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3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache
Published on: June 2, 2014
Chronic migraine: current concepts and ongoing treatments
A Negro1, M Rocchietti-March, M Fiorillo
1Department of Medical and Molecular Sciences, Internal Medicine and Regional Referral Headache Centre, School of Health Sciences, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
Abstract:
Migraine is an episodic painful disorder occasionally developing into a chronic form. Such disorder represents one of the most common neurological diseases in clinical practice. Chronicization is often accompanied by the appearance of acute drugs overuse. Chronic migraine (CM) constitutes migraine's natural evolution in its chronic form and involves headache frequency of 15 days/month, with features similar to those of migraine attacks. Medication Overuse Headache (MOH) has been defined as a headache present on > or = 15 days/month, with regular overuse for > 3 months of one or more drugs used for acute and/or symptomatic headache management. Subtypes of MOH attributed to different medications were delineated. Misuse of ergots, triptans, opioids or combination analgesics on > or = 10 days/month was required to make the diagnosis of MOH, while > or = 15 days/month were needed for simple analgesic-overuse headache. CM's low prevalence produces an extremely high disability grade. Therefore, special attention should be paid to both control and reduction of risk factors which might favour the migraine chronicization process and/or the outbreak of MOH. In MOH sufferers, the only treatment of choice is represented by drug withdrawal. Successful detoxification is necessary to ensure improvement in the headache status when treating patients who overuse acute medications. Different procedures have been suggested for withdrawal namely at home, at the hospital, with or without the use of steroids, with re-prophylaxis performed immediately or at the end of the washout period. At the moment we have not a total agreement whether prophylactic treatment should be started before, during, or after discontinuation of the overuse drug. Both drugs have been approved for CM treatment in view of their well-defined resistance to previous prophylaxis drugs. Recently, the PREEMPT clinical program has confirmed onabotulinumtoxinA as an effective, safe, and well-tolerated prophylactic treatment for adults with CM.
Insights
Chronic migraine (CM) can evolve from episodic migraine and is often linked to acute medication overuse, leading to Medication Overuse Headache (MOH). OnabotulinumtoxinA is a proven prophylactic treatment for CM.
Area of Science:
- Neurology
- Clinical Practice
Background:
- Migraine is a common neurological disorder that can become chronic, often leading to acute drug overuse and Medication Overuse Headache (MOH).
- Chronic migraine (CM) is defined by headache frequency of 15 days/month, resembling migraine attacks.
- Medication Overuse Headache (MOH) involves headaches on ≥15 days/month due to regular overuse of acute headache medications for over 3 months.
Purpose of the Study:
- To discuss the evolution of migraine into chronic forms and the associated risk factors.
- To highlight the importance of drug withdrawal in managing Medication Overuse Headache (MOH).
- To review treatment options for chronic migraine (CM), including the role of onabotulinumtoxinA.
Main Methods:
- Review of the pathophysiology and clinical presentation of chronic migraine and MOH.
- Discussion of various drug withdrawal strategies for MOH.
- Evaluation of prophylactic treatments for CM, focusing on onabotulinumtoxinA.
Main Results:
- Chronicization of migraine is associated with increased headache frequency and acute drug overuse.
- Drug withdrawal is the primary treatment for MOH, with various methods available.
- OnabotulinumtoxinA has demonstrated efficacy, safety, and tolerability as a prophylactic treatment for CM.
Conclusions:
- Effective management of CM and MOH requires addressing risk factors and implementing appropriate withdrawal strategies.
- OnabotulinumtoxinA is an approved and effective prophylactic treatment for adults with chronic migraine.
- Further research is needed to optimize the timing of prophylactic treatment initiation during drug withdrawal.
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