Pharmacological prophylaxis of chronic migraine: A review of double-blind placebo-controlled trials

U.O. Neurologia III-Cefalee, Fondazione IRCCS Istituto Neurologico C. Besta, Via Celoria 11, 20133, Milan, Italy.
Neurological Sciences (Impact Factor: 1.45). 06/2010; 31 Suppl 1(S1):S23-8. DOI: 10.1007/s10072-010-0268-7
Source: PubMed


Chronic migraine is an important public health problem. The aim of treatment should be to reduce migraine frequency and its negative impact on functioning, as well as to limit the use of acute medications. These goals may be accomplished by introducing effective prophylaxis. The aim of the present article is to critically review the published evidence on the pharmacological prophylaxis of chronic migraine, analysing published double-blind, placebo-controlled studies on adult patients. The results of the review indicate that tizanidine, gabapentin, valproic acid, and particularly topiramate are effective prophylactics against chronic migraine, with improvements in several endpoints that were significantly superior to those achieved by placebo. However, the different results found by different trials, as well as several methodological problems inherent in the trials, suggest the need for further research to provide clear indications from large, multicentre, controlled trials with homogeneous inclusion criteria and adequate endpoints.

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    • "Two-thirds of the subjects with CDH in the present study were diagnosed with CM. This high incidence suggests that CDH treatment strategies would benefit from recent advances in CM treatments.38,39,40,41 An effective treatment strategy for CDH other than that used for CM has not yet been identified.42 "
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    ABSTRACT: Background and Purpose Chronic daily headache (CDH) is a commonly reported reason for visiting hospital neurology departments, but its prevalence, clinical characteristics, and management have not been well documented in Korea. The objective of this study was to characterize the 1-year prevalence, clinical characteristics, medical consultations, and treatment for CDH in Korea. Methods The Korean Headache Survey (KHS) is a nationwide descriptive survey of 1507 Korean adults aged between 19 and 69 years. The KHS investigated headache characteristics, sociodemographics, and headache-related disability using a structured interview. We used the KHS data for this study. Results The 1-year prevalence of CDH was 1.8% (95% confidence interval, 1.1-2.5%), and 25.7% of the subjects with CDH met the criteria for medication overuse. Two-thirds (66.7%) of CDH subjects were classified as having chronic migraine, and approximately half of the CDH subjects (48.1%) reported that their headaches either substantially or severely affected their quality of life. Less than half (40.7%) of the subjects with CDH reported having consulted a doctor for their headaches and 40.7% had not received treatment for their headaches during the previous year. Conclusions The prevalence of CDH was 1.8% and medication overuse was associated with one-quarter of CDH cases in Korea. Many subjects with CDH do not seek medical consultation and do not receive appropriate treatment for their headaches.
    Journal of Clinical Neurology 07/2014; 10(3):236-43. DOI:10.3988/jcn.2014.10.3.236 · 1.70 Impact Factor
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    • "In turn, results of the present study complement previously reported data on mechanisms of therapeutic action of valproate as a preventive (D'Amico, 2010; Lovell and Marmura, 2010) and abortive (Leniger et al., 2005; Shahien et al., 2011) antimigraine agent. It is known that this anticonvulsant is capable of suppressing the cortical spreading depression (Ayata et al., 2006; Bogdanov et al., 2011; Mathew, 2011). "
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