Headache Disorders: New Advances in Management and Treatment Strategies

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 31 July 2024 | Viewed by 3757

Special Issue Editors

Neurology Department, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece
Interests: headache; pain; neuromuscular disorders; epilepsy; neurooncology
Headache Clinic, Mediterraneo Hospital, 166 75 Glyfada, Greece
Interests: headache; migraine; pain
Euromedica General Clinic, 546 45 Thessaloniki, Greece
Interests: headache; migraine; pain

Special Issue Information

Dear Colleagues,

The recent market release of monoclonal antibodies (MAbs), specifically targeting the calcitonin gene-related peptide (CGRP) or its receptor (anti-CGRP MAbs), based on the results of clinical trials and real-life data, appeared as a promising preventative option in both episodic and chronic migraine patients with a much higher efficacy/tolerability ratio, compared to the already available oral and injectable prophylactic treatment of armamentarium. Four anti-CGRP MAbs are currently in use for the prevention of episodic and chronic migraines, including erenumab used to target the CGRP-receptor and fremanezumab, galcanezumab and eptinezumab used to target the CGRP ligand. In addition, anti-CGRP MAbs can be used wth some degree of success as preventives in other headache disorders, such as cluster and post-traumatic headaches. There are, however, unmet needs associated with the prophylactic management of these headache disorders, because of inadequate headache frequency reduction in about one third of migraine patients and an even higher percentage of treatment failure in cluster and post-traumatic headache patients. Significant unmet needs are also present in the symptomatic management of these headache disorders. To overcome these issues, new acute pharmacological options for headaches have been studied in the last few years, including gepants, a class of small molecules that target the CGRP receptor, and ditans, a class of non-triptan serotonin receptor antagonists. Gepants have been also explored in migraine prevention.

The scope of this Special Issue is to summarize our existing knowledge on the pros and cons of modern therapies for headache disorders, to examine open clinical and pathogenetic issues and to explore future perspectives for future research to pursue. As such, both research papers and reviews are welcome. Thank you for agreeing to contribute towards the successful release of this Special Issue for the Journal of Clinical Medicine. The Co-Editors and I are confident that it will become a reference point for all those who want to know why, when, and how to treat headache patients with monoclonal antibodies that target the CGRP, gepants or ditans.

Dr. Andreas A. Argyriou
Dr. Vikelis Michail
Dr. Emmanouil V. Dermitzakis
Guest Editors

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Keywords

  • headache
  • migraine
  • cluster headache
  • post-traumatic headache
  • acute treatment
  • prophylaxis
  • calcitonin gene-related peptide
  • monoclonal antibodies
  • gepants
  • ditans

Published Papers (3 papers)

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Research

8 pages, 209 KiB  
Article
A Novel Virtual-Based Comprehensive Clinical Approach to Headache Care
J. Clin. Med. 2023, 12(16), 5349; https://doi.org/10.3390/jcm12165349 - 17 Aug 2023
Viewed by 1021
Abstract
One major innovation, a result of the coronavirus pandemic, has been the proliferation of telemedicine. Telehealth can help solve the access problems that plague headache medicine, allowing patients in areas with no headache expertise to consult and work with a headache specialist. This [...] Read more.
One major innovation, a result of the coronavirus pandemic, has been the proliferation of telemedicine. Telehealth can help solve the access problems that plague headache medicine, allowing patients in areas with no headache expertise to consult and work with a headache specialist. This is a retrospective chart review of patients seen by Neura Health, a comprehensive app-based telehealth headache center. Patients are seen by a specialist and, in addition to any medical recommendations, are given care plans individualized to their condition and recommendations at the end of their clinical appointments. The primary outcome of this study is a decrease in monthly headache days after 90 days; secondary outcomes include disability as determined by MIDAS score, depression determined by PHQ-9, patients’ utilization of emergency department or urgent care resources, as well as their global impression of improvement. The deidentified outcomes of consecutive patients of Neura Health were evaluated from March 2022–March 2023. Subjects were excluded if they did not complete all forms, or if they did not receive a clinical or coaching follow-up appointment within 90 days. A total of 186 consecutive patients at Neura Health were identified during the review period. The median decrease in monthly headache days was 55.0% after a 90 day period, headache severity was decreased by 16.7%, global impression of improvement increased by 60.9%, disability decreased by 38.7%, depression decreased by 12.5% and ER/urgent care visits were decreased by 66.1%. A comprehensive, telehealth-based virtual headache-care model significantly decreased migraine frequency, severity and disability, and is able to decrease ER or urgent care visits. Full article
10 pages, 1230 KiB  
Article
Effects of Fremanezumab on Psychiatric Comorbidities in Difficult-to-Treat Patients with Chronic Migraine: Post Hoc Analysis of a Prospective, Multicenter, Real-World Greek Registry
J. Clin. Med. 2023, 12(13), 4526; https://doi.org/10.3390/jcm12134526 - 06 Jul 2023
Cited by 1 | Viewed by 1171
Abstract
Objective: this post hoc analysis aimed to evaluate the efficacy of fremanezumab in difficult-to-treat chronic migraine (CM) patients with and without psychiatric comorbidities (PCs), mainly anxiety and/or depression. Methods: We assessed data from CM patients with and without PCs who failed at least [...] Read more.
Objective: this post hoc analysis aimed to evaluate the efficacy of fremanezumab in difficult-to-treat chronic migraine (CM) patients with and without psychiatric comorbidities (PCs), mainly anxiety and/or depression. Methods: We assessed data from CM patients with and without PCs who failed at least 3 preventives and eventually received at least 3 consecutive monthly doses of fremanezumab 225 mg. Outcomes included the crude response (≥50% reduction in monthly headache days (MHDs)) rates to fremanezumab from the baseline to the last clinical follow-up. The changes in MHDs; MHDs of moderate/greater severity; monthly days with intake of abortive medication; and the proportion of patients’ changing status from with PCs to decreased/without PCs were also compared. Disability and quality of life (QOL) outcomes were also assessed. Results: Of 107 patients enrolled, 65 (60.7%) had baseline PCs. The percentage of patients with (n = 38/65; 58.5%) and without (n = 28/42; 66.6%) PCs that achieved a ≥50% reduction in MHDs with fremanezumab was comparable (p = 0.41), whereas MHDs were significantly reduced (difference vs. baseline) in both patients with PCs (mean −8.9 (standard error: 6.8); p < 0.001) and without PCs (−9.8 (7.5); p < 0.001). Both groups experienced significant improvements in all other efficacy, disability, and QOL outcomes at comparable rates, including in MHD reduction. A significant proportion of fremanezumab-treated patients with baseline PCs de-escalated in corresponding severities or even reverted to no PCs (28/65; 43.1%) post-fremanezumab. Conclusions: fremanezumab appears to be effective as a preventive treatment in difficult-to-treat CM patients with and without PCs while also being beneficial in reducing the severity of comorbid anxiety and/or depression. Full article
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10 pages, 267 KiB  
Article
Predictors of Response to Fremanezumab in Migraine Patients with at Least Three Previous Preventive Failures: Post Hoc Analysis of a Prospective, Multicenter, Real-World Greek Registry
J. Clin. Med. 2023, 12(9), 3218; https://doi.org/10.3390/jcm12093218 - 29 Apr 2023
Cited by 3 | Viewed by 1256
Abstract
Objective: To define, in a real-world population of patients with high-frequency episodic (HFEM) or chronic migraine (CM), the predictive role of socio-demographic or phenotypic profiling of responders to fremanezumab. Patients and methods: Two-hundred and four adult fremanezumab-treated patients with either HFEM or CM, [...] Read more.
Objective: To define, in a real-world population of patients with high-frequency episodic (HFEM) or chronic migraine (CM), the predictive role of socio-demographic or phenotypic profiling of responders to fremanezumab. Patients and methods: Two-hundred and four adult fremanezumab-treated patients with either HFEM or CM, who failed to at least three preventive treatments, provided data at baseline on several individual socio-demographic and phenotypic variables. These variables were analyzed for their ability to independently predict the response (50–74% response rates) or super-response (≥ 75% response rates) to fremanezumab. Patients were followed from 3–18 months of fremanezumab exposure. Results: The main finding to emerge from univariate analyses was that three baseline socio-demographic/clinical variables, i.e., age group 41–70 years (p = 0.02); female gender (p = 0.03); patients with HFEM (p = 0.001), and three clinical phenotypic variables, i.e., strict unilateral pain (p = 0.05); pain in the ophthalmic trigeminal branch (p = 0.04); and the “imploding” quality of pain (p = 0.05), were significantly related to fremanezumab response. However, in multivariate analysis, only HFEM (p = 0.02), the presence of strict unilateral (p = 0.03), and pain location in the ophthalmic trigeminal branch (p = 0.036) were independently associated with good fremanezumab response. Allodynia (p = 0.04) was the only clinical predictive variable of super-responsiveness to fremanezumab. Conclusions: A precise phenotypic profiling with identification of pain characteristics consistent with peripheral and/or central sensitization might reliably predict the responsiveness to fremanezumab in migraine prophylaxis. Full article
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