Migraine Disorders: Lipton RB

Silberstein S, Tfelt-Hansen P, Dodick DW, Limmroth V, Lipton RB, Pascual J, Wang SJ, Anonymous00408. · Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. [corrected] · Cephalalgia. · Pubmed #18294250 No free full text.

Abstract: In 1991 the Clinical Trials Subcommittee of the International Headache Society (IHS) developed and published its first edition of the Guidelines on controlled trials of drugs in episodic migraine because only quality trials can form the basis for international collaboration on drug therapy, and these Guidelines would 'improve the quality of controlled clinical trials in migraine'. With the current trend for large multinational trials, there is a need for increased awareness of methodological issues in clinical trials of drugs and other treatments for chronic migraine. These Guidelines are intended to assist in the design of well-controlled clinical trials of chronic migraine in adults, and do not apply to studies in children or adolescents.

Anonymous00401, Olesen J, Bousser MG, Diener HC, Dodick D, First M, Goadsby PJ, Göbel H, Lainez MJ, Lance JW, Lipton RB, Nappi G, Sakai F, Schoenen J, Silberstein SD, Steiner TJ. · Department of Neurology, University of Copenhagen, Glostrup Hospital, Demark. · Cephalalgia. · Pubmed #16686915 No free full text.

Abstract: After the introduction of chronic migraine and medication overuse headache as diagnostic entities in The International Classification of Headache Disorders, Second Edition, ICHD-2, it has been shown that very few patients fit into the diagnostic criteria for chronic migraine (CM). The system of being able to use CM and the medication overuse headache (MOH) diagnosis only after discontinuation of overuse has proven highly unpractical and new data have suggested a much more liberal use of these diagnoses. The International Headache Classification Committee has, therefore, worked out the more inclusive criteria for CM and MOH presented in this paper. These criteria are included in the appendix of ICHD-2 and are meant primarily for further scientific evaluation but may be used already now for inclusion into drug trials, etc. It is now recommended that the MOH diagnosis should no longer request improvement after discontinuation of medication overuse but should be given to patients if they have a primary headache plus ongoing medication overuse. The latter is defined as previously, i.e. 10 days or more of intake of triptans, ergot alkaloids mixed analgesics or opioids and 15 days or more of analgesics/NSAIDs or the combined use of more than one substance. If these new criteria for CM and MOH prove useful in future testing, the plan is to include them in a future revised version of ICHD-2.

Lipton RB, Derby CA. · No affiliation provided · BMJ. · Pubmed #18687723 No free full text.

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Schulman EA, Lake AE, Lipton RB. · No affiliation provided · Headache. · Pubmed #18549355 No free full text.

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Lipton RB, Bigal ME. · No affiliation provided · JAMA. · Pubmed #16849667 No free full text.

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Lipton RB, Bigal ME. · No affiliation provided · Headache. · Pubmed #15705113 No free full text.

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Logroscino G, Lipton RB. · No affiliation provided · Neurology. · Pubmed #15623674 No free full text.

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Lipton RB, Bigal ME. · No affiliation provided · Neurology. · Pubmed #15159457 No free full text.

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Lipton RB, Pan J. · No affiliation provided · JAMA. · Pubmed #14747508 No free full text.

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Lipton RB. · No affiliation provided · Headache. · Pubmed #12786923 No free full text.

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Lipton RB. · No affiliation provided · Neurology. · Pubmed #10668682 No free full text.

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Bigal ME, Kurth T, Hu H, Santanello N, Lipton RB. · Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA. · Neurology. · Pubmed #19470970 No free full text.

Abstract: Migraine, especially migraine with aura (MA), is an established risk factor for ischemic lesions of the brain. Recent evidence has also linked migraine to a broader range of ischemic vascular disorders including angina, myocardial infarction, coronary revascularization, claudication, and cardiovascular mortality. The mechanisms which link migraine to ischemic vascular disease remain uncertain and are likely to be complex. Cortical spreading depression, the presumed substrate of aura, may directly predispose to brain lesions and that would explain why MA is consistently demonstrated as a risk factor for cerebral ischemia, while for migraine without aura (MO), the evidence is less consistent. Additionally, individuals with migraine have a higher prevalence of risk factors known to be associated with cardiovascular disease (CVD), including hypertension, diabetes, and hyperlipidemia. The increased prevalence of CVD risk factors is also higher for MA than for MO. Since the evidence linking migraine and CVD is getting robust, neurologists should be aware of this association. Individuals with MO seem to be at little increased risk of CVD. MA is associated with an increased risk of ischemic stroke and likely also for other ischemic CVD events. Accordingly, heightened vigilance is recommended for modifiable cardiovascular risk factors in migraineurs, especially with MA. Ultimately, it will be important to determine whether MA is a modifiable risk factor for CVD and if preventive medications for migraine or antiplatelet therapy might reduce the risk of CVD in patients with MA.

Buse DC, Rupnow MF, Lipton RB. · Department of Neurology, Montefiore Headache Center, Bronx, NY 10461, USA. · Mayo Clin Proc. · Pubmed #19411439 No free full text.

Abstract: Migraine can be characterized as a chronic disorder with episodic attacks and the potential for progression to chronic migraine. We conducted a PubMed literature search (January 1, 1970 through May 31, 2008) for studies on the impact of migraine, including disability, health-related quality of life (HRQoL), comorbidities, and instruments used by health care professionals to treat patients with migraine. Numerous studies have shown that migraine substantially impairs a person's functions during attacks and diminishes HRQoL during and between attacks. Despite its impact, migraine remains underestimated, underdiagnosed, and undertreated. Several tools are available to help physicians assess the impact of migraine on the daily activities and HRQoL of their patients, such as the 36-Item Short-Form Health Survey and the Headache Impact Test. Improving communication during the office visit through active listening, use of open-ended questions, and use of the "ask-tell-ask" strategy can also help in assessing migraine-related impairment. Together, these tools and communication techniques can lead to a more complete assessment of how migraine affects patients' lives and can aid in the development of the optimal treatment plan for each patient. Both pharmacotherapy (acute and preventive treatment strategies) and nonpharmacological therapies play important roles in the management of migraine.

Bigal ME, Lipton RB. · Merck Research Laboratories, Merck, Inc., Whitehouse Station, New Jersey, USA. · Curr Opin Neurol. · Pubmed #19381087 No free full text.

Abstract: PURPOSE OF REVIEW: Because migraine worsens in a sizeable subgroup of sufferers, but not in most, identifying factors that predict the change from episodic into chronic migraine is of extreme interest and should be seen as a priority in headache research. RECENT FINDINGS: Potentially remediable risk factors include frequency of migraine attacks, obesity, excessive use of medications containing opioids and barbiturates, caffeine overuse, stressful life events, depression, sleep disorders and cutaneous allodynia. SUMMARY: While we wait for evidence regarding the benefits of risk factor modifications in the prevention of chronic migraine, several interventions are justifiable based on their other established benefits. For example, decreasing headache frequency with behavioral and pharmacological interventions will decrease current disability even if it does not modify clinical course. Monitoring the body mass index and encouraging maintenance of normal body weight is good practice in patients with and without migraine. Avoiding overuse of caffeine is desirable apart from its potential benefit in preventing progression. Sleep problems should be investigated and treated. Psychiatric comorbidities should be identified and addressed. Medications containing opioids and barbiturates should be reserved for a few selected cases of migraine, and their use should be monitored. For these interventions, the possibility of preventing progression may motivate clinicians to offer good care and patients to engage in the treatment plan.

Bigal ME, Lipton RB. · Merck Research Laboratories, 1 Merck Drive, Whitehouse Station, NJ 08889, USA. · Neurol Clin. · Pubmed #19289218 No free full text.

Abstract: We describe the epidemiology and comorbidities of migraine, which affects 12% of adults in occidental countries. Prevalence is three times higher in women, but 6% of men are affected, making it the most prevalent neurologic disorder in men. Although migraine is a remarkably common cause of temporary disability, many migraineurs have never consulted a physician for the problem. Many disorders are comorbid with migraine. For some such as depression, the association has been well described, but for others, the relationship has been recently suggested, such as in the case of clinical and subclinical vascular brain lesions and coronary heart disease.

Bigal ME, Lipton RB. · Merck Research Laboratories, Merck, Inc., 1 Merck Drive, Whitehouse Station, NJ 08889, USA. · Pain. · Pubmed #19232469 No free full text.

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Lipton RB. · Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA. · Neurology. · Pubmed #19188564 No free full text.

Abstract: Migraine attacks sometimes increase in frequency over time. Headache experts conceptualize this process with a model that envisions transition into and out of four distinct states: no migraine, low-frequency episodic migraine (<10 headaches per month), high-frequency episodic migraine (10-14 headaches per month), and chronic migraine (CM, >or=15 headaches per month). Transitions may be in the direction of increasing or decreasing headache frequency and are influenced by specific risk factors. Overall, population studies estimate that patients who have low-frequency episodic migraine or high-frequency episodic migraine will transition to CM at the rate of about 2.5% per year. Two longitudinal population studies, the Frequent Headache Epidemiology study and the ongoing American Migraine Prevalence and Prevention (AMPP) study provide longitudinal population data that has defined the rates of and risk factors for transition. Launched in 2004, the AMPP study has followed a sample of >10,000 migraine sufferers annually for 4 years. Cross-sectional data from the Frequent Headache Epidemiology study and the AMPP study show that patients with chronic daily headaches have lower levels of education and household income. In addition, epidemiologic profiles show that CM sufferers tend to be older and have higher body mass indexes. These studies have also assessed a number of potential risk factors associated with the transition to CM. These include baseline high attack frequency, obesity, stressful life events, snoring, and overuse of certain classes of medication. In particular, opiate and barbiturate combination products contribute to migraine progression, and nonsteroidal anti-inflammatory agents are protective in patients with <10 headache days per month. The influence of medication is modified by both headache attack frequency and frequency of medication use. Although depression and anxiety are associated with an increased risk of new-onset CM, the influence of depression is accounted for by migraine disability assessment scale score, whereas the effect of anxiety may be independent of migraine disability assessment scale score. Emerging data on the longitudinal risk of CM suggest that, in a population at risk, CM may be a preventable disorder.

Lipton RB, Sheftell FD. · Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA. · Headache. · Pubmed #19161565 No free full text.

Abstract: The future is bright for migraine sufferers. For acute treatment, CGRP antagonists and combination products will provide more complete, longer lasting, and safer relief. "Designer drugs" for migraine prevention will be identified based on their ability to block cortical spreading depression and will improve migraine treatment. Genetic and environmental risk factors that promote migraine progression will be identified and preventing progression will become a standard goal in treatment. Some of the devices intended to treat migraine will be approved and will provide important options for sufferers seeking to avoid drugs. Clinical trials that evaluate behavioral and pharmacologic interventions and their impact on patient centered outcomes will emerge. The emergence of novel treatments, when coupled with strategies for individualizing and optimizing treatment while maximizing adherence, will result in ever improving patient outcomes.

Bigal ME, Ferrari M, Silberstein SD, Lipton RB, Goadsby PJ. · Global Director for Scientific Affairs-Neuroscience; Merck Research Laboratories, Whitehouse Station, NJ, USA. · Headache. · Pubmed #19161562 No free full text.

Abstract: The triptan era has been a time of remarkable progress for migraine diagnosis and treatment. In this paper, we review some of the advances achieved in migraine science during this era focusing on 3 themes: lessons from clinical practice, lessons from epidemiology and lessons from pathophysiology. Science has shown that migraine is a disorder of the brain, and that the key events happen in the the trigeminal neuronal pathways, not on blood vessels. Clinical science has led to the observation that migraine sometimes progresses or remits. This in turn led to longitudinal epidemiologic studies focusing on factors that determine migraine prognosis. In addition, these studies raised questions about the mechanisms of migraine progression, including the role of allodynia, obesity, inflammation, and medications as determinants of progression. This in turn opens a new set of scientific questions about the neurobiologic determinants of migraine, as well as of its clinical course, and exciting opportunities to develop new therapies for this highly disabling brain disorder.

Martin VT, Lipton RB. · Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA. · Headache. · Pubmed #19076658 No free full text.

Abstract: Migraine is frequently associated with menstruation in female migraineurs, and consequently it is commonly referred to as menstrually associated migraine. The trigger thought to be partially responsible for menstrually associated migraine is a significant drop in circulating estrogen that is noted during 2-3 days prior to onset of menses. It is estimated that approximately 50% of women have an increased risk of experiencing migraine during the premenstrual phase of decreasing estrogen levels. Understanding the biological basis of migraine associated with menses will facilitate an accurate diagnosis and help patients recognize time susceptible to migraine exacerbations. This paper will review the biological bases for the hormonal changes that occur during the menstrual cycle and review the prevalence and burden of menstrual migraine among female headache sufferers.

Bigal ME, Lipton RB. · Merck Research Laboratories, Whitehouse Station, NJ 08889, USA. · Neurology. · Pubmed #19029522 No free full text.

Abstract: Long considered a chronic disorder with a stable course, recent research demonstrates that, in a subgroup, migraine progresses to chronic migraine. Among the risk factors for migraine progression, acute symptomatic medication overuse (SMO) is regarded as one of the most important. Though SMO and chronic migraine are associated, several questions remain unanswered. First, the causal path is controversial (SMO as a cause or consequence). Second, it is unclear if specific classes of medication, as well as critical doses of exposures, are necessary. Herein we review this topic in the light of recent conducted research. Although several caveats exist and the data should be taken with caution, important findings are as follows: 1) Opiates are associated with migraine progression; critical dose of exposure is around 8 days per month, and the effect is more pronounced in men. 2) Barbiturates are also associated with migraine progression. Critical dose of exposure is around 5 days per month and the effect is more pronounced in women. 3) Triptans induced migraine progression in those with high frequency of migraine at baseline (10-14 days per month), but not overall. 4) Anti-inflammatory medications were protective in those with <10 days of headache at baseline, and, as triptans, induced migraine progression in those with high frequency of headaches. Accordingly, specific classes of medications are associated with migraine progression, and high frequency of headaches seems to be a risk factor for chronic migraine regardless of medication exposure.

Buse DC, Lipton RB. · Montefiore Headache Center, Bronx, NY 10461, USA. · Curr Pain Headache Rep. · Pubmed #18796275 No free full text.

Abstract: Effective communication is integral to good medical care. Medical professional groups, regulatory agencies, educators, researchers, and patients recognize its importance. Quality of medical communication is directly related to patient satisfaction, improvement in medication adherence, treatment compliance, other outcomes, decreased risk of malpractice, and increase in health care providers' levels of satisfaction. However, skill level and training remain problematic in this area. Fortunately, research has shown that medical communication skills can be successfully taught and acquired, and that improvement in communication skills improves outcomes. The American Migraine Communication Studies I and II evaluated the current state of health care provider-patient communication in headache care and tested a simple educational intervention. They found problematic issues but demonstrated that these areas could be improved. We review theoretical models of effective communication and discuss strategies for improving communication, including active listening, interviewing strategies, and methods for gathering information about headache-related impairment, mood, and quality of life.

Bigal ME, Lipton RB. · Global Director for Scientific Affairs, Merck Research Laboratories, Whitehouse Station, NJ 08889, USA. · Curr Pain Headache Rep. · Pubmed #18796271 No free full text.

Abstract: Studies suggest that obesity is associated with migraine progression from an episodic into a chronic form. We discuss putative mechanisms to justify this relationship. Several of the inflammatory mediators that are increased in obese individuals are important in migraine pathophysiology, including interleukins and calcitonin gene-related peptide. Both migraine and obesity are prothrombotic states. Substances that are important in metabolic control are nociceptive at certain levels. Hypothalamic dysfunction in the orexin pathways seems to be a risk factor for both conditions. In addition, we discuss the importance of metabolic syndrome and autonomic dysfunction in modulating the obesity/migraine progression relationship.

Bigal ME, Lipton RB. · Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA. · Neurology. · Pubmed #18779513 No free full text.

Abstract: Migraine is currently conceptualized as a chronic disease with episodic manifestations, with attacks that increase in frequency in a subgroup (migraine transformation or progression). Transformation of migraine may be subdivided in three partially overlapping forms, although research in this area is still in infancy, and evidence is sometimes weak. Typically, transformation refers to increases in attack frequency over time leading to chronic migraine; this process is termed clinical transformation. Additionally, in some patients with migraine, physiologic changes in the CNS manifest themselves through alterations in nociceptive thresholds (allodynia) and alterations in pain pathways (physiologic transformation). Finally, in some individuals, definitive brain lesions including stroke and deep white matter lesions emerge (anatomic transformation). Herein we discuss the evidence that migraine may transform and then consider potential mechanisms as well as risk factors. We close with a brief discussion of clinical strategies that arise based on this perspective on migraine.

Bigal ME, Lipton RB. · Albert Einstein College of Medicine, Department of Neurology, 1165 Morris Park Avenue, Bronx, NY 10451, USA. · Curr Pain Headache Rep. · Pubmed #18778575 No free full text.

Abstract: Although the influence of age on the prevalence of migraine is well known, the clinical characterization of migraine across the lifespan remains poorly studied. Limited evidence suggests that migraine attacks get shorter and less typical with advancing age. Similar results were found for transformed migraine at different ages. In this article, we first discuss the prevalence and clinical features of episodic migraine. We then discuss the epidemiology and profile of transformed migraine across the lifespan. Clarifying the influence of age on migraine is of importance for clinical diagnosis and treatment. It also may contain clues to evolving disease biology.