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Cureus Jul 2023Drugs that act on the calcitonin gene-related peptide (CGRP) pathway herald the dawn of a new era in the management of migraine headaches. The blockade of CGRP... (Review)
Review
Drugs that act on the calcitonin gene-related peptide (CGRP) pathway herald the dawn of a new era in the management of migraine headaches. The blockade of CGRP alleviates neural inflammation and has been associated with reduced pain sensitization. Zavegepant is a third-generation drug and is the first intranasal CGRP antagonist to be developed. This systematic review aims to assess the safety, efficacy, pharmacokinetics, and tolerability of Zavegepant as an abortive treatment for migraine. Studies that assessed the safety, tolerability, and efficacy of Zavegepant for migraine were identified through a systematic literature review of PubMed, Clinicaltrials.gov, and Cochrane databases in April 2023. Our systematic review yielded a total of six studies that fit our inclusion criteria. Of these, data from only two randomized control trials (RCTs) was homogenous; hence, forest plots of results pooled from the included studies were not reported. The included studies showed that Zavegepant is an efficacious and well-tolerated abortive treatment modality for episodic migraine in adult patients. Zavegepant showed safety and efficacy in migraine treatment according to various parameters throughout the six included studies. These parameters include adverse events, pharmacokinetic properties, CGRP inhibition, effect on blood pressure/electrocardiogram, pain freedom, and freedom from most bothersome symptoms.
PubMed: 37593294
DOI: 10.7759/cureus.41991 -
The Journal of Headache and Pain Aug 2023Headache is one of the most common neurological symptoms. Many previous studies have indicated a relationship between primary headaches and alcohol. Drinking has been... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Headache is one of the most common neurological symptoms. Many previous studies have indicated a relationship between primary headaches and alcohol. Drinking has been associated with increased risk of tension-type headache (TTH) and migraine. However, recently published studies have not confirmed this relationship. The existing literature is inconclusive; however, migraine patients avoid alcohol. Therefore, the primary objective was to provide a reliable assessment of alcohol intake in people with primary headaches; the secondary objective was to identify any potential relationship between alcohol consumption and headache risk.
METHODS
This study was based on PubMed, Embase and Web of Science database searches performed on 11 July 2023. This systematic review was registered in PROSPERO (CRD42023412926). Risk of bias for the included studies was assessed using the Joanna Briggs Institute critical appraisal tools. Meta-analyses were performed using Statistica software. The Risk Ratio (RR) was adopted as the measure of the final effect. Analyses were based on a dichotomous division of the respondents into "non-drinkers" and "drinkers" for headache patients and matched non-headache groups.
RESULTS
From a total of 1892 articles, 22 were included in the meta-analysis. The majority demonstrated a moderate or high risk of bias. The first part of the meta-analysis was performed on data obtained from 19 migraine studies with 126 173 participants. The risk of migraine in alcohol drinkers is approximately 1.5 times lower than in the group of non-drinkers (RR = 0.71; 95% CI: 0.57-0.89). The second part involved 9 TTH studies with 28 715 participants. No relationship was found between TTH diagnosis and alcohol consumption (RR = 1.09; 95% CI: 0.93-1.27). Two of the included cluster-headache articles had inconclusive results.
CONCLUSIONS
Alcohol consumption and migraine are inversely correlated. The exact mechanism behind this observation may indicate that migraine leads to alcohol-avoidance, rather than alcohol having any protective role against migraine. There was no relationship between TTH and drinking. However, further studies related to primary headaches and alcohol consumption with low risk of bias are required. Additionally, patients and physicians should consider the latest medical data, in order to avoid the myths about alcohol consumption and primary headaches.
Topics: Humans; Ethanol; Headache; Migraine Disorders; Tension-Type Headache; Cluster Headache
PubMed: 37612595
DOI: 10.1186/s10194-023-01653-7 -
BMJ Evidence-based Medicine Aug 2023To evaluate the effect and safety of acupuncture for acute migraine attacks in adults. (Meta-Analysis)
Meta-Analysis
UNLABELLED
To evaluate the effect and safety of acupuncture for acute migraine attacks in adults.
DESIGN AND SETTING
We searched PubMed, MEDLINE(OVID), Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database and Wanfang database from inception to 15 July 2022. We included randomised controlled trials (RCTs) published in Chinese and English comparing acupuncture alone against sham acupuncture/placebo/no treatment/pharmacological therapy or comparing acupuncture plus pharmacological therapy against the same pharmacological therapy. Results were reported as risk ratios (RRs) for dichotomous outcomes or mean differences (MDs) for continuous outcomes, with 95% CIs. Risk of bias was assessed with the Cochrane tool and the certainty of the evidence (CoE) with GRADE. : Main outcome measures : a) The rate of headache freedom (pain score=0) at 2h after the treatment; b) the rate of headache relief (at least 50% reduction of pain score); c) headache intensity at 2h after the treatment(study data from scales measuring pain intensity, including visual analogue scale, numerical rating scale) d) the improvement of headache intensity at 2h after the treatment; e) the improvement values of migraine-associated symptoms; f) adverse events.
RESULTS
We included 21 RCTs from 15 studies with 1926 participants comparing acupuncture against other interventions. Comparing to sham acupuncture or placebo, acupuncture may result in an increase in the rate of headache freedom (RR 6.03, 95% CI 1.62 to 22.41, 180 participants, 2 studies, I=0%, low CoE) and the improvement of headache intensity (MD 0.51, 95% CI 0.16 to 0.85, 375 participants, 5 studies, I=13%, moderate CoE) at 2 hours after treatment. It also may result on a higher rate of headache relief (RR 2.29, 95% CI 1.16 to 4.49, 179 participants,3 studies, I=74%, very low CoE) and greater improvement of migraine-associated symptoms (MD 0.97, 95% CI 0.33 to 1.61, 90 participants, 2 studies, I=0%, very low CoE) at 2 hours after treatment but the evidence is very uncertain. Meanwhile the analysis indicates acupuncture probably results in little to no difference in adverse events compared with sham acupuncture (RR 1.53, 95% CI 0.82 to 2.87, 884 participants, 10 studies, I=0%, moderate CoE). In acupuncture plus pharmacological intervention versus the same pharmacological intervention, acupuncture plus pharmacological therapy may result in little to no difference in the rate of headache freedom (RR 1.55, 95% CI 0.99 to 2.42, 94 participants, 2 studies, I=0%, low CoE), the rate of headache relief (RR 1.20, 95% CI 0.91 to 1.57, 94 participants, 2 studies, I=0%, low CoE) at 2 hours after treatment and adverse events(RR 1.48, 95% CI 0.25 to 8.92, 94 participants, 2 studies, I=0%, low CoE). However, it may result in a reduction in headache intensity (MD -1.05, 95% CI -1.49 to -0.62, 129 participants, 2 studies, I=0%, low CoE) and an increase in the improvement of headache intensity (MD 1.18, 95% CI 0.41 to 1.95, 94 participants, 2 studies, I=0%, low CoE) at 2 hours after treatment compared with pharmacological therapy only. In comparison to pharmacological intervention, acupuncture may result in little to no difference in the rate of headache freedom (RR 0.95, 95% CI 0.59 to 1.52, 294 participants, 4 studies, I=22%, low CoE), the rate of headache relief (RR 0.95, 95% CI 0.80 to 1.14, 206 participants, 3 studies. I=0%, low CoE) at 2 hours and adverse events (RR 0.65, 95% CI 0.35 to 1.22, 294 participants, 4 studies, I=0%, low CoE) after treatment. The evidence is very uncertain about the effect of acupuncture on the headache intensity (MD -0.07, 95% CI -1.11 to 0.98, 641 participants, 5 studies, I=98%, very low CoE) and the improvement of headache intensity (MD -0.32, 95% CI -1.07 to 0.42, 95 participants, 2 studies, I=0%, very low CoE) at 2 hours after treatment compared with pharmacological intervention.
CONCLUSION
The body of evidence suggests that acupuncture may be more effective than sham acupuncture in the treatment of migraine. Acupuncture may also be as effective as pharmacological therapy. However, the certainty evidence across outcomes was low to very low and new high-quality studies can provide more clarity.
PROSPERO REGISTRATION NUMBER
CRD42014013352.
Topics: Humans; Adult; Acupuncture Therapy; Migraine Disorders; Headache; Pain; China
PubMed: 37419658
DOI: 10.1136/bmjebm-2022-112135 -
Medicina (Kaunas, Lithuania) Nov 2022: The relationship between migraine and tension-type headache (TTH) with Parkinson's disease (PD) is controversial, while a common pathophysiological link remains... (Meta-Analysis)
Meta-Analysis Review
: The relationship between migraine and tension-type headache (TTH) with Parkinson's disease (PD) is controversial, while a common pathophysiological link remains obscure. The aim of this systematic review is to investigate the association between PD, migraine and TTH. : Following PRISMA, we searched MEDLINE, WebofScience, Scopus, CINAHL, Cochrane Library and ClinicalTrials.gov up to 1 July 2022 for observational studies examining the prevalence and/or associations of PD with migraine and TTH. We pooled proportions, standardized mean differences (SMD) and odds ratios (OR) with random effects models. The risk of bias was assessed with the Newcastle-Ottawa scale (PROSPERO CRD42021273238). : Out of 1031 screened studies, 12 were finally included in our review (median quality score 6/9). The prevalence of any headache among PD patients was estimated at 49.1% (760 PD patients; 95% CI 24.8-73.6), migraine prevalence at 17.2% (1242 PD patients; 95% CI 9.9-25.9), while 61.5% (316 PD patients; 95% CI 52.6-70.1) of PD patients with migraine reported headache improvement after PD onset. Overall, migraine was not associated with PD (302,165 individuals; OR = 1.11; 95% CI 0.72-1.72).However, cohort studies demonstrated a positive association of PD among lifetime migraineurs (143,583 individuals; OR = 1.54, 95% CI 1.28-1.84), while studies on 12-month migraine prevalence yielded an inverse association (5195 individuals; OR = 0.64, 95% CI 0.43-0.97). Similar findings were reported by 3 studies with data on the TTH-PD relationship (high prevalence, positive association when examined prospectively and an inverse relationship on 12-month prevalence). These data were not quantitatively synthesized due to methodological differences among the studies. Finally, PD patients suffering from any headache had a lower motor unified Parkinson's disease rating scale (UPDRS) score (503 PD patients; SMD -0.39; 95% CI -0.57 to -0.21) compared to PD patients not reporting headache. There is an unclear association of headaches in genetic PD cohorts. : Observational data suggest that migraine and TTH could be linked to PD, but the current literature is conflicting.
Topics: Humans; Tension-Type Headache; Parkinson Disease; Migraine Disorders; Headache; Mental Status and Dementia Tests
PubMed: 36422223
DOI: 10.3390/medicina58111684 -
Plastic and Reconstructive Surgery Nov 2023Minimally invasive techniques for treatment-resistant migraine have been developed on recent insights into the peripheral pathogenesis of migraines. Although there is a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Minimally invasive techniques for treatment-resistant migraine have been developed on recent insights into the peripheral pathogenesis of migraines. Although there is a growing body of evidence supporting these techniques, no study has yet compared the effects of these treatments on headache frequency, severity, duration, and cost.
METHODS
PubMed, Embase, and Cochrane Library databases were searched to identify randomized placebo-controlled trials that compared radiofrequency ablation, botulinum toxin type A (BT-A), nerve block, neurostimulation, or migraine surgery to placebo for preventive treatment. Data on changes from baseline to follow-up in headache frequency, severity, duration, and quality of life were analyzed.
RESULTS
A total of 30 randomized controlled trials and 2680 patients were included. Compared with placebo, there was a significant decrease in headache frequency in patients with nerve block ( P = 0.04) and surgery ( P < 0.001). Headache severity decreased in all treatments. Duration of headaches was significantly reduced in the BT-A ( P < 0.001) and surgery cohorts ( P = 0.01). Quality of life improved significantly in patients with BT-A, nerve stimulator, and migraine surgery. Migraine surgery had the longest lasting effects (11.5 months) compared with nerve ablation (6 months), BT-A (3.2 months), and nerve block (11.9 days).
CONCLUSIONS
Migraine surgery is a cost-effective, long-term treatment to reduce headache frequency, severity, and duration without significant risk of complication. BT-A reduces headache severity and duration, but it is short-lasting and associated with greater adverse events and lifetime cost. Although efficacious, radiofrequency ablation and implanted nerve stimulators have high risks of adverse events and explantation, whereas benefits of nerve blocks are short in duration.
Topics: Humans; Quality of Life; Migraine Disorders; Botulinum Toxins, Type A; Headache; Nerve Block; Randomized Controlled Trials as Topic
PubMed: 36940145
DOI: 10.1097/PRS.0000000000010429 -
Clinical Breast Cancer Apr 2023Migraine and breast cancer are 2 prevalent diseases with high morbidity and mortality rates world-wide. There have been inconsistent reports regarding the association... (Meta-Analysis)
Meta-Analysis Review
Migraine and breast cancer are 2 prevalent diseases with high morbidity and mortality rates world-wide. There have been inconsistent reports regarding the association between migraine and risk of breast cancer. This systematic review and meta-analysis aimed to assess the risk of breast cancer in patients with migraine. By December, 1, 2022, we searched PubMed, Web of Science, Scopus, and Cochrane Library databases. Odds ratio (OR), hazard ratio (HR), and 95% confidence intervals (CIs) were extracted or assessed to determine the pooled risk estimate using a random-effects model. We use the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies. We included 9 studies involving 393,282 participants. The pooled analysis showed that patients with migraine had a slightly low risk of breast cancer (OR 0.82, 95% CI, 0.72-0.94; P = .003), especially in case-control studies (OR 0.69, CI: 0.60-0.81, I = 74.1%, p < .001), and hormone receptor-positive breast cancer (OR 0.76, CI: 0.63-0.91; I = 88.6%; p = .003). Our findings demonstrate a slightly low risk of breast cancer, especially hormone receptor-positive breast cancer, in patients with migraine.
Topics: Humans; Female; Breast Neoplasms; Migraine Disorders; Risk; Proportional Hazards Models; Case-Control Studies
PubMed: 36624014
DOI: 10.1016/j.clbc.2022.12.011 -
Complementary Therapies in Clinical... Nov 2023To understand the placebo response of acupuncture and its effect on migraine and optimize the design of future acupuncture clinical trials on migraine treatment. (Meta-Analysis)
Meta-Analysis Review
AIM
To understand the placebo response of acupuncture and its effect on migraine and optimize the design of future acupuncture clinical trials on migraine treatment.
METHODS
Randomized controlled trials with sham acupuncture as a control in migraine treatment were searched in four English databases from inception to September 1, 2022. The primary outcome was placebo response rate. Secondary outcomes were migraine symptoms, emotional condition, and quality of life. Factors associated with placebo response were also explored. Results were combined using risk difference (RD) or standardized mean difference (SMD) and 95% confidence interval (CI) with a random effects model.
RESULTS
The final analysis included 21 studies involving 1177 patients. The pooled response rate of sham acupuncture was 0.34 (RD, 95% CI 0.23-0.45, I 89.8%). The results (SMD [95% CI]) showed significant improvements in migraine symptoms (pain intensity -0.56 [-0.73 to -0.38], and episode conditions -0.55 [-0.75 to -0.35]); emotional condition (anxiety scale -0.49 [-0.90 to -0.08] and depression scale -0.21 [-0.40 to -0.03]); and quality of life on the Migraine-Specific Quality-of-Life Questionnaire (restrictive 0.78 [0.61-0.95]; preventive 0.52 [0.35-0.68]; and emotional 0.45 [0.28-0.62]) and on the Medical Outcomes Study Short-Form (physical 0.48 [0.34-0.62] and mental 0.21 [0.02-0.41]). Only acupuncture treatment frequency had a significant impact on the placebo response rate (RD 0.49 vs. 0.14; p = 0.00).
CONCLUSIONS
The effect sizes for placebo response of sham acupuncture varied across migraine treatment trials. Further studies should routinely consider adjusting for a more complete set of treatment factors.
Topics: Humans; Quality of Life; Acupuncture Therapy; Migraine Disorders; Outcome Assessment, Health Care; Placebo Effect; Randomized Controlled Trials as Topic
PubMed: 37793307
DOI: 10.1016/j.ctcp.2023.101800 -
European Journal of Pain (London,... Jan 2023Migraine is a complex, neurobiological disorder usually presenting as a unilateral, moderate to severe headache accompanied by sensory disturbances. Migraine prevalence... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Migraine is a complex, neurobiological disorder usually presenting as a unilateral, moderate to severe headache accompanied by sensory disturbances. Migraine prevalence has risen globally, affecting 14% of individuals and 16% of students and carries many negative impacts in both cohorts. With no recent meta-analysis of global migraine prevalence or associated factors in students, this systematic review and meta-analysis were conducted.
DATABASES AND DATA TREATMENT
The review was registered with PROSPERO (CRD42020167927). Electronic databases (n = 12) were searched for cross-sectional studies (1988 to August 2021, IHS criteria). Ninety-two articles were meta-analysed and 103 were narratively reviewed. The risk of bias was assessed using an established tool.
RESULTS
The risk of bias ranged from low to moderate. Migraine pooled prevalence (R-Studio) was demonstrated at 19% (95% CI, 16%-22%, p < 0.001, I^2 98%): females 23% (95% CI, 19%-27%, p < 0.001), males 12% (95% CI, 9%-15%, p < 0.001). Gender (p < 0.0001), geographical region (p = 0.01), migraine types (p = 0.0002) and prevalence timeframes (p = 0.02) may be influencing the substantial heterogeneity. Migraine triggers were primarily behavioural and environmental and treatments were predominantly pharmaceutical. Impacts ranged from academic performance impairment to psychological co-morbidities.
CONCLUSIONS
This study offers the most comprehensive overview of migraine prevalence and associated factors in university students. Migraine prevalence in university students has increased and has many negative effects. Enhancing migraine recognition and management at university may have positive implications for an improved educational experience, as well as for the burden migraine currently incurs, both in university and beyond.
SIGNIFICANCE
This global systematic review and meta-analysis of 92 studies and narrative review of 103 studies provide the most comprehensive synthesis to date of migraine prevalence and associated factors in university students. Pooled prevalence has increased to 19%. The significant heterogeneity demonstrated is influenced by gender, geographical region, migraine type and prevalence timeframes. Students manage migraines primarily with pharmaceuticals. Further studies conducted in low and middle-income countries, following headache protocols and reporting frequency of treatment-seeking and medication usage are warranted.
Topics: Male; Female; Humans; Cross-Sectional Studies; Migraine Disorders; Universities; Students; Headache; Prevalence
PubMed: 36288401
DOI: 10.1002/ejp.2047 -
Aging Clinical and Experimental Research Jun 2022To conduct a comprehensive systematic review and meta-analysis to explore the correlation between migraine and the risk of dementia. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To conduct a comprehensive systematic review and meta-analysis to explore the correlation between migraine and the risk of dementia.
METHODS
The PubMed, EMBASE, and Cochrane library databases were searched systematically. We selected cohort studies (prospective and retrospective) and case-control studies that reported migraine in patients with dementia, including vascular dementia. The pooled effects were analyzed to evaluate relative risk with 95% confidence intervals.
RESULTS
In total, nine studies (two case-control and seven cohort studies) including 291,549 individuals were identified. These studies indicated that people with migraine (relative risk = 1.33; 95% confidence interval: 1.16-1.53) have an increased risk of all-cause dementia. Additionally, the pooled results of four studies showed that migraine is associated with an increased risk of vascular dementia (relative risk = 1.85; 95% confidence interval: 1.22-2.81; P = 0.004).
CONCLUSIONS
Data from observational studies suggest that migraine may be a risk factor for dementia, particularly vascular dementia. More studies are warranted to explore the association between migraine and dementia and the potential common pathophysiological mechanisms.
Topics: Dementia, Vascular; Humans; Migraine Disorders; Prospective Studies; Retrospective Studies; Risk Factors
PubMed: 35102514
DOI: 10.1007/s40520-021-02065-w -
The Ocular Surface Apr 2023Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects... (Meta-Analysis)
Meta-Analysis
Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects of dry eye disease (DED). Regarding mental health factors, several cross-sectional studies have noted associations between depression and anxiety, and medications used to treat these disorders, and DED symptoms. Sleep disorders (both involving quality and quantity of sleep) have also been associated with DED symptoms. Under the domain of physical health, several factors have been linked to meibomian gland abnormalities, including obesity and face mask wear. Cross-sectional studies have also linked chronic pain conditions, specifically migraine, chronic pain syndrome and fibromyalgia, to DED, principally focusing on DED symptoms. A systematic review and meta-analysis reviewed available data and concluded that various chronic pain conditions increased the risk of DED (variably defined), with odds ratios ranging from 1.60 to 2.16. However, heterogeneity was noted, highlighting the need for additional studies examining the impact of chronic pain on DED signs and subtype (evaporative versus aqueous deficient). With respect to societal factors, tobacco use has been most closely linked to tear instability, cocaine to decreased corneal sensitivity, and alcohol to tear film disturbances and DED symptoms.
Topics: Humans; Chronic Pain; Cross-Sectional Studies; Dry Eye Syndromes; Life Style; Tears; Meibomian Glands
PubMed: 37054911
DOI: 10.1016/j.jtos.2023.04.008