Overview on effectiveness of erenumab, fremanezumab, and galcanezumab in reducing medication overuse headache in chronic migraine patients.

BACKGROUND: Migraine is a disabling primary headache disorder with socioeconomic burden. Medication overuse headache (MOH) is caused by chronic overuse of symptomatic drugs often observed in migraine patients. The approved for migraine prevention CGRP antagonists erenumab, fremanezumab, and galcanezumab are effective in migraine prophylaxis but there are only few data regarding efficacy on MOH. AIM OF THE STUDY: To assess efficacy of erenumab, galcanezumab, and fremanezumab in reducing headache in patients with chronic migraine complicated by medication overuse headache. METHODS: Patients fitting International Classification of Headache Disorders 3rd Edition criteria for chronic migraine and MOH were enrolled and treated with CGRP antagonists without performing drug withdrawal. Efficacy was assessed by improvement of Migraine Impact and Disability Assessment Scale (MIDAS) and reduction of monthly use of symptomatic medications. Patients reporting a ≥ 50% reduction of monthly headache days and ≥ 50% reduction of analgesic and/or triptan use compared with a 3-month baseline period were defined as responders. RESULTS: Three hundred three patients, 252 females and 51 males, were enrolled. Patients were treated for at least 6 months up to 1 year. Two hundred forty-two out of 303 (80%) showed both a ≥ 50% reduction of monthly headache days and analgesics intake at 3-month follow-up visit compared to the 3-month baseline period; 239 on 303 (78.8%) continued to have ≥ 50% improvement in both at 6-month follow-up visit. CONCLUSION: Monoclonal antibodies inhibiting CGRP are effective in reducing monthly headache days in migraine patients with MOH.

The Role of Dental Occlusion and Neuromuscular Behavior in Professional Ballet Dancers' Performance: A Pilot Study.

Clinical practice and some scientific evidence seem to suggest that there is some kind of relationship between the components that form the postural chain. For professional dancers, good posture and balance are essential. The aim of the present retrospective study is to evaluate whether gnathological treatment could have an impact on the postural balance and sports performance of professional ballet dancers. Electromyographic (EMG) data and balance tests were recorded before and after six months of treatment with a customized occlusal splint. Twenty athletes were examined during ballet exercises in terms of balance and speed of execution by two experienced clinicians. The results showed statistically significant changes for all EMG tests carried out and the Flamingo Balance Test. It appears that the use of a customized occlusal device improved neuro-muscular coordination and the overall performance of dancers.

Transcutaneous supraorbital neurostimulation for the prevention of chronic migraine: a prospective, open-label preliminary trial.

Since chronic migraine is difficult to treat and often associated with medication overuse, non-invasive neurostimulation approaches are worth investigating. Transcutaneous supraorbital neurostimulation using the Cefaly® device is promising as a non-invasive preventive treatment for episodic migraine, but no data are available for chronic migraine. Our aim was to perform a preliminary evaluation of the efficacy of the Cefaly® device for the prophylaxis of chronic migraine with or without medication overuse. Primary endpoints were 50% reduction in monthly migraine days and 50% reduction in monthly medication use over 4 months. In an open-label study, twenty-three consecutive headache center patients with chronic migraine, diagnosed according to International Headache Society criteria, were recruited prospectively. After informed consent, patients were trained to use Cefaly® and instructed to use it for 20 min daily over 4 months. All patients received active neurostimulation. Thirty-five percent of the patients enrolled in the study achieved the study endpoints. Over half the patients had a greater than 50% reduction in acute medication consumption.

Study of parafunctions in patients with chronic migraine.

The purpose of this paper is to present the results of a questionnaire investigating parafunctions (particularly clenching and grinding) in patients with chronic migraine presenting sign of temporomandibular disorder. The questionnaire was elaborated by the Dental Clinic of the University of Milano and completed by 125 patients experiencing chronic migraine and attending the Neurological Institute Carlo Besta for an inpatient withdrawal protocol to treat medication overuse. Our results showed high percentages of parafunctions, which were present in 80 % of patients. We note that patient information on possible behaviours and coexisting conditions which may be involved in the mechanisms of chronic headaches, as well as education about these factors, are crucial aspects in the management of chronic headache patients. We suggest that patients suffering from chronic migraine with medication overuse headache should be evaluated in relation to the possible presence of parafunctions, and as far as the need for interocclusal devices, in order to limit the role of temporomandibular dysfunctions as trigger factors or coexisting conditions favouring the development/maintaining of headache chronification.