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J Headache Pain: The second cause of disabling, the blasting migraine!

 Last Update: 2022-08-12
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Summary

abstract abstract

According to the Global Burden of Disease (GBD) study, headache is one of the most prevalent and disabling diseases worldwide, including general headache, migraine and tension-type headache, with the prevalence of migraine increasi.

According to the 2019 Global Burden of Disease (GBD) study, migraine alone ranks second as a cause of disability and first among women under the age of 5 These data are enough to show the danger of migrai.

52% of people worldwide suffer from headaches every year, especially women

A research team led by epidemiologists from the Norwegian University of Science and Technology summarized epidemiological headache studies published between 1961 and 2020 and found that 52% of people worldwide suffer from some form of headache disease [1], related research results The title " The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates " (Figure 1), was published in The Journal of Headache and Pa.

The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates

Figure 1 Research results (source: [1])

For this study, the researchers retrieved 357 research papers published as of 2020 on the prevalence of headaches through a literature sear.

In addition, the researchers found:

① All headache types are more common in women, and migraine has the largest difference between the sexes (prevalence in women is 17%, prevalence in men is 6%);

②Women are more likely to report headaches as a persistent health problem, with 6% of women reporting that their headaches last 15 days or more per month, compared with 9% of men who have the same probl.

Lars Jakob Stoffner, a neuroscientist at the Norwegian University of Science and Technology, said: "The prevalence of headache disorders is high worldwide, and we should take steps to reduce this disease through prevention as well as treatme.

The pathogenesis and common triggers of migraine

The pathogenesis of migraine

● Vascular theory

The vascular theory believes that the symptoms of migraine are caused by vasomotor dysfunction, which is mainly based on changes in the levels of vasoactive substances, such as serotonin (5-HT), during migraine attacks [

● The theory of cortical spreading depression (CSD)

The essence of CSD is an electrophysiological phenomenon, which is caused by the excitation of local neurons in the cerebral cortex causing excessive depolarization of neurons, and the phenomenon of excessive depolarization wave diffusion from local to surroundi.

● Trigeminal Vascular Theory (TVS)

The TVS theory believes that migraine occurs because of the dysfunction of the endogenous analgesic system of the trigeminal vascular system and the central nervous system, coupled with internal and external stimulati.

Common triggers of migraine

Migraine is an episodic disorder that is often associated with a variety of triggers, including sleep deprivation, food additives, alcohol, caffeine, fasting, artificial sweeteners, substance abuse, stress, and obstructive sleep apnea syndrome e.

How to effectively diagnose and manage migraine?

Despite the prevalence of headaches and migraine, their diagnosis and treatment are currently inadequa.

Figure 2 Research results (source: [4])

In this consensus statement, a European panel of experts developed a ten-step approach to migraine diagnosis and management (Figure

Figure 3 Ten-step approach to migraine diagnosis and management (Source: [4])

The ten-step approach to migraine diagnosis and management includes: when to suspect migraine; diagnosis of migraine; education and patient-centredness; acute treatment; preventive treatment; management of migraine in special populations; follow-up, treatment response and failure; Management of complications; identification and management of comorbidities; long-term follow-.

This article focuses on the preventive treatment of migrai.

It is worth mentioning that the discovery of the key target of calcitonin gene-related peptide (CGRP) has made a breakthrough in the preventive treatment of migrai.

NURTEC, ODT that combines prevention and treatment in one "tablet"

NURTEC developed by Biohaven? ODT (Rimegepant) is the first and only CGRP receptor antagonist with a rapidly dissolving orally disintegrating tablet form, and is currently the only oral CGRP receptor antagonist approved for both the treatment and prevention of migrai.

Rimegepant was approved by the FDA in 2020 for the acute treatment of migraine in adults, and was approved for a new indication in May 2021 for the preventive treatment of migrai.

Long half-life, good oral bioavailability and high affinity for CGRP receptors make it a potential best-in-class anti-acute migraine drug [

In a 2021 study published in The Lancet (Figure 4), researchers compared rimegepant to placebo in the prevention and treatment of migrai.

In the study, subjects were randomly assigned to the Rimegepant group (348) and the placebo group (347), taking either Rimegepant or placebo daily for 12 wee.

The researchers found that between weeks 9-12, Rimegepant was superior to the placebo group in the change in the average number of migraine days per month, with patients in the Rimegepant group experiencing a 3-day reduction in the average number of migraine days per month compared with the placebo gro.

5 days less [

Figure 4 Research results (Source: The Lancet)

Compared with triptans, oral CGRP-targeted drugs show strong growth momentum, so Rimegepant has huge market potenti.

Novartis' blockbuster new migraine drug Erenumab

Erenumab is a fully human monoclonal antibody jointly developed by Amgen and Novartis that prevents migraine by blocking the activity of calcitonin gene-related peptide (CGR.

Erenumab was approved by the FDA in May 2018, becoming the first approved CGRP receptor antagonist; in July of the same year, Erenumab was launched in the European Uni.

In March 2021, Novartis announced positive results from the Phase III DRAGON study, meeting the primary endpoi.

This is a randomized, double-blind, multicenter, placebo-controlled phase III clinical trial to evaluate the efficacy and safety of Erenumab in the prophylactic treatment of chronic migraine in adul.

The study enrolled 557 patien.

Asian-centric, Chinese-dominated populati.

The data showed that the erenumab group was significantly better than the placebo group on the efficacy endpoint (primary endpoint) of reducing monthly migraine headaches (MMD) from baseline in the final 4 weeks of the 12-week double-blind treatment peri.

Moreover, the response rate of more than 50% reduction in monthly migraine headaches from baseline was significantly higher in the Erenumab group than in the placebo group, and no serious adverse events were found during the tri.

At present, no CGRP drug has been approved in China, and Novartis' Erenumab is expected to become the first in Chi.

Migraine is affecting more and more people, and it has a tendency to be young.

It has a certain negative impact on our life and work, and should be paid attention .

In daily life, pay attention to sleep and rest to avoid excessive fatigue; pay attention to the signs and symptoms of migraine, and seek medical attention in time if you find discomfo.

Because migraine is especially preferred to women, women should pay special attention to the prevention of migraine, maintain healthy eating habits and daily routine during menstruation, and ensure adequate sle.

At the same time, you should also avoid taking some medicines and foods that trigger migraine attacks, such as cured meats, cheese, chocolate containing phenethylamine, and snacks containing sodium glutama.

References:

[1] Stovner LJ, Hagen K, Linde M, et .

The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimate.

J Headache Pa.

2022 Apr 12;23(1):3
doi: 11186/s10194-022-01402- PMID: 35410119; PMCID: PMC900418 The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates

[2] Zhou Xia, Sun Zhong.

The pathogenesis, diagnosis and treatment progress of migraine [.

Chinese General Medicine, 2019, 17(05): 714-71

[3] Ye Shenqiong, Wang Xiangming, Zhang Yueh.

Research progress on the pathogenesis of migraine [.

Medical Review, 2020, 26(06): 1086-109

[4] Eigenbrodt AK, Ashina H, Khan S, et .

Diagnosis and management of migraine in ten ste.

Nat Rev Neur.

2021 Aug;17(8):501-51 doi:11038/s41582-021-00509-Epub 2021 Jun 1 PMID: 34145431; PMCID: PMC832189

[5] Migraine attack, do not use the wrong medicine

[6]Rimegepant: The second oral anti-migraine CGRP preparation, launched in the United States, is expected to surpass Ubrogepant in sales

[7] Croop R, Lipton RB, Kudrow D, et .

Oral rimegepant for preventive treatment of migraine: a phase 2/3, randomised, double-blind, placebo-controlled tri.

Lanc.

2021 Jan 2;397(10268) : 51-6 doi: 11016/S0140-6736(20)32544- Epub 2020 Dec 1 PMID: 3333843

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