Annals Of Headache Medicine Journal最新文献

{"title":"Combined Prophylaxis of Chronic Migraine with OnabotulinumtoxinA and Anti-CGRP Antibodies","authors":"Audrey Blazek","doi":"10.30756/ahmj.2023.11.01","DOIUrl":"https://doi.org/10.30756/ahmj.2023.11.01","url":null,"abstract":"Objective: To evaluate the efficacy of adding large molecule anti-calcitonin gene-related peptide monoclonal antibodies (mAbs) to onabotulinumtoxinA (OBT-A) for chronic migraine prevention.\u0000Background: Chronic migraine (CM) is a highly prevalent, debilitating disorder that leads to personal, social, and economic burdens. Both OBT-A and mAbs are proven safe and effective in chronic migraine prevention. The use of combination therapy has not been formally studied but may prove more effective than either monotherapy alone in select patients.\u0000Methods: This is a retrospective chart review of patients with chronic migraine, treated with OBT-A, who received additional mAb preventative therapy. The primary endpoint was migraine headache days per month (MHD) after 3 months of combined therapy. Secondary endpoints included total headache days per month, headache intensity, disability level, and use of abortive medications.\u0000Results: Of 1503 patients reviewed, 133 met inclusion criteria. At 3 months of combined therapy, mean reduction of MHD from baseline was 6.2 (95% CI 4.91 to 7.49, p < 0.0001). Nearly 2/3rd of patients (60.9%) experienced ≥ 50% MHD reduction. Fewer patients reported high disability level (14.6% [17/126], compared to 29.4%) and high headache intensity (13.0% [16/119], compared to 51.3%) at 3 months (all p < 0.0001). A reduction in abortive medication doses needed and discontinuation of concomitant oral preventative medications was also noted in 15.8% and 6.8% of patients, respectively. \u0000Conclusions: Combined therapy with OBT-A and mAbs is well-tolerated, effective in further reducing migraine frequency, and may improve quality of life for patients with CM refractory to monotherapy.","PeriodicalId":131981,"journal":{"name":"Annals Of Headache Medicine Journal","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128895314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketamine Applications for Migraines: A Scoping Narrative Review","authors":"Peter D Vu","doi":"10.30756/ahmj.2023.10.01","DOIUrl":"https://doi.org/10.30756/ahmj.2023.10.01","url":null,"abstract":"In the United States alone, nearly 40 million children and adults suffer from migraines, which are the primary cause of morbidity, quality of life reduction, and loss of productivity for persons aged 15-49. Despite their global prevalence and various available treatment options, these disabilities are often still under-treated due to the individuality of treatment regimens and effect profiles. Compelling arguments have been made for ketamine use in opioid-sparing pain management. An increase in opioid stewardship, especially during the outbreak of the novel COVID-19, has only accentuated arguments for ketamine in migraine alleviation. However, within the last 20 years, the overall body of work addressing its role has not been clearly elucidated, with variations in optimal dosage and administration routes. Thus, this review aims to consolidate previous findings of ketamine as a migraine analgesic agent and to amass the most recent burgeoning data on its effectiveness in clinical settings. A comparison of intravenous, intranasal, and subcutaneous ketamine is examined, with a discussion on pharmacology, pharmacokinetics, and results in pain outcomes analyzed.","PeriodicalId":131981,"journal":{"name":"Annals Of Headache Medicine Journal","volume":" 18","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132187178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Botulinum Toxin: Treatment for Refractory Chronic Migraine and Red Ear Syndrome","authors":"A. Tolebeyan","doi":"10.30756/ahmj.2022.09.03","DOIUrl":"https://doi.org/10.30756/ahmj.2022.09.03","url":null,"abstract":"Objectives: The objective of this case report is to discuss botulinum toxin as a treatment for Red Ear Syndrome (RES) and refractory chronic migraine, as well as provide a brief overview of possible RES etiologies.\u0000\u0000Background: Because RES presents with several conditions, its pathophysiology and treatment options are difficult to define. Given their similar clinical presentations, RES may be an auricular subtype of erythromelalgia. Additionally, RES presents consistently with chronic migraine. Botulinum toxin has been proven an effective medication for erythromelalgia and refractory migraine, and it may be just as useful for RES.\u0000\u0000Results: This paper reports one case of a patient who presented with chronic migraine with aura and unilateral RES. This patient failed several treatment options, and the most recent regimen only reduced the intensity of migraine attacks. With the addition of botulinum toxin, both chronic migraine and RES symptoms were mitigated.\u0000\u0000Conclusion: While a definitive treatment for RES has not been determined, a promising option for patients with concomitant chronic migraine may be botulinum toxin.","PeriodicalId":131981,"journal":{"name":"Annals Of Headache Medicine Journal","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126834047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Surgical CSF leak with Inconclusive Diagnostic Studies: A Case Report","authors":"A. Tolebeyan","doi":"10.30756/ahmj.2022.09.02","DOIUrl":"https://doi.org/10.30756/ahmj.2022.09.02","url":null,"abstract":"Objectives: To report a case with post-surgical intracranial hypotension and inconclusive diagnostic findings.\u0000\u0000Background: The diagnosis of spontaneous intracranial hypotension is based on positive neuroimaging findings and/or low CSF pressure on spinal tap. Despite this conventional definition, cases with normal CSF pressure have also been reported.\u0000\u0000Results: This report explains a patient with post-surgical CSF leak, normal CSF opening pressure, and unremarkable imaging studies that responded well to the surgical repair. \u0000\u0000Conclusion: Our case challenges the conventional diagnostic criteria of spontaneous intracranial hypotension. We suggest that clinical judgment should be considered in regard to the diagnosis of spontaneous intracranial hypotension.","PeriodicalId":131981,"journal":{"name":"Annals Of Headache Medicine Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131314815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intermediate Cervical Plexus Block (ICPB) In Refractory Chronic Daily Headache After Whiplash: Prospective Audit In 43 Patients","authors":"G. Niraj","doi":"10.30756/ahmj.2022.08.01","DOIUrl":"https://doi.org/10.30756/ahmj.2022.08.01","url":null,"abstract":"Background: Chronic daily headache can develop or pre-existing episodic headache can worsen after whiplash and is termed persistent headache attributed to whiplash. It can be a therapeutic challenge and often results in severe disability. The objective was to assess the management of patients with refractory secondary chronic daily headache referred to a pain physician in consideration for greater occipital nerve block.\u0000\u0000Methods: Prospective service evaluation in adult patients with oro-facial pain and headaches. Patients underwent specialist neurology review and analgesic overuse headache was excluded. Patients with chronic daily headache with a past history of neck trauma were included. Cervical facet joint dysfunction and intracranial pathology were excluded. An initial cohort of 27 patients received occipital nerve block without benefit. Subsequently, all patients were offered ultrasound guided intermediate cervical plexus block with local anesthetic and steroid mixture. Four-week headache diary, Brief Pain Inventory-Short Form and Hospital Anxiety Depression Scale questionnaires were completed at baseline and three months post-intervention.\u0000\u0000Results: Over a 41-month period, 43 patients were reviewed. The first 27 patients (27/43, 63%) reported no benefit with occipital nerve block. Subsequently, patients were offered intermediate cervical plexus block(s). Four patients refused. Thirty-nine patients received the intervention. Thirty-two patients (32/39, 82%) reported significant reduction in headache frequency and intensity at three months. Failure rate was 18% (7/39).\u0000\u0000Conclusion: The cervical plexus could play a significant role in the development or worsening of pre-existing headache after whiplash. Intermediate cervical plexus block may have a role in the management of refractory chronic daily headache following whiplash injury.","PeriodicalId":131981,"journal":{"name":"Annals Of Headache Medicine Journal","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114920469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Of Probable Paroxysmal Hemicrania Mistaken For Cervicogenic Headache","authors":"Leith Hobbs","doi":"10.30756/ahmj.2022.09.01","DOIUrl":"https://doi.org/10.30756/ahmj.2022.09.01","url":null,"abstract":"Objectives: To describe a unique case of probable paroxysmal hemicrania which was mistaken for cervicogenic headache and to investigate reasons for misdiagnosis, which includes imperfect diagnostic criteria, unique pathophysiology, and inadequate headache education in the field of pain medicine.\u0000\u0000Case report: We present a sixty-six-year-old female with multiple disorders of the cervical spine and a two-year history of left-sided neck pain and headache. She was seen by multiple specialists and originally assumed to have cervicogenic headache. She did not respond to conservative measures or medial branch block. Ultimately, she was suspected to have paroxysmal hemicrania, despite her not having obvious autonomic features. She obtained complete relief with indomethacin.\u0000\u0000Conclusions: Trigeminal autonomic cephalalgias such as paroxysmal hemicrania and hemicrania continua can be mistaken for cervicogenic headache. The diagnostic criteria for cervicogenic headache should be better defined. Cervicogenic headache and the trigeminal autonomic cephalalgias, including paroxysmal hemicrania, can refer pain to various areas of the head and neck.1-4 This occurs via convergent afferent fibers and the trigeminocervical complex. 5-7 This overlapping symptomatology and pathophysiology explains how misdiagnosis of certain headache disorders can occur. Lastly, it is imperative that pain medicine providers have adequate training in headache medicine.","PeriodicalId":131981,"journal":{"name":"Annals Of Headache Medicine Journal","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125642563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comorbid Depression Among Patients with Migraine in Low Resource Setting","authors":"M. Ali","doi":"10.30756/ahmj.2022.07.02","DOIUrl":"https://doi.org/10.30756/ahmj.2022.07.02","url":null,"abstract":"Background and objectives: Migraine is commonly associated with psychiatric comorbidities, especially in developed countries. Herein, we investigated the burden of comorbid depression and associated factors among patients with migraine (PWM) in low resource setting. Methods: This was a hospital-based cross-sectional study of PWM conducted at Federal Neuropsychiatric Hospital (FNPH) Maiduguri. Consenting participants with known migraine on follow up visits were consecutively recruited. Depressive symptoms were ascertained using the Beck’s Depression Inventory (BDI), while the impact of migraine was assessed using the Headache Impact Test-6 (HIT-6) questionnaire. Multivariate regression analysis was done to determine independent factors associated with depression among migraineurs. Results: The study constituted 165 PWM. Participants were predominantly females (72.1%) and the mean age of the participants was 29.6 ± 9.6, with age range of 17-55 years. About 46% of migraineurs had mild to no impact, while 37.6% of the participants had severe headache impact. Increased migraine impact was associated with: female gender (P<0.037), migraine with aura (P<0.001), chronic migraine (P<0.001), photophobia (P<0.001), and poor utilization of prophylactic drugs (P<0.014). Forty-five percent of the participants had varying degrees of depression among which the majority (43.4%) had mild, 19.6% moderate, 14.3% severe, and 1.79% had extreme comorbid depression. Factors associated with depression were: female gender, migraine with aura, chronic migraine, photophobia, utilization of migraine prophylactic drugs, and impactful migraine all with P≤0.001. We found a strong positive linear relationship between headache impact and depression (r=0.76, P<0.001). On multivariate analysis, males had 76.3% less likelihood of being depressed [95% confidence interval (CI) of (0.068-0.828)] compared with their female counterparts. Increasing migraine impact was also significantly (P<0.05) associated with depression. Those with no impact, mild impact, and substantial impact of migraine had 97.4%, 97.1%, and 88.4% less likelihood of being depressed compared to those with severe impact with 95% CI (0.004-0.159), (0.006-0.148)], and (0.029-0.463)] respectively. Conclusion: We found a high prevalence of comorbid depression among PWM in our environment with inadequate utilization of treatment contributing to both the burden of migraine and depression.","PeriodicalId":131981,"journal":{"name":"Annals Of Headache Medicine Journal","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122942417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prolonged Post Traumatic Headache after Repetitive Sports Related Concussions","authors":"Liza Smirnoff","doi":"10.30756/ahmj.2022.07.01","DOIUrl":"https://doi.org/10.30756/ahmj.2022.07.01","url":null,"abstract":"Background: Human and animal studies have shown evidence of pathological brain changes as well as increased cognitive dysfunction with repetitive injury.\u0000\u0000Case Presentation: We present a case of prolonged persistent post concussive symptoms after a mild concussion, in the setting of multiple prior concussions. In this case a 29-year-old man presented for a moderate persistent daily headache for one month after a minor injury due to a branch hitting his helmet while mountain biking. He had previously sustained one non-sports related concussion with loss of consciousness as well as at least two other sports related concussions in the past five years which caused one-to-two-week intervals of headaches and dizziness. At initial evaluation he reported persistent photosensitivity, difficulty working on screens, as well as intermittent lightheadedness, insomnia, irritability, anxiety, and anhedonia. Symptoms of headache completely resolved over the course of three months with serotonin norepinephrine reuptake inhibitors (SSRI) management, but he reported some persistent anxiety and depressive symptoms.\u0000\u0000Conclusion: This case report highlights the long-term impact as well as the need for more specific return to activity guidelines for patients with multiple prior concussions.","PeriodicalId":131981,"journal":{"name":"Annals Of Headache Medicine Journal","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121993048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication-Overuse Headache: Results from a Pain Medicine Clinic Cohort","authors":"L. Moskatel","doi":"10.30756/ahmj.2021.06.03","DOIUrl":"https://doi.org/10.30756/ahmj.2021.06.03","url":null,"abstract":"Background and Objective: Medication-overuse headache (MOH) is a common, disabling, and treatable cause of chronic daily headache. This study evaluates the characteristics of a cohort of patients with MOH seen in a pain medicine clinic.\u0000\u0000Methods: We conducted a retrospective study of consecutive patients seen by a neurologist in the pain medicine clinic at the University of California, San Diego. Demographics, headache diagnoses, and overused medications were extracted from clinical records from 83 patients ≥ 18 years of age where a diagnosis of MOH was entered into the electronic medical record September 12, 2017-March 30, 2020.\u0000\u0000Results: Opioids were the most overused medications (42/83, 50.6%) followed by caffeine-containing compounds (20/83, 24.1%), triptans (12/83, 14.5%) and non-steroidal anti-inflammatory drugs (10/83, 12.9%). Chronic migraine was the most common underlying headache syndrome (54/83, 65.1%), followed by secondary headache disorder (13/83, 15.7%) and tension-type headache (8/83, 9.6%). Men were more likely to be overusing opioids (OR 3.3, p = 0.026) while women were more likely to be overusing caffeine-containing compounds (OR 5.4, p = 0.041).\u0000\u0000Discussion and Conclusions: It is crucial for pain specialists to recognize MOH in the pain clinic setting. Opioid overuse headache is more common among men, likely in part due to migraine being underrecognized in men and therefore men not receiving migraine-specific medications. Caffeine-containing compound overuse is more common among women; these are over-the-counter (OTC) and often do not appear on patients’ medications lists. Pain specialists should specifically ask patients with headache whether they are using OTC caffeine-containing compounds.","PeriodicalId":131981,"journal":{"name":"Annals Of Headache Medicine Journal","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122601527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Human Factors Study Exploring the Experience of Participants Using VEGA, a Smartphone Migraine Management Application","authors":"B. Vargas","doi":"10.30756/ahmj.2021.06.02","DOIUrl":"https://doi.org/10.30756/ahmj.2021.06.02","url":null,"abstract":"Background and objectives: There is increasing interest by patients and healthcare providers in using digital tools such as smartphone applications to log migraine days, potential triggers and medication use. However, there are opportunities to optimize the learnability and ease of use of these applications. In this human factors study, we evaluated the experience of individuals with migraine using the VEGA mobile application. \u0000\u0000Material and methods: For 4 weeks, individuals diagnosed with migraine used the VEGA application, which generated a migraine report containing 4 weeks of data, where migraine days were reported based on functional impact, pain severity, and medication use. Participants also responded to a survey and rated the ease of use of the application using a 6-point Likert scale, with “very easy” being the highest ranking.\u0000Results: A total of 22 participants completed this study, ranged between 22 to 57 years old, and 54% were males. Eighteen participants completed the migraine report and logged 160 total migraine days. Participants reported the functional impact of migraine as \"mild,\" \"moderate,\" or \"severe\" for respectively 2, 44, and 50 of the logged migraine days. The pain severity was scored as “mild” for 24 days, “moderate” for 65 days, and “severe” for 63 days. Moreover, 20 participants reported it was “easy” or “very easy” to learn how to use the application, and 19 participants found it “simple” or “extremely simple” to use.\u0000\u0000Conclusions: In this human factors study, the VEGA application was easy to use, providing real-time patient-reported data.","PeriodicalId":131981,"journal":{"name":"Annals Of Headache Medicine Journal","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133122814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}