Zastosowanie blokad, kannabinoidów i metod pozafarmakologicznych w leczeniu migreny

Działania niepożądane, interakcje lekowe, a także farmakooporność mogą w znacznym stopniu utrudniać farmakologiczne leczenie migreny. W związku z tym coraz częściej stosuje się niekonwencjonalne i niefarmakologiczne metody leczenia. W szczególności nieinwazyjna neuromodulacja, blokady nerwów obwodowych, nutraceutyki i metody behawioralne są dobrze tolerowane i wskazane dla określonych grup pacjentów, takich jak młodzież, kobiety w ciąży i pacjenci, którzy z różnych powodów muszą lub chcą ograniczyć farmakoterapię. Metody te są coraz częściej postrzegane jako ważna opcja terapeutyczna w leczeniu migreny, konieczne są jednak dalsze badania nad ich skutecznością, także w odniesieniu do efektów długoterminowych, zwłaszcza że skuteczności części metod niekonwencjonalnych (np. kannabinoidów) dotychczas nie zweryfikowano w dobrej jakości badaniach naukowych. Celem pracy jest przedstawienie i omówienie głównych metod wspomagających leczenie farmakologiczne migreny na podstawie aktualnego piśmiennictwa. Słowa kluczowe: migrena, neuromodulacja, nutraceutyki, kannabinoidy, techniki behawioraln

COVID-19-related headache and innate immune response — a narrative review

Headache is one of the most prevalent, although often underreported, symptoms of coronavirus disease 2019 (COVID-19). It is generally accepted that this symptom is a form of secondary headache due to systemic viral infection. There are several hypotheses that try to explain its aetiopathogenesis. One of the most compelling is related to innate immune response to viral infection. This rationale is supported by similarities to other viral infections and the temporal overlap between immunological reactions and headache. Moreover, several key factors in innate immunity have been shown to facilitate headache e.g. interferons, interleukin (IL) –1-β, IL-6, and tumour necrosis factor. There is also a possibility that the virus causes headache by the direct activation of afferents through pattern recognition receptors (i.e. Toll-like receptor 7). Moreover, some data on post COVID-19 headache and after vaccination against SARS-CoV-2 infection suggests a similar cytokine-mediated pathomechanism in these clinical situations. Future research should look for evidence of causality between particular immune response factors and headache. Identifying key molecules responsible for headache during acute viral infection would be an important step towards managing one of the most prevalent secondary headache disorders

Excellent Response to OnabotulinumtoxinA : Different Definitions, Different Predictors

The identification of patients who can benefit the most from the available preventive treatments is important in chronic migraine. We explored the rate of excellent responders to onabotulinumtoxinA in a multicenter European study and explored the predictors of such response, according to different definitions. A pooled analysis on chronic migraineurs treated with onabotulinumtoxinA and followed-up for, at least, 9 months was performed. Excellent responders were defined either as patients with a ≥75% decrease in monthly headache days (percent-based excellent responders) or as patients with <4 monthly headache days (frequency-based excellent responders). The characteristics of excellent responders at the baseline were compared with the ones of patients with a <30% decrease in monthly headache days. Percent-based excellent responders represented about 10% of the sample, whilst frequency-based excellent responders were about 5% of the sample. Compared with non-responders, percent-based excellent responders had a higher prevalence of medication overuse and a higher excellent response rate even after the 1st and the 2nd injection. Females were less like to be frequency-based excellent responders. Chronic migraine sufferers without medication overuse and of female sex may find fewer benefits with onabotulinumtoxinA. Additionally, the excellent response status is identifiable after the first cycle

Headache onset after vaccination against SARS-CoV-2: A systematic literature review and meta-analysis

Background Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are used to reduce the risk of developing Coronavirus Disease 2019 (COVID-19). Despite the significant benefits in terms of reduced risk of hospitalization and death, different adverse events may present after vaccination: among them, headache is one of the most common, but nowadays there is no summary presentation of its incidence and no description of its main features. Methods We searched PubMed and EMBASE covering the period between January 1(st) 2020 and August 6(th), 2021, looking for record in English and with an abstract and using three main search terms (with specific variations): COVID-19/SARS-CoV-2; Vaccination; headache/adverse events. We selected manuscript including information on subjects developing headache after injection, and such information had to be derived from a structured form (i.e. no free reporting). Pooled estimates and 95% confidence intervals were calculated. Analyses were carried out by vaccine vs. placebo, by first vs. second dose, and by mRNA-based vs. "traditional" vaccines; finally, we addressed the impact of age and gender on post-vaccine headache onset. Results Out of 9338 records, 84 papers were included in the review, accounting for 1.57 million participants, 94% of whom received BNT162b2 or ChAdOx1. Headache was generally the third most common AE: it was detected in 22% (95% CI 18-27%) of subjects after the first dose of vaccine and in 29% (95% CI 23-35%) after the second, with an extreme heterogeneity. Those receiving placebo reported headache in 10-12% of cases. No differences were detected across different vaccines or by mRNA-based vs. "traditional" ones. None of the studies reported information on headache features. A lower prevalence of headache after the first injection of BNT162b2 among older participants was shown. Conclusions Our results show that vaccines are associated to a two-fold risk of developing headache within 7 days from injection, and the lack of difference between vaccine types enable to hypothesize that headache is secondary to systemic immunological reaction than to a vaccine-type specific reaction. Some descriptions report onset within the first 24 h and that in around one-third of the cases, headache has migraine-like features with pulsating quality, phono and photophobia; in 40-60% of the cases aggravation with activity is observed. The majority of patients used some medication to treat headache, the one perceived as the most effective being acetylsalicylic acid

Migrena — współczesne metody leczenia, przyszłe terapie

Migrena jest uwar unkowanym genetycznie pier wotnym bólem głowy, który przebiega z epizodycznymi napadami, między którymi u chorych występuje stała gotowość do ich rozwinięcia. Wieloczynnikowa i złożona etiopatogeneza tej choroby znacznie utrudnia skuteczne leczenie. Autorzy na podstawie najnowszych doniesień i pr zeglądu badań klinicznych pr zedstawili aktualny stan wiedzy dotyczący leczenia doraźnego i profilaktycznego migreny. W ar tykule omówiono także pr zyszłe terapie, z któr ymi są wiązane duże nadzieje i które być może w niedalekiej przyszłości poszerzą możliwości skutecznego leczenia migreny

Zastosowanie blokad, kannabinoidów i metod pozafarmakologicznych w leczeniu migreny

Działania niepożądane, interakcje lekowe, a także farmakooporność mogą w znacznym stopniu utrudniać farmakologiczne leczenie migreny. W związku z tym coraz częściej stosuje się niekonwencjonalne i niefarmakologiczne metody leczenia. W szczególności nieinwazyjna neuromodulacja, blokady nerwów obwodowych, nutraceutyki i metody behawioralne są dobrze tolerowane i wskazane dla określonych grup pacjentów, takich jak młodzież, kobiety w ciąży i pacjenci, którzy z różnych powodów muszą lub chcą ograniczyć farmakoterapię. Metody te są coraz częściej postrzegane jako ważna opcja terapeutyczna w leczeniu migreny, konieczne są jednak dalsze badania nad ich skutecznością, także w odniesieniu do efektów długoterminowych, zwłaszcza że skuteczności części metod niekonwencjonalnych (np. kannabinoidów) dotychczas nie zweryfikowano w dobrej jakości badaniach naukowych. Celem pracy jest przedstawienie i omówienie głównych metod wspomagających leczenie farmakologiczne migreny na podstawie aktualnego piśmiennictwa. Słowa kluczowe: migrena, neuromodulacja, nutraceutyki, kannabinoidy, techniki behawioraln

The Prevalence of Different Types of Headache in Patients with Subjective Tinnitus and Its Influence on Tinnitus Parameters: A Prospective Clinical Study

Both tinnitus and headache are very prevalent conditions in the general population, with bidirectional co-occurrence of them. A number of studies revealed a high prevalence of headache in tinnitus patients; however, most of them used self-reported symptoms, questionnaires, or health databases and were retrospective. The aim of this study was to evaluate the prevalence of different types of headache in a cohort of tinnitus patients and to assess the influence of headache on tinnitus parameters, focusing on appropriate headache and tinnitus diagnosis verified by clinical examination. This prospective study involved 286 patients diagnosed with subjective non-pulsating tinnitus. Patients&rsquo; clinical information was thoroughly assessed by the multidisciplinary team, including tinnitus characteristics and severity according to the Tinnitus Handicap Inventory (THI), loudness assessed by the Visual Analogue Scale (VAS), audiometry, type of headache diagnosed according to the third edition of the International Classification of Headache Disorders, severity of headache assessed by the Numeric Rating Scale (NRS), and impact of headache using the Headache Impact Test (HIT). In total, 141 (49.3%) tinnitus patients were diagnosed with headache, most of them with tension-type headache or migraine. They were significantly younger; mostly women; had bilateral tinnitus, vertigo, and depression more frequently; and had hearing loss less frequently as compared with the non-headache group. In total, 82 (58.16%) patients had the same localization of tinnitus and headache. Younger age, female gender, higher tinnitus burden measured by THI, and coexistence of hearing loss were independent variables connected with the occurrence of headache in the tinnitus group. According to our study, headaches impact tinnitus on many different levels and may be an important co-factor for tinnitus subtyping. We recommend screening for headache coexistence in all tinnitus patients

Changes in Cerebral Blood Flow after Erenumab Treatment in Good and Non-Responders—A Pilot Study of Migraine Patients

Erenumab showed efficacy in migraine prevention, however we cannot identify which patients to treat by predicting efficacy response. The aim of this study was to compare changes in cerebral blood flow (CBF) reflected by transcranial Doppler (TCD) in erenumab good responders (GR) and non-responders, in order to identify a parameter that could predict the treatment response. In this study, migraineurs treated with erenumab underwent clinical and TCD evaluations before and 6 weeks after the treatment, including data on migraine type, monthly migraine days (MMD), medication overuse headache (MOH) presence, mean blood flow velocity (Vm) and pulsatility index (PI) in cerebral arteries (CA). GR were defined as reporting ≥50% reduction in MMD. Thirty women were enrolled, of mean age 40.53 years, 20 with chronic migraine, 14 with MOH, and 19 were GR. Baseline Vm values in right CA and basilar artery (BA) were significantly lower in GR as compared with non-responders. Vm values in all arteries significantly increased after the treatment as compared with corresponding baseline values, but only in GR. A significant negative correlation was observed between baseline Vm in right CA and treatment effectiveness. Baseline Vm in right CA and basilar artery is reduced in erenumab GR as compared with non-responders. This asymmetry normalizes after the treatment with significant Vm increase in CA which may reflect CBF increase in GR only. Lower baseline Vm in right CA may predict erenumab efficacy; however, these results should be replicated in a larger cohort

Zastosowanie blokad, kannabinoidów i metod pozafarmakologicznych w leczeniu migreny

Działania niepożądane, interakcje lekowe, a także farmakooporność mogą w znacznym stopniu utrudniać farmakologiczne leczenie migreny. W związku z tym coraz częściej stosuje się niekonwencjonalne i niefarmakologiczne metody leczenia. W szczególności nieinwazyjna neuromodulacja, blokady nerwów obwodowych, nutraceutyki i metody behawioralne są dobrze tolerowane i wskazane dla określonych grup pacjentów, takich jak młodzież, kobiety w ciąży i pacjenci, którzy z różnych powodów muszą lub chcą ograniczyć farmakoterapię. Metody te są coraz częściej postrzegane jako ważna opcja terapeutyczna w leczeniu migreny, konieczne są jednak dalsze badania nad ich skutecznością, także w odniesieniu do efektów długoter minowych, zwłaszcza że skuteczności części metod niekonwencjona lnych (np. kannabinoidów) dotychczas nie zweryfikowano w dobrej jakości badaniach naukowych. Celem pracy jest przedstawienie i omówienie głównych metod wspomagających leczenie farmakologiczne migreny na podstawie aktualnego piśmiennictwa

Etiology of ‘Sinus Headache’—Moving the Focus from Rhinology to Neurology. A Systematic Review

‘Sinus headache and/or facial pain’ (SH) is a common complaint encountered by otorhinolaryngologists, neurologists and general practitioners. However, several studies suggested that the majority of those cases may be attributed to primary headaches (i.e., migraine and tension-type headache (TTH). The purpose of this review is to evaluate the etiology of SH. The first part includes cross-sectional studies analyzing the prevalence of respective diagnoses in subjects with SH. The majority of these publications indicate that migraine and TTH are the most prevalent causes of SH, although most of these studies were conducted in a clinical setting. The second part of this review included treatment trials in subjects with SH. The findings from this part of the review show that SH without rhinosinusitis responds well to pharmacotherapy targeted at primary headaches. This observation further supports a neurologic etiology of the majority of SH cases