United States. Most of the direct
More informationPREVALENCE BY HEADACHE TYPE
CLINICAL CLUES AND CLINICAL RULES: PRIMARY VS SECONDARY HEADACHE * Based on a presentation by David W. Dodick, MD ABSTRACT Headache is a common condition, accounting for many specialist office visits annually.
More informationMigraine and Tension Headache Diagnosis and Treatment Guideline
Migraine and Tension Headache Diagnosis and Treatment Guideline Diagnosis 2 Treatment Migraine Headaches 4 Medication Overuse Headaches 7 Migraine Prophylaxis 8 Monitoring/Follow-up 11 Evidence Summary
More informationZonisamide for migraine prophylaxis in refractory patients
Thomas Jefferson University Jefferson Digital Commons Department of Neurology Faculty Papers Department of Neurology March 2006 Zonisamide for migraine prophylaxis in refractory patients Avi Ashkenazi
More informationWhat is new in the migraine world! Modar Khalil Consultant neurologist Hull Royal Infirmary
What is new in the migraine world! Modar Khalil Consultant neurologist Hull Royal Infirmary Overview Understanding the burden Commonly used terms Acute therapy What we currently have What we are going
More informationOnabotulinumtoxinA treatment for chronic migraine: experience in 52 patients treated with the PREEMPT paradigm
Pedraza et al. SpringerPlus (2015) 4:176 DOI 10.1186/s40064-015-0957-z a SpringerOpen Journal RESEARCH Open Access OnabotulinumtoxinA treatment for chronic migraine: experience in 52 patients treated with
More informationWhat is the Effectiveness of OnabotulinumtoxinA (Botox ) in Reducing the Number of Chronic Migraines (CM) in Patients Years Old?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2013 What is the Effectiveness of OnabotulinumtoxinA
More informationMigraine is a very common medical disorder
MENSTRUALLY RELATED MIGRAINE: IMPLICATIONS FOR EMPLOYERS AND MANAGED CARE * Richard B. Lipton, MD ABSTRACT Migraine is a common disorder, affecting approximately 28 million men and women in the United
More informationExpert Opinion. OnabotulinumtoxinA for Chronic Migrainehead_2071 CLINICAL HISTORY. Andrew Blumenfeld, MD; Randolph W. Evans, MD
142..148 Headache 2011 American Headache Society ISSN 0017-8748 doi: 10.1111/j.1526-4610.2011.02081.x Published by Wiley Periodicals, Inc. Expert Opinion OnabotulinumtoxinA for Chronic Migrainehead_2071
More informationAdvances in the Treatment of Migraine
Advances in the Treatment of Migraine C. Philip O Carroll, M.D. Director Neurobehavioral Medicine Hoag Neurosciences Institute Guyuron B Headache, 2015;55:1464-1473 I m sorry your head hurts, sweetie.is
More informationปวดศ รษะมา 5 ป ก นยาแก ปวดก ย งไม ข น นพ.พาว ฒ เมฆว ช ย โรงพยาบาลนครราชส มา
ปวดศ รษะมา 5 ป ก นยาแก ปวดก ย งไม ข น นพ.พาว ฒ เมฆว ช ย โรงพยาบาลนครราชส มา 1 CONTENT 1 2 3 Chronic Daily Headache Medical Overused Headache Management Headaches are one of the most common symptoms List
More informationCaspian Journal of Neurological Sciences "Caspian J Neurol Sci" Journal Homepage:
Caspian Journal of Neurological Sciences "Caspian J Neurol Sci" Journal Homepage: http://cjns.gums.ac.ir Research aper: or for Treatment of Medication Overuse Headache: A Randomized, Double- Blind Clinical
More informationDescription. Section: Surgery Effective Date: January 15, 2016 Subsection: Surgery Original Policy Date: December 6, 2012 Subject:
Last Review Status/Date: December 2015 Description Page: 1 of 11 Surgical deactivation of trigger sites is a proposed treatment of migraine headache. The procedure involves identifying a patient s predominant
More informationHeadache: Using Neuromodulation as Therapy
Headache: Using Neuromodulation as Therapy Rashmi Halker, MD, FAHS Assistant Professor of Neurology Department of Neurology Mayo Clinic Phoenix Arizona Disclosures Nothing to disclose 2013 MFMER slide-2
More informationTreatment of headaches with botulinum toxin
For reprint orders, please contact reprints@future-drugs.com Review Treatment of headaches with botulinum toxin Julia Samton and Alexander Mauskop CONTENTS Mechanism of action of botulinum toxin Product
More informationI have no financial relationships to disclose. I will not discuss investigational use of medication in my presentation.
I have no financial relationships to disclose. I will not discuss investigational use of medication in my presentation. In 1962, Bille published landmark epidemiologic survey of headache among 9,000 school
More informationGet ahead of the ACHE: Monoclonal Antibodies in Migraine Prevention
Get ahead of the ACHE: Monoclonal Antibodies in Migraine Prevention Amanda Janisch, PharmD PGY2 Ambulatory Care Pharmacy Resident MCHS SWMN, Mankato, MN 2018 MFMER slide-1 Disclosures No financial interest
More informationBotox (Botulinum toxin type A) in the prophylaxis of headaches in chronic migraine
Botox (Botulinum toxin type A) in the prophylaxis of headaches in chronic migraine Manufacturer responses to clarification questions from the Evidence Review Group November 2011 Clarification on manufacturer
More informationClinical Trials. Hans-Christoph Diener Senior Professor of Clinical Neuroscienes Medical Faculty University Duisburg-Essen Germany
Clinical Trials Hans-Christoph Diener Senior Professor of Clinical Neuroscienes Medical Faculty University Duisburg-Essen Germany Conflict of Interest Statement German Research Council German Ministry
More informationRISK FACTORS AND PROGNOSIS OF CHRONIC MIGRAINE
RISK FACTORS AND PROGNOSIS OF CHRONIC MIGRAINE Gretchen E. Tietjen, MD University of Toledo Toledo, Ohio Learning objectives At the conclusion of this presentation, participants should be able to: 1. Understand
More informationSpecific Objectives A. Topics to be lectured and discussed at the plenary sessions
Specific Objectives A. Topics to be lectured and discussed at the plenary sessions 0. Introduction: Good morning ICHD-III! Let s start at the very beginning. When you read you begin with A-B-C, so when
More informationEFFECTIVENESS OF HIGH DOSE RIBOFLAVIN IN MIGRAINE PROPHYLAXIS: A RANDOMIZED CONTROLLED TRIAL.
EFFECTIVENESS OF HIGH DOSE RIBOFLAVIN IN MIGRAINE PROPHYLAXIS: A RANDOMIZED CONTROLLED TRIAL. J. Schoenen, MD, PhD; J. Jacquy, MD; and M. Lenaerts, MD Neurology 1998; 50:466-470 This information is current
More informationThe Effect of Feverfew Cultivated in Iran for the Prophylactic Treatment of Migraine: A Randomized Placebo-controlled Clinical Trial
Jundishapur J Nat Pharm Prod. 2016 February; 11(1): e29275. Published online 2015 November 28. doi: 10.17795/jjnpp-29275 Research Article The Effect of Feverfew Cultivated in Iran for the Prophylactic
More informationLevetiracetam in the Preventive Treatment of Transformed Migraine: A Prospective, Open-Label, Pilot Study
VOLUME 66, NUMBER 3, MAY/JUNE 2005 Levetiracetam in the Preventive Treatment of Transformed Migraine: A Prospective, Open-Label, Pilot Study Alan M. Rapoport, MD1,2; Fred D. Sheftell, MD2,3; Stewart J.
More information1/25/2018 ARE CGRP ANTAGONISTS ANY BETTER THAN CURRENT EVIDENCE BASED TREATMENTS? Disclosures: Objectives: Headache Division
ARE CGRP ANTAGONISTS ANY BETTER THAN CURRENT EVIDENCE BASED TREATMENTS? Lawrence C Newman, MD, FAHS, FAAN Clinical Professor of Neurology Disclosures: Advisory Board: Alder, Allergan, Amgen, Lilly, Supernus,
More informationPrevalence of primary headaches in Germany: results of the German Headache Consortium Study
J Headache Pain (2012) 13:215 223 DOI 10.1007/s10194-012-0425-x ORIGINAL Prevalence of primary headaches in Germany: results of the German Headache Consortium Study M-S Yoon Z. Katsarava M. Obermann G.
More informationManagement of headache
Management of headache TJ Steiner Imperial College London Based on European principles of management of common headache disorders TJ Steiner, K Paemeleire, R Jensen, D Valade, L Savi, MJA Lainez, H-C Diener,
More informationEffectiveness of Pharmacological Treatments in Imploding vs. Exploding Headaches
Effectiveness of Pharmacological Treatments in Imploding vs. Exploding Headaches Item Type Thesis Authors Hunt, Megan Publisher The University of Arizona. Rights Copyright is held by the author. Digital
More informationInpatient Treatment of Status Migraine With Dihydroergotamine in Children and Adolescents
Headache 2008 the Authors Journal compilation 2008 American Headache Society ISSN 0017-8748 doi: 10.1111/j.1526-4610.2008.01293.x Published by Wiley Periodicals, Inc. Brief Communication Inpatient Treatment
More informationClinical Characteristics of Chronic Daily Headache Patients Visit to University Hospital
Clinical Characteristics of Chronic Daily Headache Patients Visit to University Hospital Jin-Kuk Do, M.D., Hee-Jong Oh, M.D., Dong-Kuck Lee, M.D. Department of Neurology, Taegu Hyosung Catholic University
More informationA case of a patient with chronic headache. Focus on Migraine. None related to the presentation Grants to conduct clinical trials from: Speaker bureau:
Chronic Daily Headache Bassel F. Shneker, MD, MBA Associate Professor Vice Chair, OSU Neurology The Ohio State University Wexner Medical Center Financial Disclosures None related to the presentation Grants
More informationTreatment Of Medication. Overuse Headache
7 November 2012 BASH GPwSI Meeting Lecture title... Treatment Of Medication Dr... Overuse Headache Dr Marcus Lewis Dr... The National Migraine Centre International Headache Society Diagnostic criteria
More informationRiboflavin: An Alternative Approach to Managing Migrane Attacks in the Adult Population
UCLA Nutrition Bytes Title : An Alternative Approach to Managing Migrane Attacks in the Adult Population Permalink https://escholarship.org/uc/item/2rd9m4j0 Journal Nutrition Bytes, 14(1) ISSN 1548-601X
More informationPreventive Effect of Greater Occipital Nerve Block on Severity and Frequency of Migraine Headache
Global Journal of Health Science; Vol. 6, No. 6; 2014 ISSN 1916-9736 E-ISSN 1916-9744 Published by Canadian Center of Science and Education Preventive Effect of Greater Occipital Nerve Block on Severity
More informationMigraine much more than just a headache
Migraine much more than just a headache Session hosted by Teva UK Limited PUU4 11:15 12:15 UK/NHSS/18/0021b Date of Preparation: August 2018 The views expressed in this presentation are those of the speaker
More informationAleksandra Radojičić. Headache Center, Neurology Clinic, Clinical Center of Serbia
European Headache School Belgrade 2012 MEDICATION OVERUSE HEADACHE Aleksandra Radojičić Headache Center, Neurology Clinic, Clinical Center of Serbia Historical data First cases were described in XVII century
More informationA two years open-label prospective study of OnabotulinumtoxinA 195 U in medication overuse headache: a real-world experience
Negro et al. The Journal of Headache and Pain (2016) 17:1 DOI 10.1186/s10194-016-0591-3 RESEARCH ARTICLE A two years open-label prospective study of OnabotulinumtoxinA 195 U in medication overuse headache:
More informationTABLE 1. Current Diagnostic Criteria for Migraine Without Aura 2 A. At least 5 attacks fulfilling criteria B-D B. Headache attacks lasting 4-72 hours
ANSWERS CONCISE TO FREQUENTLY REVIEW ASKED QUESTIONS FOR CLINICIANS ABOUT MIGRAINE Answers to Frequently Asked Questions About Migraine IVAN GARZA, MD, AND JERRY W. SWANSON, MD Migraine is a common primary
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
CGRP Page 1 of 8 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: CGRP (calcitonin gene-related peptide) Prime Therapeutics will review Prior Authorization requests
More informationZolmitriptan is effective and well tolerated in Japanese patients with migraine: a dose response study
is effective and well tolerated in Japanese patients with migraine: a dose response study F Sakai 1, M Iwata 2, K Tashiro 3, Y Itoyama 4, S Tsuji 5, Y Fukuuchi 6, G Sobue 7, K Nakashima 8 & M Morimatsu
More informationValue of postmarketing surveillance studies in achieving a complete picture of antimigraine agents: using almotriptan as an example
J Headache Pain (2006) 7:27 33 DOI 10.1007/s10194-006-0266-6 ORIGINAL Julio Pascual Hans-Christoph Diener Hélène Massiou Value of postmarketing surveillance studies in achieving a complete picture of antimigraine
More informationStudy No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationProposed Project Scope. OPTIMAL USE OnabotulinumtoxinA for the Prevention of Chronic Migraine Clinical Evidence, Policies and Practice
Proposed Project Scope OPTIMAL USE OnabotulinumtoxinA for the Prevention of Chronic Migraine Clinical Evidence, Policies and Practice May 2018 1. BACKGROUND AND RATIONALE Migraine is a common, debilitating
More informationDisclosures. Triptans for Kids 5/16/13
5/16/13 Disclosures Triptans for Kids Amy A. Gelfand, MD GelfandA@neuropeds.ucsf.edu Departments of Neurology and Pediatrics UCSF Child Neurology and Headache Center I receive grant funding from: NIH/NINDS
More informationBotulinum toxin type A for the prevention of headaches in adults with chronic migraine
Botulinum toxin type A for the prevention of headaches in adults with chronic migraine Issued: June 2012 guidance.nice.org.uk/ta260 NICE has accredited the process used by the Centre for Health Technology
More informationprevalence was 13.8% among females
1 2 3 1. Woldeamanuel YW et al. Migraine affects 1 in 10 people worldwide featuring recent rise: a systematic review and meta-analysis of communitybased studies involving 6 million participants. J Neurol
More informationUNDERSTANDING CHRONIC MIGRAINE. Learn about diagnosis, management, and treatment options for this headache condition
UNDERSTANDING CHRONIC MIGRAINE Learn about diagnosis, management, and treatment options for this headache condition 1 What We re Going to Cover Today The symptoms and phases of migraine Differences between
More informationAtenolol in the prophylaxis of chronic migraine: a 3-month open-label study
Edvardsson SpringerPlus 2013, 2:479 a SpringerOpen Journal RESEARCH Open Access Atenolol in the prophylaxis of chronic migraine: a 3-month open-label study Bengt Edvardsson Abstract Background: Chronic
More informationThe majority of primary headaches fall into
NEUROTOXINS Neurotoxins: Expanding Uses of Neuromodulators in Medicine Headache Edward Nahabet, BA Jeffrey E. Janis, MD, FACS Bahman Guyuron, MD, FACS Cleveland and Columbus, Ohio Summary: Over the course
More informationOccipital Nerve Stimulation with the Bion Microstimulator for the Treatment of Medically Refractory Chronic Cluster Headache
Pain Physician 2011; 14:435-440 ISSN 1533-3159 Case Report Occipital Nerve Stimulation with the Bion Microstimulator for the Treatment of Medically Refractory Chronic Cluster Headache Natalie H. Strand
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: surgical_deactivation_of_migraine_headache_trigger_sites 10/2012 5/2017 5/2018 5/2017 Description of Procedure
More informationOnabotulinumtoxinA in the treatment of patients with chronic migraine: clinical evidence and experience
731521TAN0010.1177/1756285617731521Therapeutic Advances in Neurological DisordersC-C Chiang and AJ Starling research-article2017 Therapeutic Advances in Neurological Disorders Review OnabotulinumtoxinA
More informationRizatriptan vs. ibuprofen in migraine: a randomised placebo-controlled trial
J Headache Pain (2007) 8:175 179 DOI 10.1007/s10194-007-0386-7 ORIGINAL Usha Kant Misra Jayantee Kalita Rama Kant Yadav Rizatriptan vs. ibuprofen in migraine: a randomised placebo-controlled trial Received:
More informationAalborg Universitet. Botulinum neurotoxin A for chronic migraine headaches Cairns, Brian Edwin; Gazerani, Parisa. Published in: Pain Management
Aalborg Universitet Botulinum neurotoxin A for chronic migraine headaches Cairns, Brian Edwin; Gazerani, Parisa Published in: Pain Management DOI (link to publication from Publisher): 10.2217/PMT.14.30
More informationTriptans: Nonresponse, Recurrence, and Serious AEs for Many Patients
Efficacy, Safety, and Tolerability of Rimegepant 75 mg, an Oral CGRP Receptor Antagonist, for the Acute Treatment of Migraine: Results from a Phase 3, Double-Blind, Randomized, Placebo-Controlled Trial,
More informationDefining the Differences Between Episodic Migraine and Chronic Migraine
Curr Pain Headache Rep (2012) 16:86 92 DOI 10.1007/s11916-011-0233-z CHRONIC DAILY HEADACHE (SJ WANG, SECTION EDITOR) Defining the Differences Between Episodic Migraine and Chronic Migraine Zaza Katsarava
More informationNeurostimulation 2016
Neurostimulation 2016 Stephen D Silberstein, MD Jefferson Headache Center Thomas Jefferson University Hospital Philadelphia, PA 1 Neuromostimulation Occipital Nerve Stimulation (ONS) Transcranial Magnetic
More informationAmericans who suffer from migraine headaches are far
Taking an integrative approach to migraine headaches With about half of migraine sufferers using CAM, it s important to know which alternative approaches are most likely to help and what to tell your patients.
More informationPsychiatric Comorbidity in Transformed Migraine: Presentation, Treatment, Impact and Outcome
Jefferson Journal of Psychiatry Volume 23 Issue 1 Article 3 December 2010 Psychiatric Comorbidity in Transformed Migraine: Presentation, Treatment, Impact and Outcome Muhammad A. Abbas M.D Thomas Jefferson
More informationHow do we treat migraine? New SIGN Guidelines
How do we treat migraine? New SIGN Guidelines Managing your migraine Migraine Trust, Edinburgh 2018 Callum Duncan Consultant Neurologist Aberdeen Royal Infirmary Chair SIGN Guideline 155 Premonitory Mood
More informationS. Holland, S.D. Silberstein, F. Freitag, et al. DOI /WNL.0b013e d0c
Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults : Report of the Quality Standards Subcommittee of the American Academy of Neurology
More informationA new questionnaire for assessment of adverse events associated with triptans: methods of assessment influence the results. Preliminary results
J Headache Pain (2004) 5:S112 S116 DOI 10.1007/s10194-004-0123-4 Michele Feleppa Fred D. Sheftell Luciana Ciannella Amedeo D Alessio Giancarlo Apice Nino N. Capobianco Donato M.T. Saracino Walter Di Iorio
More informationBotulinum Toxin for Treatment of Primary Chronic Headache Disorders
Technology Evaluation Center Botulinum Toxin for Treatment of Primary Chronic Headache Disorders Assessment Program Volume 19, No. 10 December 2004 Executive Summary Primary chronic headache disorders,
More informationBotulinum toxins: abobotulinumtoxina (Dysport ), incobotulinumtoxina (Xeomin ), onabotulinumtoxina (Botox ), & rimabotulinumtoxinb (Myobloc )
Botulinum toxins: abobotulinumtoxina (Dysport ), incobotulinumtoxina (Xeomin ), onabotulinumtoxina (Botox ), & rimabotulinumtoxinb (Myobloc ) These services may or may not be covered by your HealthPartners
More informationThe validity of questionnaire-based diagnoses: the third Nord-Trøndelag Health Study
J Headache Pain (2010) 11:67 73 DOI 10.1007/s10194-009-0174-7 ORIGINAL The validity of questionnaire-based diagnoses: the third Nord-Trøndelag Health Study 2006 2008 Knut Hagen John-Anker Zwart Anne Hege
More informationTopiramate plus nortriptyline in the preventive treatment of migraine: a controlled study for nonresponders
J Headache Pain (2012) 13:53 59 DOI 10.1007/s10194-011-0395-4 ORIGINAL Topiramate plus nortriptyline in the preventive treatment of migraine: a controlled study for nonresponders Abouch Valenty Krymchantowski
More informationBotox for Chronic Migraine: Tips and Tricks
Botox for Chronic Migraine: Tips and Tricks Ten Questions for Andrew M. Blumenfeld, MD Andrew M. Blumenfeld is director of The Headache Center of Southern California. Most of his research has focused on
More information10/13/17. Christy M. Jackson, MD Director, Dalessio Headache Center Scripps Clinic, La Jolla Clinical Professor, Neurosciences UCSD
Christy M. Jackson, MD Director, Dalessio Headache Center Scripps Clinic, La Jolla Clinical Professor, Neurosciences UCSD } Depomed Consultant 2014 to present } Avanir Consultant 2014 to present } Amgen
More informationAn open-label pilot study on the efficacy and tolerability of levetiracetam in the prophylaxis of migraine
J Headache Pain () :9 9 DOI 1.1/s119--- RAPID COMMUNICATION Virgilio Gallai Andrea Alberti Cristiana Rossi Francesca Coppola Beatrice Gallai Giovanni Mazzotta Paola Sarchielli An open-label pilot study
More information6/2/2017. Objectives. Statement of Problem: Migraine Headaches Are Common. Chronic Headache In Pediatrics, Botox and Beyond
Chronic Headache In Pediatrics, Botox and Beyond Ken Mack MD PhD Mayo Clinic 2015 MFMER slide-1 Objectives Understand pediatric chronic headache presentations Review evidence for the treatment of chronic
More informationPreventive Effect of Greater Occipital Nerve Block on Severity and Frequency of Migraine Headache
Proceeding S.Z.P.G.M.I. Vol: 31(2): pp. 75-79, 2017. Preventive effect of Greater Occipital Nerve Block on Severity and Frequency of Migraine Headache Dr. Syed Mehmood Ali, Dr. Mudassar Aslam, Dr. Dawood
More informationIs OnabotulinumtoxinA Good for Other Head and Face Pain? Disclosures BoNT/A for non- CM Botulinum neurotoxin (BoNT) in clinical use for headache >20
1 2 3 4 5 6 Is OnabotulinumtoxinA Good for Other Head and Face Pain? Disclosures BoNT/A for non- CM Botulinum neurotoxin (BoNT) in clinical use for headache >20 years Efficacy of BoNT type A (onabotulinumtoxina,
More information...SELECTED ABSTRACTS...
The following abstracts, from medical journals containing literature on migraine management, were selected for their relevance to this Special Report supplement. Two Sumatriptan Studies Two double-blind
More information6/20/2018 PROCEDURAL TREATMENTS FOR HEADACHE. Case study: Emily. Diary
Headache severity (Scale 0 10) Topiramate started on July 20, D/C July 29 Amitriptyline initiated, D/C on Sep 23 PROCEDURAL TREATMENTS FOR HEADACHE Andrew M. Blumenfeld Director of the Headache Center
More information