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Prevention and Acute Treatment of Migraine

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (20 January 2022) | Viewed by 54268

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Dr. Antonio Russo

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Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 2–80138 Naples, Italy
Interests: migraine; headache; advanced neuroimaging; migraine pathophysiology; headache clinical practice

Special Issue Information

Dear colleagues,

In recent years, we have been experiencing epochal changes in migraine therapy.

We come from a time when migraine prevention therapy was based on drugs from different medical specialties, not specific or targeted, and burdened with troublesome or important adverse effects.

Today we can use pharmacological treatments, such as botulinum toxin or the most recent monoclonal antibodies, and direct them against the path of CGRP. They are specific, targeted, effective, and tolerable drugs. Similarly, the peripheral neuro-stimulation as well as dietetic, nutraceutical, and phytotherapic approaches have tremendously improved the management of migraine patients.

Moreover, in recent decades we have had the opportunity to use specific drugs for migraine attacks such as triptans. Most probably, in the near future we will use drugs such as ditans, which are characterized by greater tolerability and safety in the treatment of migraine attacks.

However, for cultural reasons, headache in general and migraine in particular, are still considered pathologies of competence of a few experts. Several difficulties still remain in exporting headache medicine insights into general medicine.

I believe that your collaboration on this Special Issue of the Journal of Clinical Medicine, entitled “Preventive and Acute Treatment of Migraine” may lead to the dissemination of the knowledge of migraine as an actual disorder, freeing it from prejudices and false myths that have gripped it.

In addition, the dissemination of migraine treatments, both acute and preventive, will allow to meet the needs of patients even when they do not come to the attention of headache medicine experts.

Thank you for agreeing to collaborate in writing a chapter of this Special Issue of the Journal of Clinical Medicine. The editors and I are confident that it will become a reference point for all those who want to know why, when, and how to treat migraine patients.

Dr. Antonio Russo
Guest Editor

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Keywords

migraine
headache
preventive treatment
acute treatment
therapy

Published Papers (12 papers)

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Research

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15 pages, 1554 KiB

Open AccessArticle

Effect of a Craniosacral Therapy Protocol in People with Migraine: A Randomized Controlled Trial

by Elena Muñoz-Gómez, Marta Inglés, Marta Aguilar-Rodríguez, Sara Mollà-Casanova, Núria Sempere-Rubio, Pilar Serra-Añó and Gemma V. Espí-López

J. Clin. Med. 2022, 11(3), 759; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11030759 - 30 Jan 2022

Cited by 8 | Viewed by 7097

Abstract

Background: Migraine is a common neurological disorder, and it is the second leading cause of disability worldwide. Manual techniques based on physical therapy have been proposed to improve migraine aspects; however, further research is needed on their effectiveness. The aim of this study was to evaluate the effectiveness of a craniosacral therapy protocol on different features in migraine patients. Methods: Fifty individuals with migraine were randomly divided into two groups (n = 25 per group): (i) craniosacral therapy group (CTG), following a craniosacral therapy protocol, and (ii) sham control group (SCG), with a sham treatment. The analyzed variables were pain, migraine severity and frequency of episodes, functional, emotional, and overall disability, medication intake, and self-reported perceived changes, at baseline, after a 4 week intervention, and at 8 week follow-up. Results: After the intervention, the CTG significantly reduced pain (p = 0.01), frequency of episodes (p = 0.001), functional (p = 0.001) and overall disability (p = 0.02), and medication intake (p = 0.01), as well as led to a significantly higher self-reported perception of change (p = 0.01), when compared to SCG. In addition, the results were maintained at follow-up evaluation in all variables. Conclusions: A protocol based on craniosacral therapy is effective in improving pain, frequency of episodes, functional and overall disability, and medication intake in migraineurs. This protocol may be considered as a therapeutic approach in migraine patients. Full article

(This article belongs to the Special Issue Prevention and Acute Treatment of Migraine)

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12 pages, 738 KiB

Open AccessArticle

Headache Worsening after COVID-19 Vaccination: An Online Questionnaire-Based Study on 841 Patients with Migraine

by Marcello Silvestro, Alessandro Tessitore, Ilaria Orologio, Pasquale Sozio, Giuseppe Napolitano, Mattia Siciliano, Gioacchino Tedeschi and Antonio Russo

J. Clin. Med. 2021, 10(24), 5914; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10245914 - 16 Dec 2021

Cited by 18 | Viewed by 4494

Abstract

Vaccines have represented the breakthrough in the fight against COVID-19. Based on reported headache attacks after vaccination in randomized controlled trials, we focused on the effects of COVID-19 vaccine administration on the migraine population, using an online questionnaire published on Italian Facebook groups oriented to headache patients. We collected data about the demographics and clinical parameters of migraine severity, COVID-19 infection, vaccination, and characteristics of headaches following vaccination. Out of 841 migraine patients filling in the questionnaire, 66.47% and 60.15% patients experienced a headache attack (from 1 hour to 7 days) after the first and the second vaccine dose, respectively. The main finding concerns headaches perceived by 57.60% of patients: attacks following vaccination were referred to as more severe (50.62% of patients), long-lasting (52.80% of patients) and hardwearing (49.69% of patients) compared to the usually experienced migraine attacks. This could be related to the production of inflammatory mediators such as type Iβ interferon. Considering the high prevalence of migraine in the general population, awareness of the possibility of headaches worsening following COVID-19 vaccination in these patients may allow both patients and clinicians to face this clinical entity with conscious serenity, and to reduce the waste of resources towards inappropriate health-care. Full article

(This article belongs to the Special Issue Prevention and Acute Treatment of Migraine)

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8 pages, 372 KiB

Open AccessArticle

Associations between Zygoma Fracture and Post-Traumatic Headache: A Study among Taiwanese Population

by I-Han Hsiao, Shao-Yun Hsu, Mei-Chen Lin and Pin-Keng Shih

J. Clin. Med. 2021, 10(22), 5377; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10225377 - 18 Nov 2021

Viewed by 1348

Abstract

Few studies have discussed the development of post-traumatic headache (PTH) after zygoma fracture. This research aimed to examine the association between zygoma fracture and PTH and its other associated factors. A total of 3043 patients with zygoma fracture and 3043 patients with non-fracture were included in this analysis. They were matched to a non-fracture cohort from the National Health Insurance database according to age, sex, and index year. The incidence of PTH and its association with zygoma fracture were assessed. The zygoma fracture cohort had a significantly higher cumulative incidence of PTH than the non-fracture cohort in a 10-year follow-up. The confounding risk factors of PTH included zygoma fracture, female sex, and comorbidities, including obesity and depression. Female patients under 40 years old who had zygoma fractures had a higher incidence of PTH than the non-fracture group. Moreover, patients with zygoma fractures commonly developed PTH within three months after injury. Female patients under 40 years old with precedent zygoma fractures had a higher incidence rate of PTH than those without fractures. Moreover, patients with zygoma fractures commonly developed PTH within three months after injury. Nevertheless, before widely applying our results, a prospective study must be conducted to verify the risk factors found in this study. Full article

(This article belongs to the Special Issue Prevention and Acute Treatment of Migraine)

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8 pages, 811 KiB

Open AccessArticle

Real-Life Analysis with Erenumab: First Target Therapy in the Episodic and Chronic Migraine’s Prophylaxis

by Zaira Maraia, Diletta Ricci, Marco Bruno Luigi Rocchi, Alessandro Moretti, Celestino Bufarini, Arturo Cavaliere and Manola Peverini

J. Clin. Med. 2021, 10(19), 4425; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10194425 - 27 Sep 2021

Cited by 7 | Viewed by 1958

Abstract

Background: to research retrospectively the efficacy of Erenumab’s treatment, thus allowing to describe a summary more in line with the reality observed every day in clinical practice, relative to a sample of patients widely heterogeneous. The study aims to confirm the efficacy of Erenumab, in terms of reduction of migraine days per month, from baseline to month 12 of treatment. Additional objectives included a reduction in the number of days of symptomatic drug use and change from baseline in the Migraine Disability Assessment Score Questionnaire (MIDAS); Methods: the analysis included all patients treated for 12 months with Erenumab during the year 2019–2020. The population analyzed consists of twenty-six patients from the Neurology outpatient clinic in Fossombrone. Several quantitative and qualitative variables were recorded by reading the medical records of the patients. The MIDAS was administered to patients to assess the disability related to migraine; Results: at the end of treatment, a statistically significant reduction in the mean number of monthly migraine days, acute medication use per month, and MIDAS questionnaire score was observed; Conclusions: as a preventive treatment of episodic and chronic migraine, our analysis data confirm the efficacy of Erenumab for the prevention of the migraine. The success is achieved in 96% of cases. Full article

(This article belongs to the Special Issue Prevention and Acute Treatment of Migraine)

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9 pages, 846 KiB

Open AccessArticle

Association between Arthritis and Migraine: A US Nationally Representative Study Including 2649 Adults

by Louis Jacob, Jae Il Shin, Guillermo F. López-Sánchez, Josep Maria Haro, Ai Koyanagi, Jong Yeob Kim, Jae Han Kim, Hans Oh and Lee Smith

J. Clin. Med. 2021, 10(2), 342; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10020342 - 18 Jan 2021

Cited by 3 | Viewed by 2641

Abstract

This study aimed to investigate the cross-sectional association between arthritis and migraine in a large representative sample of the US adult population. The study used data from adults who participated in the RAND American Life Panel (ALP). Arthritis (excluding rheumatoid arthritis) and migraine were self-reported. Control variables included sex, age, ethnicity, marital status, education, employment, annual family income, stroke, epilepsy, coronary artery disease, asthma, depression, anxiety, bipolar disorder, and alcohol dependence. The association between arthritis and migraine was investigated using multivariable logistic regression models, while sex and age interaction analyses were also conducted. This study included 2649 adults (51.7% women; mean (SD) age 50.6 (15.9 years). The prevalence of migraine was 10.7% in the sample. After adjusting for several potential confounders, there was a significant association between arthritis and migraine (OR = 1.83, 95% CI = 1.20–2.81). Further sensitivity analyses revealed that the association was significant in women, adults aged ≤45 years, and those aged >65 years. The mere fact that arthritis and migraine may coexist is problematic, as this could lead to an important medical and economic burden. Therefore, strategies should be implemented to reduce the cooccurrence of these two chronic conditions. Full article

(This article belongs to the Special Issue Prevention and Acute Treatment of Migraine)

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Review

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11 pages, 280 KiB

Open AccessReview

New Generation Gepants: Migraine Acute and Preventive Medications

by David Moreno-Ajona, María Dolores Villar-Martínez and Peter J. Goadsby

J. Clin. Med. 2022, 11(6), 1656; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11061656 - 16 Mar 2022

Cited by 34 | Viewed by 5929

Abstract

Migraine is a debilitating disease whose clinical and social impact is out of debate. Tolerability issues, interactions, contraindications, and inefficacy of the available medications make new options necessary. The calcitonin-gene-related peptide (CGRP) pathway has shown its importance in migraine pathophysiology and specific medications targeting this have become available. The first-generation CGRP receptor antagonists or gepants, have undergone clinical trials but their development was stopped because of hepatotoxicity. The new generation of gepants, however, are efficacious, safe, and well tolerated as per recent clinical trials. This led to the FDA-approval of rimegepant, ubrogepant, and atogepant. The clinical trials of the available gepants and some of the newer CGRP-antagonists are reviewed in this article. Full article

(This article belongs to the Special Issue Prevention and Acute Treatment of Migraine)

9 pages, 462 KiB

Open AccessReview

Clinical Evidence of Cannabinoids in Migraine: A Narrative Review

by Flavia Lo Castro, Carlo Baraldi, Lanfranco Pellesi and Simona Guerzoni

J. Clin. Med. 2022, 11(6), 1479; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11061479 - 8 Mar 2022

Cited by 6 | Viewed by 2961

Abstract

The endocannabinoid system (ECS) influences many biological functions, and hence, its pharmacological modulation may be useful for several disorders, such as migraine. Preclinical studies have demonstrated that the ECS is involved in the modulation of trigeminal excitability. Additionally, clinical data have suggested that an endocannabinoid deficiency is associated with migraine. Given these data, phytocannabinoids, as well as synthetic cannabinoids, have been tried as migraine treatments. In this narrative review, the current clinical evidence of potential ECS involvement in migraine pathogenesis is summarized. Furthermore, studies exploring the clinical effects of phytocannabinoids and synthetic cannabinoids on migraine patients are reviewed. Full article

(This article belongs to the Special Issue Prevention and Acute Treatment of Migraine)

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11 pages, 260 KiB

Open AccessReview

Non-Invasive Neurostimulation Methods for Acute and Preventive Migraine Treatment—A Narrative Review

by Stefan Evers

J. Clin. Med. 2021, 10(15), 3302; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10153302 - 27 Jul 2021

Cited by 11 | Viewed by 3056

Abstract

Neurostimulation methods have now been studied for more than 20 years in migraine treatment. They can be divided into invasive and non-invasive methods. In this narrative review, the non-invasive methods are presented. The most commonly studied and used methods are vagal nerve stimulation, electric peripheral nerve stimulation, transcranial magnetic stimulation, and transcranial direct current stimulation. Other stimulation techniques, including mechanical stimulation, play only a minor role. Nearly all methods have been studied for acute attack treatment and for the prophylactic treatment of migraine. The evidence of efficacy is poor for most procedures, since no stimulation device is based on consistently positive, blinded, controlled trials with a sufficient number of patients. In addition, most studies on these devices enrolled patients who did not respond sufficiently to oral drug treatment, and so the role of neurostimulation in an average population of migraine patients is unknown. In the future, it is very important to conduct large, properly blinded and controlled trials performed by independent researchers. Otherwise, neurostimulation methods will only play a very minor role in the treatment of migraine. Full article

(This article belongs to the Special Issue Prevention and Acute Treatment of Migraine)

13 pages, 1212 KiB

Open AccessReview

OnabotulinumtoxinA in Migraine: A Review of the Literature and Factors Associated with Efficacy

by Jason C. Ray, Elspeth J. Hutton and Manjit Matharu

J. Clin. Med. 2021, 10(13), 2898; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10132898 - 29 Jun 2021

Cited by 13 | Viewed by 5524

Abstract

The efficacy of onabotulinumtoxinA (OnaB-A) as a preventative treatment for chronic migraine, emerging fortuitously from clinical observation is now supported by class one evidence and over two decades of real-world clinical data. There is still limited ability to predict a clinically meaningful response to OnaB-A for individual patients, however. This review summarises briefly the proposed mechanism of OnaB-A in chronic migraine, the literature of predictors of clinical response, and recent developments in the field. Full article

(This article belongs to the Special Issue Prevention and Acute Treatment of Migraine)

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20 pages, 839 KiB

Open AccessReview

Nasal Delivery of Acute Medications for Migraine: The Upper Versus Lower Nasal Space

by Vincent Martin, John Hoekman, Sheena K. Aurora and Stephen B. Shrewsbury

J. Clin. Med. 2021, 10(11), 2468; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10112468 - 2 Jun 2021

Cited by 19 | Viewed by 6419

Abstract

The acute treatment of migraine requires effective drugs that are well tolerated and provide rapid and consistent pain relief. Oral tablets are the most commonly used acute treatment for migraine; however, their effectiveness is limited by the rate of gastrointestinal (GI) tract absorption and first-pass hepatic metabolism, and they may not be ideal for patients experiencing GI motility issues. Nasal delivery is an attractive alternative route as it may circumvent GI tract absorption, avoid first-pass metabolism in the liver, and potentially reduce the frequency of GI adverse events. The large surface area and high vascularity within the nose may permit rapid absorption of therapeutics into the systemic circulation, allowing for rapid onset of action. However, the site of drug deposition (upper versus lower nasal cavity) may influence drug pharmacokinetics. Most approved nasal migraine therapies target the lower nasal space where the epithelium is less permeable, and they may be quickly cleared away due to increased ciliary function or dripping from the nose or swallowing, resulting in variable absorption and limited bioavailability. Together with its abundant vascularization, relative mucosal thickness stability, and low clearance rates, the upper nasal space harnesses the benefits of nasal delivery to potentially maximize drug efficacy. Full article

(This article belongs to the Special Issue Prevention and Acute Treatment of Migraine)

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16 pages, 1948 KiB

Open AccessReview

Acute and Preventive Management of Migraine during Menstruation and Menopause

by Raffaele Ornello, Eleonora De Matteis, Chiara Di Felice, Valeria Caponnetto, Francesca Pistoia and Simona Sacco

J. Clin. Med. 2021, 10(11), 2263; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10112263 - 24 May 2021

Cited by 9 | Viewed by 8773

Abstract

Migraine course is influenced by female reproductive milestones, including menstruation and perimenopause; menstrual migraine (MM) represents a distinct clinical entity. Increased susceptibility to migraine during menstruation and in perimenopause is probably due to fluctuations in estrogen levels. The present review provides suggestions for the treatment of MM and perimenopausal migraine. MM is characterized by long, severe, and poorly treatable headaches, for which the use of long-acting triptans and/or combined treatment with triptans and common analgesics is advisable. Short-term prophylaxis with triptans and/or estrogen treatment is another viable option in women with regular menstrual cycles or treated with combined hormonal contraceptives; conventional prevention may also be considered depending on the attack-related disability and the presence of attacks unrelated to menstruation. In women with perimenopausal migraine, hormonal treatments should aim at avoiding estrogen fluctuations. Future research on migraine treatments will benefit from the ascertainment of the interplay between female sex hormones and the mechanisms of migraine pathogenesis, including the calcitonin gene-related peptide pathway. Full article

(This article belongs to the Special Issue Prevention and Acute Treatment of Migraine)

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Other

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7 pages, 1503 KiB

Open AccessCase Report

Could the New Anti-CGRP Monoclonal Antibodies Be Effective in Migraine Aura? Case Reports and Literature Review

by Maria Albanese and Nicola Biagio Mercuri

J. Clin. Med. 2022, 11(5), 1228; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11051228 - 24 Feb 2022

Cited by 12 | Viewed by 2483

Abstract

Recently, monoclonal antibodies (mAbs) directed against calcitonin gene-related peptide (CGRP) (Eptinezumab, Fremanezumab, and Galcanezumab) or its receptor (Erenumab) have been approved for clinical use as prophylactic drugs for high-frequency episodic and chronic migraine. While their therapeutic effects on headache pain is well documented, there is scarce information on the usefulness of these medications in preventing migraine aura, which is believed to be associated with cortical spreading depression (CSD). Because of their large size, mAbs cannot easily cross the blood–brain barrier in high quantities, rendering the peripheral trigeminovascular system to likely be a major site of their action. In this paper, we report two cases of patients suffering from migraine with and without aura, who reported a complete disappearance of aura or reduced aura duration and intensity while taking Galcanezumab or Erenumab, respectively. Then, we present a brief overview of the literature about the controversial relationship between CSD and CGRP and about the potential “additional central” role of these mAbs in the pathophysiology of migraine aura. Full article

(This article belongs to the Special Issue Prevention and Acute Treatment of Migraine)

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