Neuromodulation Devices in Migraine: The Latest

Migraine is a neurobiological disease characterized by episodic disabling attacks of moderate to severe head pain, associated with nausea and/or vomiting and light or sound sensitivity; it affects up to 12% of the US population. Untreated, attacks reduce an individual’s ability to function, creating a significant impact on work and family activities. Treatment to abate attacks is required by most patients, though studies show that only a portion of patients take medications to treat migraine attacks]. Up to 40% of people with migraine would benefit from additional treatment to reduce the frequency of migraine—ie, a preventive—but studies show that only 13% of people in the United States use migraine prevention measures. Treatment options for migraine vary from over-the-counter medications to prescription treatments. Prescription medications are often stopped due to lack of tolerance and poor efficacy as stated by patients.… [Continue Reading]

A headband delivering electrical nerve stimulation can prevent onset of migraine headaches and can be marketed for that purpose in the U.S., the FDA said Tuesday.

Called Cefaly, the Belgian-made device is the first to win FDA approval for migraine prevention and is also the first transcutaneous electrical nerve stimulation (TENS) system OK’d for any type of pain prevention, as opposed to acute treatment, the agency said.

The device is battery-powered and worn around the head, with the actual TENS stimulator centered on the forehead just above the eyes. It delivers a small, steady current to trigeminal nerve branches. Patients will be instructed to use the device once daily for a maximum of 20 minutes. It is approved for adults only.

… [Continue Reading]

The pathogenesis of migraine is still, today, a hotly debated issue. Recent biochemical studies report the occurrence in migraine of metabolic abnormalities in the synthesis of neurotransmitters and neuromodulators. These include a metabolic shift directing tyrosine metabolism toward the decarboxylation pathway, therein resulting in an unphysiological production of noradrenaline and dopamine along with increased synthesis of traces amines such as tyramine, octopamine, and synephrine. This biochemical alteration is possibly favored by impaired mitochondrial function and high levels of glutamate in the central nervous system (CNS) of migraine patients.

The unbalanced levels of the neurotransmitters (dopamine and noradrenaline) and neuromodulators (eg, tyramine, octopamine, and synephrine) in the synaptic dopaminergic and noradrenergic clefts of the pain matrix pathways may activate, downstream, the trigeminal system that releases calcitonin gene-related peptide. This induces the formation of an inflammatory soup, the sensitization of first trigeminal neuron, and the migraine attack. In view of this, we propose that migraine attacks derive from a top-down dysfunctional process that initiates in the frontal lobe in a hyperexcitable and hypoenergetic brain, thereafter progressing downstream resulting in abnormally activated nuclei of the pain matrix.… [Continue Reading]

by Susan Jeffrey

April 24, 2012 (New Orleans, Louisiana) — New guidelines for the prevention of episodic migraine, co-developed by the American Academy of Neurology (AAN) and the American Headache Society (AHA), upgrade the level of evidence supporting the use of some drugs but downgrade others.

Major changes include a new Level A endorsement for topiramate, but gabapentin and verapamil and other calcium-channel blockers are now considered Level U, or without sufficient evidence for or against their usefulness.

“The guidelines tell us about the evidence,” Stephen D. Silberstein, MD, from the Jefferson Headache Center at Thomas Jefferson University in Philadelphia, Pennsylvania, lead author of the guidelines, told Medscape Medical News. “If there’s a drug out there that’s never been tested in migraine, that doesn’t mean it doesn’t work. The example is topiramate, which in the first guideline we didn’t have good evidence for.”… [Continue Reading]

Christine L. Bagley, PharmD; Regina Rendas-Baum, MS; Gregory A. Maglinte, PhD; Min Yang, MD, PhD; Sepideh F. Varon, PhD; Jeff Lee, PharmD, FCCP; Mark Kosinski, MA

Posted: 04/20/2012; Headache. 2012;52(3):409-421. © 2012 Blackwell Publishing
Abstract and Introduction
Abstract

Objective.— To provide evidence for the reliability and validity of the Migraine-Specific Quality of Life Questionnaire Version 2.1 (MSQ) for use in chronic migraine (CM) in adults.
Background.— MSQ is one of the most frequently utilized disease-specific tools assessing impact of migraine on health-related quality of life (HRQL). However, evidence for its reliability and validity are based on studies in episodic migraine (EM) populations. Additional studies assessing the reliability and validity of the MSQ in patients with CM are needed.
Methods.— Cross-sectional data were collected via web-based survey in 9 countries/regions. Participants were classified as having CM (≥15 headache days/month)… [Continue Reading]

Marcelo E. Bigal, MD, MSc, PhD; Abouch V. Krymchantowski, MD, MSc, PhD

Migraine is a chronic neurologic disorder with heterogeneous characteristics resulting in a range of symptom profiles, burden, and disability. Migraine affects nearly 12% of the adult population in occidental countries, imposing considerable economic and social losses. The pharmacologic treatment of migraine includes preventive and acute strategies. A better understanding of the migraine pathophysiology along with the discovery of novel molecular targets has lead to a growing number of upcoming therapeutic proposals. This review focuses on new and emerging agents for the treatment of migraine.… [Continue Reading]