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Migraine

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Abstract

Migraine is one of the most common pain disorders in the United States, affecting over 15% of the general population. Treatment guidelines exist regarding the use of both prophylactic and abortive therapies. However, there is still controversy over the utility and practice of polytherapy in those who do not respond to a first-line preventative agent. There is a small body of evidence to support the use of polytherapy for the management of refractory migraine, and a much larger pool of anecdotal clinical experience. In addition to the confusion between mono- and polytherapy, many new treatment modalities including injectable medications and nerve stimulators for episodic migraine have become available. The incorporation of these interventions into the migraine treatment plan will be discussed.

Keywords

  • Episodic migraine
  • Chronic migraine
  • Migraine with aura
  • Polytherapy
  • Monotherapy
  • CGRP antagonist
  • Neuromodulation

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Fig. 20.1

References

  1. Smitherman TA. The prevalence, impact, and treatment of migraine and severe headaches in the United States: a review of statistics from national surveillance studies. Headache. 2013;53(3):427–36. https://doi.org/10.1111/head.12074.

    CrossRef  PubMed  Google Scholar 

  2. Younger DS. Epidemiology of migraine. Neurol Clin. 2016;34(4):849–61. https://doi.org/10.1016/j.ncl.2016.06.011.

    CrossRef  PubMed  Google Scholar 

  3. Olesen J. The International Classification of Headache Disorders. ICHD-3; 2017.

    Google Scholar 

  4. Rothrock JF. Migraine “chronification”. Headache. 2008;48(1):181–2. https://doi.org/10.1111/j.1526-4610.2007.00989.x.

    CrossRef  PubMed  Google Scholar 

  5. Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000;55(6):754–62. https://doi.org/10.1212/wnl.55.6.754.

    CAS  CrossRef  PubMed  Google Scholar 

  6. Pringsheim T. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012;39(2 suppl 2):S1–59.

    PubMed  Google Scholar 

  7. Gaul C. Improvement of migraine symptoms with a proprietary supplement containing riboflavin, magnesium and Q10: a randomized, placebo-controlled, double-blind, multicenter trial. J Headache Pain. 2015;16(1):1–8. https://doi.org/10.1186/s10194-015-0516-6.

    CAS  CrossRef  Google Scholar 

  8. Schwedt TJ. Preventive therapy of migraine. Continuum (Minneapolis, Minn). 2018;24(4, headache):1052–65. https://doi.org/10.1212/CON.0000000000000635.

  9. D’Amico D. Polytherapy for the prophylaxis of chronic migraine: an Italian survey. Neurol Sci. 2011;32(Suppl 1):185–8. https://doi.org/10.1007/s10072-011-0521-8.

  10. D’Amico D. Controversies in migraine: monotherapy. Neurol Sci. 2012;33(Suppl 1):141–5. https://doi.org/10.1007/s10072-012-1059-0.

  11. The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache. 2019;59(1):1–18. https://doi.org/10.1111/head.13456.

  12. Silberstein SD. Pharmacological approaches to managing migraine and associated comorbidities--clinical considerations for monotherapy versus polytherapy. Headache. 2007;47(4):585–99.

    CrossRef  Google Scholar 

  13. Krymchantowski AV. Topiramate plus nortriptyline in the preventive treatment of migraine: a controlled study for nonresponders. J Headache Pain. 2012;13(1):53–9. https://doi.org/10.1007/s10194-011-0395-4.

    CAS  CrossRef  PubMed  Google Scholar 

  14. Keskinbora K. A double-blind randomized controlled trial of topiramate and amitriptyline either alone or in combination for the prevention of migraine. Clin Neurol Neurosurg. 2008;110(10):979–84. https://doi.org/10.1016/j.clineuro.2008.05.025.

    CrossRef  PubMed  Google Scholar 

  15. Bordini CA. Propranolol vs flunarizine vs flunarizine plus propranolol in migraine without aura prophylaxis. A double-blind trial. Arq Neuropsiquiatr. 1997;55(3b):536–41. https://doi.org/10.1590/s0004-282x1997000400003.

    CAS  CrossRef  PubMed  Google Scholar 

  16. Domingues RB. A double-blind randomized controlled trial of low doses of propranolol, nortriptyline, and the combination of propranolol and nortriptyline for the preventive treatment of migraine. Arq Neuropsiquiatr. 2009;67(4):973–7. https://doi.org/10.1590/s0004-282x2009000600002.

    CrossRef  PubMed  Google Scholar 

  17. Krymchantowski AV. Low-dose topiramate plus sodium divalproate for positive responders intolerant to full-dose monotherapy. Headache. 2012;52(1):129–32. https://doi.org/10.1111/j.1526-4610.2011.02035.x.

    CrossRef  PubMed  Google Scholar 

  18. Goadsby PJ. Controlled trial of erenumab for episodic migraine. N Engl J Med. 2017;377(22):2123–32. https://doi.org/10.1056/NEJMoa1705848.

    CAS  CrossRef  PubMed  Google Scholar 

  19. Tepper S. Safety and efficacy of erenumab for preventive treatment of chronic migraine: a randomised, double-blind, placebo-controlled phase 2 trial. Lancet Neurol. 2017;16(6):425–34. https://doi.org/10.1016/S1474-4422(17)30083-2.

    CAS  CrossRef  PubMed  Google Scholar 

  20. Ashina M. Eptinezumab in episodic migraine: a randomized, double-blind, placebo-controlled study (PROMISE-1). Cephalalgia. 2020;40(3):241–54. https://doi.org/10.1177/0333102420905132.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  21. Lipton RB. Efficacy and safety of eptinezumab in patients with chronic migraine: PROMISE-2. Neurology. 2020;94(13):e1365–77. https://doi.org/10.1212/WNL.0000000000009169.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  22. Silberstein SD. Fremanezumab for the preventive treatment of chronic migraine. N Engl J Med. 2017;377(22):2113–22. https://doi.org/10.1056/NEJMoa1709038.

    CAS  CrossRef  PubMed  Google Scholar 

  23. Detke HC. Galcanezumab in chronic migraine: The randomized, double-blind, placebo-controlled REGAIN study. Neurology. 2018;91(24):e2211–21. https://doi.org/10.1212/WNL.0000000000006640.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  24. Nappi G. Tolerability of the triptans: clinical implications. Drug Saf. 2003;26(2):93–107. https://doi.org/10.2165/00002018-200326020-00003.

    CAS  CrossRef  PubMed  Google Scholar 

  25. Mathew PG. A retrospective analysis of triptan and dhe use for basilar and hemiplegic migraine. Headache. 2016;56(5):841–8. https://doi.org/10.1111/head.12804.

    CrossRef  PubMed  Google Scholar 

  26. Mathew PG. Getting to the heart of the matter: migraine, triptans, DHE, ditans, CGRP antibodies, first/second-generation gepants, and cardiovascular risk. Headache. 2016;59(8):1421–6. https://doi.org/10.1111/head.13601.

    CrossRef  Google Scholar 

  27. Chaitman BR. A randomized, placebo-controlled study of the effects of telcagepant on exercise time in patients with stable angina. Clin Pharmacol Ther. 2012;91(3):459–66. https://doi.org/10.1038/clpt.2011.246.

    CAS  CrossRef  PubMed  Google Scholar 

  28. Ho TW. Randomized, controlled study of telcagepant in patients with migraine and coronary artery disease. Headache. 2012;52(2):224–35. https://doi.org/10.1111/j.1526-4610.2011.02052.x.

    CrossRef  PubMed  Google Scholar 

  29. Diener H-C. Non-invasive vagus nerve stimulation (nVNS) for the preventive treatment of episodic migraine: The multicentre, double-blind, randomised, sham-controlled PREMIUM trial. Cephalalgia. 2019;39(12):1475–87. https://doi.org/10.1177/0333102419876920.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  30. Tassorelli C. Noninvasive vagus nerve stimulation as acute therapy for migraine: the randomized PRESTO study. Neurology. 2018;91(4):e364–73. https://doi.org/10.1212/WNL.0000000000005857.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  31. Schoenen JE. Migraine prevention with a supraorbital transcutaneous stimulator: a randomized controlled trial. Neurology. 2013;86(2):201–2. https://doi.org/10.1212/01.wnl.0000479686.32453.cc.

    CrossRef  Google Scholar 

  32. Lipton RB. Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: a randomised, double-blind, parallel-group, sham-controlled trial. Lancet Neurol. 2010;9(4):373–80. https://doi.org/10.1016/S1474-4422(10)70054-5.

    CrossRef  PubMed  Google Scholar 

  33. Krymchantowski AV. Polytherapy in the preventive and acute treatment of migraine: fundamentals for changing the approach. Expert Rev Neurother. 2006;6(3):283–9. https://doi.org/10.1586/14737175.6.3.283

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Purbaugh, M.V., Vuppala, AA.D. (2021). Migraine. In: Henderson, A.D., Carey, A.R. (eds) Controversies in Neuro-Ophthalmic Management. Springer, Cham. https://doi.org/10.1007/978-3-030-74103-7_20

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  • DOI: https://doi.org/10.1007/978-3-030-74103-7_20

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