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June 10, 2020 In Headache,Medication,Migraine

Monoclonal Antibodies Against CGRP

Monoclonal Antibodies Against CGRP

Calcitonin gene-related peptide (CGRP) in humans exists in two forms: α-CGRP and β-CGRP. α-CGRP is a 37-amino acid neuropeptide produced in both peripheral and central neurons. It is a potent peptide vasodilator and can function in the transmission of pain.

Since April of 2018 there are new medicines on the market that contain antibodies against CGRP. They are called monoclonal antibodies (MABs) and are large molecules that do not cross the blood-brain barrier, do not interact with other drugs and have a longer half-life than many chemical drugs.

These drugs must be given parenterally (preferably by injection) to be absorbed properly by the body.
CGRP-MABs have been proved to be effective in migraine patients both with and without aura, and both episodic and chronic migraineurs. These are the first class of preventive medications originally designed and approved for migraineurs.

The first approved by the FDA is called Erenumab (trade name Aimovig) it blocks the CGRP receptor. It is injected SC once monthly with a dose of 70 or 140MG.

The second approved by the FDA is called Fremanezumab (trade name Ajovy). It blocks the CGRP ligand. It may be administered SC monthly (225mg) or every three months (675mg), giving options for users.

The third approved by the FDA is called Galcanezumab (trade name Emgality). It also blocks the CGRP ligand. It is injected SC once a month (120mg), after the first month having a double dose (240mg).

The new latest drug, Eptinezumab (Vyepti), is an intravenous migraine prophylactic medication injected SC every 3 months.

Posted by itsolutionsmart
June 10, 2020 In Botox,Headache,Medication,Migraine

Botox for Chronic Migraines

Botox for Chronic Migraines

Botox is FDA-approved for chronic migraines (headaches on 15 or more days a month), since 2010. Botox is not recommended for patients who experience fewer than 15 headache days a month. Botox is a form of botulinum toxin, a neurotoxin produced by the bacteria that causes botulism. When the botulinum toxin is purified and used in tiny doses in specific areas, it temporarily reduces muscle contractions for approximately 3 months.

Botox is injected around pain fibers that are involved in headaches. Botox enters the nerve endings around where it is injected and blocks the release of chemicals involved in pain transmission. This prevents activation of pain networks in the brain.

Botox prevents migraine headaches before they start, but takes time to work. Patients will see a decrease in headache frequency with an increase in the number of treatment cycles. One treatment lasts for 10-12 weeks.
In general, the FDA-recommended dosage is 155 units. The doctor uses a very small needle that feels like a pinprick and injects small amounts of Botox into shallow muscles in the skin. Each treatment typically involves 31 injections in seven key areas of the head and neck.

The most common side effect from the Botox shots is a sore neck, and we recommend using an ice pack to reduce the discomfort.

Because Botox is FDA approved for chronic migraines, it’s covered by most plans, including Medicare and Medicaid. Before your insurance approves Botox as a treatment for your chronic migraine, you typically must have tried and failed two other preventative treatments (anti-seizure medications, antidepressants, or blood pressure medications).

Posted by Migrane-Now
June 4, 2020 In Headache,Medication,Migraine,MOH

Medication Overuse Headaches (MOH)

Medication Overuse Headaches (MOH)

Medication overuse headache (MOH), previously called rebound headache, drug-induced headache, and medication misuse headache, is a subset of chronic daily headache (CDH), occurring on 15 days or more per month, 4 or more hours per day, for 3 or more months with the added feature of overuse of at least 1 class of abortive drug. In clinical practice, the common scenario is a patient with episodic migraine (EM) that transforms to chronic migraine (CM) in the setting of overusing 1 or more classes of abortive drugs. The main classes of drugs that cause MOH are: opioids, butalbital-containing mixed analgesics, triptans, simple analgesics, except for plain aspirin, and perhaps NSAIDs. There is an increase in frequency and intensity of headache attacks and enhanced sensitivity to stimuli that would trigger these attacks.

MOH prevalence is estimated in about 1-2% of the general population and is overwhelmingly more prevalent in women than in men. In specialized headache centers, the prevalence of MOH can be as high as 70% among referred patients, and if its high socioeconomic impact is taken into account (work absenteeism, recurrent emergency room visits, hospital admissions, and unnecessary diagnostic tests), MOH is likely to be one of the most if not the most costly neurological disorder known.

The general quality of life of MOH patients is worse than patients with episodic headaches

The most frequent headache diagnoses at onset are the following: migraine in 65%, tension-type headaches in 27%, and mixed or other headaches in 8%.

It also appears that migraine starts earlier in the life of patients with MOH than in those with EM. Cluster headache with coexisting migraine disorder can also be susceptible to developing MOH, and triptans along with opioids are the most common offending drugs.

The treatment of MOH consists of discontinuation of the offending drug(s), acute treatment of the withdrawal symptoms and escalating pain, establishing a preventive treatment when necessary, and the implementation of educational and behavioral programs to prevent recidivism.

In most patients MOH can be treated in the outpatient setting but for the most difficult cases including those with opioid or butalbital overuse, or in patients with serious medical or behavioral disturbances, effective treatment requires a multidisciplinary, comprehensive headache program, either day-hospital with infusion or inpatient hospital setting.

Posted by Migrane-Now