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International Journal of Surgery... Apr 2024Migraine affects approximately 14-15% of the global population, contributing to nearly 5% of the world's health burden. When drug treatments prove ineffective for...
BACKGROUND
Migraine affects approximately 14-15% of the global population, contributing to nearly 5% of the world's health burden. When drug treatments prove ineffective for intractable migraines, highly specific surgical interventions emerge as potential solutions. We aimed to analyze surgical approaches for these refractory or intractable migraines through a systematic review and meta-analysis.
METHODS
We conducted a literature search across databases such as PubMed, Scopus, Web of Science, and Embase, focusing on studies related to migraines and surgical outcomes. We considered clinical trials or observational studies that included any surgical intervention for refractory or intractable migraines, emphasizing key outcomes such as reductions in migraine intensity, Migraine Disability Assessment scores (MIDAS), and 50% Migraine Headache Index (MHI) reduction rates. Statistical analyses were performed using R version 4.3.
RESULTS
Eleven studies were included in the systematic review. A meta-analysis of four studies involving overall 95 patients showed a significant reduction in mean migraine intensity scores using ONS (-2.27, 95% CI: -3.92 to -0.63, P=0.021). Three studies with 85 patients showed an average MIDAS score reduction of -52.3, though this was not statistically significant (95% CI: -136.85 to 32.19, P=0.116). Two additional studies corroborated these reductions in MIDAS scores. Nerve decompression surgery showed a substantial decrease in the average migraine intensity (from 8.31 down to 4.06). Median MIDAS score dropped from 57 to 20. Two studies indicated a success rate of 40% and 82%, respectively, in achieving a 50% reduction in the Migraine MHI through nerve decompression. Findings from two studies suggest that septorhinoplasty and sinus surgery effectively decrease migraine intensity scores.
CONCLUSION
The existing evidence emphasizes the potential advantages of surgical interventions as a promising approach to managing intractable or refractory migraines. However, robust and comprehensive research is crucial to refine and solidify the efficacy of these surgical methods, aiming for widespread benefits for patients, considering cost-effectiveness factors.
PubMed: 38626410
DOI: 10.1097/JS9.0000000000001480 -
Journal of Clinical Medicine Mar 2024Phase II/III randomized clinical trials (RCTs) are vulnerable to many types of bias beyond randomization. Insights into the reporting quality of RCTs involving migraine... (Review)
Review
Phase II/III randomized clinical trials (RCTs) are vulnerable to many types of bias beyond randomization. Insights into the reporting quality of RCTs involving migraine patients treated with monoclonal antibodies targeting the calcitonin gene-related peptide system (anti-CGRP MAbs) are currently lacking. Our aim was to analyze the reporting quality of phase II/III RCTs involving migraine patients treated with anti-CGRP MAbs. A systematic search was performed on the PubMed and EMBASE databases, according to PRISMA guidelines, for relevant RCTs in either episodic or chronic migraine prevention. Additionally, an adapted version of the 2010 CONSORT statement checklist was utilized. The ROBvis online tool was used to document the risk of bias. From the initially identified 179 articles, we finally found 31 RCTs that were eligible for evaluation. The average CONSORT compliance was 88.7% (69.7-100%), while 93.5% (N = 29) of the articles had a compliance greater than 75%. Twenty-eight CONSORT items were reported in more than 75% of the articles. The average compliance of the analyzed RCTs was 93.9% for Galcanezumab, 91.3% for Fremanezumab, followed by 85.4% for Erenumab and Eptinezumab studies. Implementation of the ROB2 tool showed some concerning "missing information" arising from the inadequate reporting. Specifically, 50% of the studies (N = 16) were categorized as having inadequate information regarding the randomization process. Adequate reporting quality was disclosed in the evaluated RCTs with anti-CGRP MAbs in migraine prevention. However, some methodological issues need to be highlighted to be addressed in future studies assessing the efficacy of new molecules targeting CGRP or other candidate pathways implicated in migraine pathophysiology.
PubMed: 38610729
DOI: 10.3390/jcm13071964 -
The Journal of Headache and Pain Apr 2024Autonomic nervous system (ANS) testing has aided in our ability to evaluate autonomic dysfunction in migraine patients. We reviewed the literature in multiple databases... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Autonomic nervous system (ANS) testing has aided in our ability to evaluate autonomic dysfunction in migraine patients. We reviewed the literature in multiple databases which investigate ANS function in migraine patients and healthy subjects.
METHODS
This systematic review and meta-analysis examined the respective deep breathing, Valsalva manoeuvre, orthostatic and isometric challenge results, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analyses of Observational Studies in Epidemiology (MOOSE) statements.
RESULTS
Seven articles met all inclusion criteria. Fixed-effects meta-analysis showed migraine patients (n = 424), collectively, had lower interictal autonomic test results compared with healthy controls (n = 268). In detail, this was true for the standardized mean difference (g) of deep breathing (g= -0.32; 95% confidence interval (CI) -0.48, -0.16), orthostatic challenge (g= -0.28; 95% CI -0.44, -0.13) and isometric challenge (g= -0.55; 95% CI -0.71, -0.39) and for the difference of means (MD) of the Valsalva ratio (MD = -0.17; 95% CI -0.23, -0.10).
CONCLUSIONS
Interictal ANS dysfunction can be identified in migraine patients when compared to healthy controls. These findings indicate the importance to evaluate ANS function in migraine patients - especially, as migraine-specific prophylactic therapies (such as anti-calcitonin gene-related peptide (CGRP) antibodies) may affect the function of the ANS.
Topics: Humans; Autonomic Nervous System; Heart Rate; Migraine Disorders; Observational Studies as Topic
PubMed: 38600467
DOI: 10.1186/s10194-024-01758-7 -
Headache Apr 2024To compare various exercise modalities' efficacy on migraine frequency, intensity, duration, and disability. (Review)
Review
OBJECTIVE
To compare various exercise modalities' efficacy on migraine frequency, intensity, duration, and disability.
BACKGROUND
Exercise has been shown to be an effective intervention to reduce migraine symptoms and disability; however, no clear evidence exists regarding the most effective exercise modalities for migraine treatment.
METHODS
A systematic review was performed in PubMed, PEDro, Web of Science, and Google Scholar. Clinical trials that analyzed the efficacy of various exercise modalities in addressing the frequency, intensity, duration, and disability of patients with migraine were included. Eight network meta-analyses based on frequentist (F) and Bayesian (B) models were developed to estimate the direct and indirect evidence of various exercise modalities. Standardized mean difference (SMD) and 95% confidence (CI) and credible intervals (CrI) were calculated for each treatment effect based on Hedge's g and p scores to rank the modalities.
RESULTS
We included 28 studies with 1501 migraine participants. Yoga (F: SMD -1.30; 95% CI -2.09, -0.51; B: SMD -1.33; 95% CrI -2.21, -0.45), high-intensity aerobic exercise (F: SMD -1.30; 95% CI -2.21, -0.39; B: SMD -1.17; 95% CrI -2.20, -0.20) and moderate-intensity continuous aerobic exercise (F: SMD -1.01; 95% CI -1.63, -0.39; B: SMD -1.06; 95% CrI -1.74, -0.38) were significantly superior to pharmacological treatment alone for decreasing migraine frequency based on both models. Only yoga (F: SMD -1.40; 95% CI -2.41, -0.39; B: SMD -1.41; 95% CrI -2.54, -0.27) was significantly superior to pharmacological treatment alone for reducing migraine intensity. For diminishing migraine duration, high-intensity aerobic exercise (F: SMD -1.64; 95% CI -2.43, -0.85; B: SMD -1.56; 95% CrI -2.59, -0.63) and moderate-intensity continuous aerobic exercise (SMD -0.96; 95% CI -1.50, -0.41; B: SMD -1.00; 95% CrI -1.71, -0.31) were superior to pharmacological treatment alone.
CONCLUSION
Very low-quality evidence showed that yoga, high- and moderate-intensity aerobic exercises were the best interventions for reducing migraine frequency and intensity; high- and moderate-intensity aerobic exercises were best for decreasing migraine duration; and moderate-intensity aerobic exercise was best for diminishing disability.
PubMed: 38597252
DOI: 10.1111/head.14696 -
Pain Research & Management 2024To assess the effectiveness of myofascial release (MFR) techniques on the intensity of headache pain and associated disability in patients with tension-type headache... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the effectiveness of myofascial release (MFR) techniques on the intensity of headache pain and associated disability in patients with tension-type headache (TTH), cervicogenic headache (CGH), or migraine.
DESIGN
A systematic review and meta-analysis.
METHODS
Eight databases were searched on September 15, 2023, including PubMed, Scopus, Web of Science, CINAHL, Cochrane Library, Embase, CNKI, and Wanfang Database. The risk of bias was evaluated utilizing the Cochrane Risk of Bias 2 (RoB 2) tool.
RESULTS
Pooled results showed that MFR intervention significantly reduces pain intensity [SMD = -2.01, 95% CI (-2.98, -1.03), = 90%, < 0.001] and improves disability [SMD = -1.3, 95% CI (-1.82, -0.79), = 74%, < 0.001]. Subgroup analysis based on the type of headache revealed significant reductions in pain intensity for CGH [SMD = -2.01, 95% CI (-2.73, -1.29), = 63%, < 0.001], TTH [SMD = -0.86, 95% CI (-1.52, -0.20), = 50%, =0.01] and migraine [SMD = -6.52, 95% CI (-8.15, -4.89), < 0.001] and in disability for CGH [SMD = -1.45, 95% CI (-2.07, -0.83), = 0%, < 0.001]; TTH [SMD = -0.98, 95% CI (-1.32, -0.65), = 0%, < 0.001] but not migraine [SMD = -2.44, 95% CI (-6.04, 1.16), = 97%, =0.18].
CONCLUSION
The meta-analysis results indicate that MFR intervention can significantly alleviate pain and disability in TTH and CGH. For migraine, however, the results were inconsistent, and there was only moderate quality evidence of disability improvement for TTH and CGH. In contrast, the quality of other evidence was low or very low.
Topics: Humans; Post-Traumatic Headache; Myofascial Release Therapy; Migraine Disorders; Headache; Tension-Type Headache; Pain
PubMed: 38585645
DOI: 10.1155/2024/2042069 -
Frontiers in Neurology 2024Growing evidence suggests that headache disorders and atopic dermatitis share similar pathological mechanisms and risk factors. The aim of this study was to assess the...
BACKGROUND
Growing evidence suggests that headache disorders and atopic dermatitis share similar pathological mechanisms and risk factors. The aim of this study was to assess the risk for headache disorders in patients with atopic dermatitis.
METHODS
We systematically searched the PubMed and Embase databases from inception to December 1, 2023, for observational studies that examined risk of migraine in subjects with atopic dermatitis. Risk estimates from individual studies were pooled using random-effects models.
RESULTS
Ten studies with 12,717,747 subjects were included in the meta-analysis. Our results showed that patients with atopic dermatitis were associated with a higher risk of headache disorder (OR, 1.46, 95% CI = 1.36-1.56; < 0.001; I = 98%) or migraine (OR, 1.32, 95% CI = 1.18-1.47; < 0.001; I = 98.9%). Most of the results of the subgroup analyses were consistent with the overall results.
CONCLUSION
The findings of this meta-analysis suggest that atopic dermatitis is a potential risk indicator for headache disorder or migraine. Further studies are still needed to verify our findings due to the substantial heterogeneity in our analyses.
PubMed: 38576533
DOI: 10.3389/fneur.2024.1383832 -
Neurological Sciences : Official... Apr 2024The objective of this systematic review and meta-analysis was to determine whether patients with episodic (EM) or chronic migraine (CM), who were treated with anti-CGRP...
The transition of medication overuse status by acute medication categories in episodic or chronic migraine patients to non-overuse status after receiving anti-CGRP monoclonal antibodies: a systematic review and meta-analysis of phase 3 randomized control trial.
OBJECTIVE
The objective of this systematic review and meta-analysis was to determine whether patients with episodic (EM) or chronic migraine (CM), who were treated with anti-CGRP antibodies, showed a reversal from medication overuse (MO) or medication overuse headache (MOH) status at their baseline to non-overuse status. Furthermore, this study aimed to establish which acute headache medication (AHM) categories responded more effectively to anti-CGRP antibodies.
METHODS
A systematic search was conducted in the PubMed database for relevant studies from January 2013 to September 2023. We included phase three randomized controlled trials to examine the role of anti-CGRP antibodies in patients with EM or CM and their MO status. A meta-analysis was conducted to find the association between anti-CGRP antibodies and the number of EM and CM patients with MO or MOH at baseline that reverted to non-MO status or below the MOH threshold.
RESULTS
The initial search yielded a total of 345 studies. After removing duplicates and screening with inclusion criteria, 5 studies fulfilled our conditions. Each study reviewed the response to changes in the MO status of patients after receiving anti-CGRP antibodies, including eptinezumab, fremanezumab, galcanezumab, and erenumab, compared to placebo. Our study analyzed three AHM categories: triptans, simple analgesics, and multiple drugs. The overall relative risk (RR) was 1.44 (95% CI, 1.31 to 1.59; p < 0.001). The RRs for triptans, simple analgesics, and multi-drug groups were 1.71 (95% CI, 1.53 to 1.91; p < 0.001), 1.10 (95% CI, 0.83 to 1.47; p = 0.5), and 1.29 (95%CI 1.14 to 1.46; p < 0.001) respectively.
CONCLUSION
The meta-analysis has shown that anti-CGRP antibodies were statistically significant in transitioning from MO or MOH status to non-MO status or below the MOH threshold (RR = 1.44) for all included studies and all AHM categories except for simple analgesics. Patients from the triptan group had the highest RR of 1.71 with a p-value < 0.001, while the simple analgesics group had an RR of 1.10, however, with a p-value > 0.05. Interestingly, this analysis can be interpreted as that anti-CGRP antibodies might not be effective in reducing simple analgesics use in EM or CM patients. Further studies are needed to investigate these matters.
PubMed: 38564060
DOI: 10.1007/s10072-024-07496-7 -
Efficacy of Acupuncture-Related Therapy for Migraine: A Systematic Review and Network Meta-Analysis.Journal of Pain Research 2024Migraine is a common neurological disorder, which resulting in significant societal and personal burdens. Acupuncture has attracted widespread attention in migraine... (Review)
Review
OBJECTIVE
Migraine is a common neurological disorder, which resulting in significant societal and personal burdens. Acupuncture has attracted widespread attention in migraine prophylaxis and treatment in recent years. Although some studies have confirmed the effectiveness of acupuncture therapy in treating migraines, there is still a lack of comprehensive evaluation regarding the comparison between different types of migraines and various acupuncture therapies. Furthermore, certain special acupuncture methods have not received sufficient attention and research. Therefore, the objective of this study is to summarize and expand upon previous research, update existing evidence, and compare the efficacy of different acupuncture therapies for migraine. We aim to provide stronger evidence-based support for clinical practice through this study, thereby promoting wider application of acupuncture therapy in migraine treatment.
METHODS
A exhaustive and methodical search was conducted across the nine databases: PubMed, EMBASE, Web of Science, Scopus, the Cochrane Library, CBM, CNKI, WANFANG and VIP Data. The Visual Analog Scale (VAS) scores, migraine attack frequency, duration, days of attack and adverse effects were observation indicators.
RESULTS
This study included 34 studies involving a total of 3365 migraineurs. The results of the study demonstrated that acupuncture therapy reduced VAS scores of migraine patients better compared to medication (MD=-1.29, 95% CI=[-1.67,-0.92]) and exhibited greater efficacy in reducing the frequency of migraine attacks (MD=-1.95, 95% CI=[-3.06,-0.85]), the duration of attacks (MD=- 3.29, 95% CI=[-4.65,-1.93]), and days of attack (MD=-1.02, 95% CI=[-1.58,-0.47]). Significant heterogeneity suggested that different acupuncture therapies had varying effects, and that the efficacy of the same therapy may also vary in different migraine types. In the context of network meta-analysis, the SUCRA of acupuncture therapies for reducing VAS scores was ranked as special acupuncture method (98.3%), acupuncture plus medicine (71.9%), and acupuncture (54.5%). Blood-letting and cupping was the most effective treatment for lowering the frequency of migraine attacks. The most effective treatment for shortening the duration of migraine was acupuncture plus medication (81.2%). When it comes to decreasing the days of migraine, acupuncture (80.3%) came out on top. 14 studies reported the occurrence of adverse effects, of which 4 studies had no adverse effects in the test group.
CONCLUSION
Initial findings indicate that acupuncture-related therapy exhibits superior effectiveness in the treatment of migraine and clinical decision-making should be patient-specific.
PubMed: 38505499
DOI: 10.2147/JPR.S452971 -
Multiple Sclerosis and Related Disorders May 2024To look for any potential association of headache disorders with multiple sclerosis (MS). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To look for any potential association of headache disorders with multiple sclerosis (MS).
BACKGROUND
The prevalence of headache disorders has been found to be increased in people with MS (pwMS), however, an association has not been established. Existing studies have provided conflicting results mostly because of methodological differences.
METHODS
PubMed, Embase and Scopus were searched to identify eligible studies. Studies were included if they were cross-sectional, case-control or cohort. Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias of the included studies. Case-control, cross sectional or cohort studies that used the International Classification of Headache Disorders (ICHD)-2 or-3 criteria for headache diagnosis and Mc Donald or Poser criteria for MS diagnosis were included. Data were extracted using standardized data collection form. Meta-analysis was conducted by calculating the overall prevalence of headache disorders in pwMS as well as the association of headache disorders with MS. The Newcastle-Ottawa Scale (NOS), a tool for assessing the quality of non-randomized studies, was used to assess the quality of the included studies.
RESULTS
Twenty-three studies were included yielding a total of 5,440 MS patients and 28,0958 controls. The majority of them scored a NOS score between 5 and 6 (max 9), which indicates that they did not rank high in terms of quality, because most studies were cross-sectional and uncontrolled, and only one was prospective, controlled, and longitudinal, but with small population size. Pooled prevalence for all headache disorders, migraine and tension-type headache (TTH) in pwMS was 58 % (95 % CI 0.54-0.61), 30 % (95 % CI 0.25-0.34) and 19 % (95 % CI 0.15-0.23) respectively. A significant association between migraine and MS was found (OR = 2.02, 95 % CI = 1.14-3.57).
CONCLUSION
PwMS are twice as likely to experience migraine as controls, but the results need to be translated with caution since most of the studies included in the meta-analysis were of low or moderate quality. Larger prospective cohort, controlled, longitudinal studies are needed to confirm whether there is indeed an association between MS and migraine.
Topics: Humans; Multiple Sclerosis; Headache Disorders; Comorbidity
PubMed: 38489946
DOI: 10.1016/j.msard.2024.105536 -
Clinical NeuropharmacologyLasmiditan holds important potential in treating migraine, but its ideal dose remains elusive. This meta-analysis is conducted based on aggregate data and aims to... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Lasmiditan holds important potential in treating migraine, but its ideal dose remains elusive. This meta-analysis is conducted based on aggregate data and aims to compare the efficacy of lasmiditan 200 mg versus 100 mg for acute treatment of migraine attack.
METHODS
PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases were systematically searched, and we included the randomized controlled trials comparing the efficacy of lasmiditan 200 mg versus 100 mg for migraine patients. This meta-analysis was conducted using the random-effect model or fixed-effect model based on the heterogeneity. The primary outcome was pain free at 2 hours. Secondary outcomes included pain relief at 2 hours, pain free at 24 hours, most bothersome symptom free at 2 hours, and adverse events.
RESULTS
Seven randomized controlled trials and 6515 patients were included in this meta-analysis. Compared with lasmiditan 100 mg for migraine patients, lasmiditan 200 mg was able to significantly improve pain free at 2 hours (odd ratio [OR], 1.28; 95% confidence interval [CI], 1.14-1.44; P < 0.0001) and pain free at 24 hours (OR, 1.35; 95% CI, 1.14-1.60; P = 0.0005), but showed no effect on pain relief at 2 hours (OR, 1.00; 95% CI, 0.90-1.12; P = 0.98) or most bothersome symptom free at 2 hours (OR, 0.93; 95% CI, 0.83-1.03; P = 0.17). Lasmiditan 200 mg was associated with the increase in adverse events compared with lasmiditan 100 mg (OR, 1.28; 95% CI, 1.15-1.43; P < 0.0001).
CONCLUSIONS
Lasmiditan 200 mg is more effective to improve pain free at 2 hours and 24 hours than lasmiditan 100 mg for the acute treatment of migraine patients.
Topics: Humans; Treatment Outcome; Double-Blind Method; Serotonin Receptor Agonists; Migraine Disorders; Pain; Randomized Controlled Trials as Topic; Benzamides; Piperidines; Pyridines
PubMed: 38478364
DOI: 10.1097/WNF.0000000000000584