17 research outputs found
Novas opçÔes para o tratamento preventivo da migrùnea: revisão com consideraçÔes fisiopatológicas
BACKGROUND: The pharmacological treatment of migraine may be acute or preventive. Frequent, severe and long-lasting migraine attacks require prophylaxis. Multiple threads of research over the last 15 years have led to the concept that migraine is generated from a hyperexcitable brain. A variety of causes for hyperexcitability of the brain in migraine have been suggested. These causes include low cerebral magnesium levels, mitochondrial abnormalities, dysfunctions related to increased nitric oxide or the existence of a P/Q type calcium channelopathy. The better knowledge about migraine pathophisiology led us to discuss new treatment options. OBJECTIVES: The aim of the present study is to present an evidence-based review of some new drugs or some agents that even though available for a long time, are not frequently used. METHODS/RESULTS: We present a review of anticonvulsants with various mechanisms of action such as lamotrigine, gabapentin, topiramate, tiagabine, levetiracetam and zonisamide. We also review natural products, like riboflavin and magnesium, botulinum toxin A, a specific CGRP antagonist and the anti-asthma medication montelukast, with pathophysiological discussion. CONCLUSIONS: We aimed to present an update of newer or less frequently used preventive migraine therapies, drugs that might reduce the burden and the costs of a disease that should be considered as a public health problem all around the world.INTRODUĂĂO: O tratamento farmacolĂłgico da migrĂąnea pode ser dividido em agudo e preventivo. Crises de migrĂąnea severas, de longa duração e incapacitante requerem profilaxia. MĂșltiplas linhas de pesquisa ao longo dos Ășltimos 15 anos sedimentaram o conceito de que a migrĂąnea Ă© gerada a partir de um cĂ©rebro hiperexcitĂĄvel. Variadas causas para essa hiperexcitabilidade tĂȘm sido sugeridas e incluem baixo nĂvel de magnĂ©sio cerebral, anormalidades mitocondriais, disfunçÔes relacionadas ao Ăłxido nĂtrico e a existĂȘncia de distĂșrbios nos canais de cĂĄlcio do tipo P/Q. O melhor conhecimento sobre a fisiopatologia da migrĂąnea nos permite discutir novas opçÔes terapĂȘuticas. OBJETIVOS: O objetivo do presente estudo Ă© apresentar revisĂŁo baseada em evidĂȘncias de novos agentes e outros que, embora disponĂveis hĂĄ mais tempo, nĂŁo sĂŁo freqĂŒentemente utilizados, com consideraçÔes fisiopatolĂłgicas. MĂTODOS/RESULTADOS: SerĂŁo revistos anticonvulsivantes com vĂĄrios mecanismos de ação, como gabapentina, lamotrigina, topiramato, tiagabina, levetiracetam e zonisamida. SerĂŁo revistos tambĂ©m produtos naturais, como riboflavina e magnĂ©sio, toxina botulĂnica do tipo A, um antagonista CGRP especĂfico e uma nova opção para o tratamento da asma, o montelukast. CONCLUSĂES: Objetivamos apresentar artigo de atualização em opçÔes novas ou nĂŁo freqĂŒentemente utilizadas no tratamento preventivo da migrĂąnea, drogas que podem reduzir o fardo e os custos de uma doença que deve ser considerada um problema de saĂșde pĂșblica em todo o mundo
Favorable outcome of early treatment of new onset child and adolescent migraine-implications for disease modification.
There is evidence that the prevalence of migraine in children and adolescents may be increasing. Current theories of migraine pathophysiology in adults suggest activation of central cortical and brainstem pathways in conjunction with the peripheral trigeminovascular system, which ultimately results in release of neuropeptides, facilitation of central pain pathways, neurogenic inflammation surrounding peripheral vessels, and vasodilatation. Although several risk factors for frequent episodic, chronic, and refractory migraine have been identified, the causes of migraine progression are not known. Migraine pathophysiology has not been fully evaluated in children. In this review, we will first discuss the evidence that early therapeutic interventions in the child or adolescent new onset migraineur, may halt or limit progression and disability. We will then review the evidence suggesting that many adults with chronic or refractory migraine developed their migraine as children or adolescents and may not have been treated adequately with migraine-specific therapy. Finally, we will show that early, appropriate and optimal treatment of migraine during childhood and adolescence may result in disease modification and prevent progression of this disease
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Favorable outcome of early treatment of new onset child and adolescent migraine-implications for disease modification.
There is evidence that the prevalence of migraine in children and adolescents may be increasing. Current theories of migraine pathophysiology in adults suggest activation of central cortical and brainstem pathways in conjunction with the peripheral trigeminovascular system, which ultimately results in release of neuropeptides, facilitation of central pain pathways, neurogenic inflammation surrounding peripheral vessels, and vasodilatation. Although several risk factors for frequent episodic, chronic, and refractory migraine have been identified, the causes of migraine progression are not known. Migraine pathophysiology has not been fully evaluated in children. In this review, we will first discuss the evidence that early therapeutic interventions in the child or adolescent new onset migraineur, may halt or limit progression and disability. We will then review the evidence suggesting that many adults with chronic or refractory migraine developed their migraine as children or adolescents and may not have been treated adequately with migraine-specific therapy. Finally, we will show that early, appropriate and optimal treatment of migraine during childhood and adolescence may result in disease modification and prevent progression of this disease