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Migraine is a complex and highly disabling neurovascular disease that affects more than 1 billion people worldwide
.
Migraine is characterized by frequent repetitions, throbbing headache attacks and accompanying symptoms
.
Chronic migraine refers to headaches that occur for 8 days or more per month, and last for more than 3 months, and have migraine elements for at least 8 days per month
.
It is estimated that more than 10% of migraine sufferers suffer from chronic migraine, which can have a negative impact on many aspects of life, such as marriage, parenting, love and family relationships, professional/economic achievements and stability, and overall health
.
In order to reduce the burden of chronic migraine, experts recommend preventive treatment
.
How much do you know about the prevention points of chronic migraine? This article will test everyone's understanding through 5 small questions, let's try it together
.
Yimaitong compiles and organizes, please do not reprint without authorization
.
Question 1 What factors may contribute to migraine attacks in patients with chronic migraine? A.
Low humidity B.
Not eating C.
Grape juice D.
Neuroepilepsy drugs Figure 1 Single photon emission computed tomography (SPECT) image of a patient's brain during a typical migraine attack
.
The color-coded image shows the metabolically active areas of the brain (red); the low activity of reduced blood flow is caused by migraines (lower left corner)
.
Slide to view the answer↓↓↓↓↓↓↓↓↓【Answer and Analysis】B
.
Avoiding factors that trigger migraine attacks is an important part of chronic migraine prevention
.
Some common triggers for migraine include not eating, high humidity, red wine, stress, and the use of certain medications
.
Question 2 What conditions may be an indication for preventive treatment of migraine patients? A.
A single attack lasts more than 12 hours B.
Migraine attacks more than 2 times a month C.
Use of abortion drugs more than once a week D.
Insufficient use of frustration treatment slide to see the answer↓↓↓↓↓↓↓↓↓【Answer and A]
B .
The goal of preventive treatment is to reduce the frequency, severity, and duration of migraine attacks
.
Preventive treatment may also improve the response to acute migraine treatment and improve the patient's quality of life
.
The indications for preventive migraine treatment may include: ➤The frequency of migraine attacks: more than 2 times a month
.
➤ Duration of a single attack: more than 24 hours
.
➤The patient's life>
.
➤Sudden treatment failure or overuse
.
➤Contraindications or ineffectiveness of symptomatic drugs
.
➤Use more than twice a week frustration drugs
.
Preventive treatment is also suitable for patients with hemiplegic migraines or rare headache attacks (resulting in the risk of severe damage or permanent nerve damage)
.
Question 3 What kind of drugs are used for the preventive treatment of chronic migraine? A.
Vasopressors B.
Beta blockers C.
Selective serotonin reuptake inhibitors (SSRI) D.
Atypical antipsychotics slide to see the answer↓↓↓↓↓↓↓↓↓【Answer and A]
B .
Like frustration drugs, the choice of preventive drugs for patients with chronic migraine must consider comorbidities and side effects
.
Beta blockers are first-line drugs for migraine prevention, two of which have been approved by the U.
S.
Food and Drug Administration (FDA) for migraine prevention (propranolol and timolol)
.
Other first-line drugs include tricyclic antidepressants (not approved by the FDA) and two anticonvulsants, divalproex sodium and topiramate (both approved by the FDA)
.
The only FDA-approved therapy specifically for the prevention of chronic migraine is botulinum toxin A
.
Question 4 Which of the following statements accurately describes patients with chronic migraine and allodynia? A.
Men are associated with a higher incidence of allodynia.
B.
Beta blockers are more effective than tricyclic antidepressants in alleviating allodynia.
C.
Anticonvulsants and tricyclic antidepressants are more effective in relieving abnormal pain.
Sexual pain is as effective as preventive treatment.
D.
The duration and severity of migraine does not seem to increase the risk of allodynia.
Slide to see the answer↓↓↓↓↓↓↓↓↓【Answer and analysis】C
.
In patients with chronic migraine with allodynia, a randomized controlled trial found that anticonvulsants (divalproex sodium) and tricyclic antidepressants (amitriptyline) are less effective in relieving allodynia.
Preventive treatment is equally effective
.
The presence of allodynia has been shown to be related to women and the duration, severity and frequency of migraines
.
Question 5 Which statements about drug treatment to prevent chronic migraine are accurate? A.
For most patients, antiepileptic drugs used for migraine prevention are effective and well tolerated.
B.
No non-steroidal anti-inflammatory drugs have been proven to be superior to placebo in preventing migraine.
C.
Not yet proven Combination therapy of beta-blockers and behavior management can improve results D.
Compared with other preventive drugs, the reduction in the frequency of administration of calcitonin gene-related peptide inhibitors can improve the compliance of patients with chronic migraine.
Slide View Answers ↓↓↓↓↓↓↓↓↓【Answer and Analysis】D
.
Calcitonin gene-related peptide inhibitors such as erenumab, fremanezumab, galcanezumab and eptinezumab have been approved by the FDA for the prevention of migraine
.
These drugs can reduce the frequency of migraine attacks, the number of headache days, and the use of acute medications; in addition, compared with other preventive drugs, reducing the dose may help improve compliance
.
Antiepileptic drugs are effective, but adverse events cause most patients to discontinue the drug within 6-12 months
.
With topiramate, hypoesthesia and cognitive delay may occur; with divalproex sodium, adverse events may include weight gain, hair loss, and polycystic ovary disease
.
In controlled clinical trials, the non-steroidal anti-inflammatory drug naproxen sodium is more effective than placebo and is similar to propranolol
.
However, the drug should be reserved for short-term use, such as for menstrual migraine
.
Beta-blocker therapy combined with behavioral management can improve the outcome of patients with frequent migraine attacks
.
Yimaitong compiled from: Stephanie J.
Nahas.
Fast Five Quiz: Chronic Migraine Prevention-Medscape-Jul 01, 2021.
.
Migraine is characterized by frequent repetitions, throbbing headache attacks and accompanying symptoms
.
Chronic migraine refers to headaches that occur for 8 days or more per month, and last for more than 3 months, and have migraine elements for at least 8 days per month
.
It is estimated that more than 10% of migraine sufferers suffer from chronic migraine, which can have a negative impact on many aspects of life, such as marriage, parenting, love and family relationships, professional/economic achievements and stability, and overall health
.
In order to reduce the burden of chronic migraine, experts recommend preventive treatment
.
How much do you know about the prevention points of chronic migraine? This article will test everyone's understanding through 5 small questions, let's try it together
.
Yimaitong compiles and organizes, please do not reprint without authorization
.
Question 1 What factors may contribute to migraine attacks in patients with chronic migraine? A.
Low humidity B.
Not eating C.
Grape juice D.
Neuroepilepsy drugs Figure 1 Single photon emission computed tomography (SPECT) image of a patient's brain during a typical migraine attack
.
The color-coded image shows the metabolically active areas of the brain (red); the low activity of reduced blood flow is caused by migraines (lower left corner)
.
Slide to view the answer↓↓↓↓↓↓↓↓↓【Answer and Analysis】B
.
Avoiding factors that trigger migraine attacks is an important part of chronic migraine prevention
.
Some common triggers for migraine include not eating, high humidity, red wine, stress, and the use of certain medications
.
Question 2 What conditions may be an indication for preventive treatment of migraine patients? A.
A single attack lasts more than 12 hours B.
Migraine attacks more than 2 times a month C.
Use of abortion drugs more than once a week D.
Insufficient use of frustration treatment slide to see the answer↓↓↓↓↓↓↓↓↓【Answer and A]
B .
The goal of preventive treatment is to reduce the frequency, severity, and duration of migraine attacks
.
Preventive treatment may also improve the response to acute migraine treatment and improve the patient's quality of life
.
The indications for preventive migraine treatment may include: ➤The frequency of migraine attacks: more than 2 times a month
.
➤ Duration of a single attack: more than 24 hours
.
➤The patient's life>
.
➤Sudden treatment failure or overuse
.
➤Contraindications or ineffectiveness of symptomatic drugs
.
➤Use more than twice a week frustration drugs
.
Preventive treatment is also suitable for patients with hemiplegic migraines or rare headache attacks (resulting in the risk of severe damage or permanent nerve damage)
.
Question 3 What kind of drugs are used for the preventive treatment of chronic migraine? A.
Vasopressors B.
Beta blockers C.
Selective serotonin reuptake inhibitors (SSRI) D.
Atypical antipsychotics slide to see the answer↓↓↓↓↓↓↓↓↓【Answer and A]
B .
Like frustration drugs, the choice of preventive drugs for patients with chronic migraine must consider comorbidities and side effects
.
Beta blockers are first-line drugs for migraine prevention, two of which have been approved by the U.
S.
Food and Drug Administration (FDA) for migraine prevention (propranolol and timolol)
.
Other first-line drugs include tricyclic antidepressants (not approved by the FDA) and two anticonvulsants, divalproex sodium and topiramate (both approved by the FDA)
.
The only FDA-approved therapy specifically for the prevention of chronic migraine is botulinum toxin A
.
Question 4 Which of the following statements accurately describes patients with chronic migraine and allodynia? A.
Men are associated with a higher incidence of allodynia.
B.
Beta blockers are more effective than tricyclic antidepressants in alleviating allodynia.
C.
Anticonvulsants and tricyclic antidepressants are more effective in relieving abnormal pain.
Sexual pain is as effective as preventive treatment.
D.
The duration and severity of migraine does not seem to increase the risk of allodynia.
Slide to see the answer↓↓↓↓↓↓↓↓↓【Answer and analysis】C
.
In patients with chronic migraine with allodynia, a randomized controlled trial found that anticonvulsants (divalproex sodium) and tricyclic antidepressants (amitriptyline) are less effective in relieving allodynia.
Preventive treatment is equally effective
.
The presence of allodynia has been shown to be related to women and the duration, severity and frequency of migraines
.
Question 5 Which statements about drug treatment to prevent chronic migraine are accurate? A.
For most patients, antiepileptic drugs used for migraine prevention are effective and well tolerated.
B.
No non-steroidal anti-inflammatory drugs have been proven to be superior to placebo in preventing migraine.
C.
Not yet proven Combination therapy of beta-blockers and behavior management can improve results D.
Compared with other preventive drugs, the reduction in the frequency of administration of calcitonin gene-related peptide inhibitors can improve the compliance of patients with chronic migraine.
Slide View Answers ↓↓↓↓↓↓↓↓↓【Answer and Analysis】D
.
Calcitonin gene-related peptide inhibitors such as erenumab, fremanezumab, galcanezumab and eptinezumab have been approved by the FDA for the prevention of migraine
.
These drugs can reduce the frequency of migraine attacks, the number of headache days, and the use of acute medications; in addition, compared with other preventive drugs, reducing the dose may help improve compliance
.
Antiepileptic drugs are effective, but adverse events cause most patients to discontinue the drug within 6-12 months
.
With topiramate, hypoesthesia and cognitive delay may occur; with divalproex sodium, adverse events may include weight gain, hair loss, and polycystic ovary disease
.
In controlled clinical trials, the non-steroidal anti-inflammatory drug naproxen sodium is more effective than placebo and is similar to propranolol
.
However, the drug should be reserved for short-term use, such as for menstrual migraine
.
Beta-blocker therapy combined with behavioral management can improve the outcome of patients with frequent migraine attacks
.
Yimaitong compiled from: Stephanie J.
Nahas.
Fast Five Quiz: Chronic Migraine Prevention-Medscape-Jul 01, 2021.
