Migraine Disorders: Silberstein SD

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.

Silberstein SD. · American Academy of Neurology, St. Paul, MN 55116, USA. · Neurology. · Pubmed #10993991 No free full text.

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Silberstein SD, Aoki KR. · No affiliation provided · Headache. · Pubmed #12887387 No free full text.

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Silberstein SD. · Department of Neurology, Jefferson Headache Center, Thomas Jefferson University Hospital, 111 South Eleventh Street, Gibbon Building, Suite 8130, Philadelphia, PA 19107, USA. · Neurol Clin. · Pubmed #19289224 No free full text.

Abstract: The pharmacologic treatment of migraine may be acute (abortive) or preventive (prophylactic), and patients with frequent severe headaches often require both approaches. Preventive therapy is used to try to reduce the frequency, duration, or severity of attacks. The preventive medications with the best-documented efficacy are amitriptyline, divalproex, topiramate, and the beta-blockers. Choice is made based on a drug's proven efficacy, the physician's informed belief about medications not yet evaluated in controlled trials, the drug's adverse events, the patient's preferences and headache profile, and the presence or absence of coexisting disorders. Because comorbid medical and psychologic illnesses are prevalent in patients who have migraine, one must consider comorbidity when choosing preventive drugs. Drug therapy may be beneficial for both disorders; however, it is also a potential confounder of optimal treatment of either.

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.

Hutchinson SL, Silberstein SD. · Orange County Migraine and Headache Center, University of California, Irvine, CA, USA. · Headache. · Pubmed #19076659 No free full text.

Abstract: This paper presents 2 case scenarios that illustrate the complexity of diagnosing and managing migraine associated with hormonal changes. Migraine is commonly associated with comorbidies such as depression, anxiety, obesity, cardiovascular disease, as well as other conditions, thereby making management more challenging for the physician and the patient. The first case is a 35-year-old woman who has migraine almost exclusively during menstruation. She is under a physician's care for long-term management of premenstrual dysphoric disorder (PMDD). Achieving a differential diagnosis of pure menstrual migraine is illustrated, and a detailed treatment plan including use of a migraine miniprophylaxis protocol, management of her PMDD, and prescription of acute treatment medications is reviewed. The second case scenario describes the diagnosis of menstrually associated migraine in a woman who suffers from a frequent disabling migraine along with work-related anxiety and depression. This paper reviews her differential diagnosis, laboratory testing, treatment plan, including management of her comorbid anxiety and depressive symptoms.

Silberstein SD, Hutchinson SL. · Thomas Jefferson University, Philadelphia, PA, USA. · Headache. · Pubmed #19076657 No free full text.

Abstract: Women presenting with recurrent disabling headache frequently have migraine; but physicians need to rule out other headache disorders before they reach a diagnosis of migraine with or without aura. Many women who experience migraine in close association to their menstrual cycle may meet the diagnostic criteria for either menstrually related migraine (MRM), or pure menstrual migraine (PMM). Once an accurate diagnosis is made, treatment may be established to best suit the individual needs of that patient. Most women will find that migraine associated with hormone fluctuations respond well to standard treatment approaches including pharmacological and nonpharmacological treatments. Pharmacological approaches include acute, preventive, and short-term prophylaxis. Herein we review the difference between non-menstrual migraine, PMM, and MRM and identify effective treatment strategies for appropriate management of migraine associated with hormonal fluctuations.

Silberstein SD. · Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA 19107, USA. · Nat Clin Pract Neurol. · Pubmed #18665146 No free full text.

Abstract: The pharmacological treatment of migraine can be acute or preventive. Acute treatment attempts to stop the progression of an attack or relieve pain and functional impairment once an attack has begun, whereas preventive therapy is given to reduce attack frequency and severity. Additional benefits of preventive therapy include improving responsiveness to acute attack treatment, and reducing disability. Treatment protocols should also include education and reassurance, avoidance of triggers, nonpharmacological treatments, and physical and/or complementary medicine when appropriate. The treatment plan should be reassessed at regular intervals. Acute attack medication can be specific or nonspecific, and needs to be tailored to the individual patient. Backup and rescue medication should be available in case the initial treatment fails. The route of drug administration depends on attack severity, how rapidly the attack escalates, the patient's preference, the presence or absence of severe nausea or vomiting, and the need for rapid relief. Preventive migraine treatments include beta-blockers, antidepressants, calcium channel antagonists, 5-hydroxytryptamine antagonists, anticonvulsants, and NSAIDs. Preventive treatments are selected on the basis of the drugs' side-effect profiles and the patient's coexistent and comorbid conditions.

Goadsby PJ, Goldberg J, Silberstein SD. · Headache Group, Department of Neurology, University of California, San Francisco, CA 94143-0114, USA. · BMJ. · Pubmed #18583683 No free full text.

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Dodick DW, Silberstein SD. · Department of Neurology, Mayo Clinic Arizona, Scottsdale, Arizona 85259, USA. · Pract Neurol. · Pubmed #18024778 No free full text.

Abstract: Preventive medications reduce migraine frequency and severity, and improve migraine-specific quality of life. Recent evidence also suggests that these same medications enhance the patient's response to acute migraine therapies, and may also reduce the likelihood of developing chronic daily headache. However, many patients who should receive or be offered preventive treatment are not. Most patients can be successfully managed when patient and physician expectations are realistic and aligned, the selection of preventive medications is individualised, and the initiation and titration strategy is appropriate and carefully followed. Rational combinations of preventive medications may also be useful. This review provides an evidence and experience-based approach to the preventive treatment of migraine.

Silberstein SD, Goldberg J. · Department of Neurology, Jefferson Headache Center, Division of General Obstetrics and Gynecology and Jefferson Fibroid Center, Jefferson Medical College, Philadelphia, Pennsylvania, USA. · J Reprod Med. · Pubmed #17977161 No free full text.

Abstract: The purpose of this review is to provide a simple, evidence-based approach to the diagnosis and treatment of migraine. The review is based on clinical experience data, results from placebo-controlled trials and pharmacokinetic information of clinical importance and is a distillation of material from a comprehensive literature review of the epidemiology, pathophysiology, diagnostic features and treatment of menstrual migraine. Migraine, particularly menstrual migraine, is most prevalent in women of childbearing age. Menstrual migraine is generally severe, lasts longer, recurs more frequently, results in greater disability and is more resistant to therapy than nonmenstrual migraine. Despite the associated disability for otherwise-healthy women, migraine is frequently not diagnosed. The initial visit to an obstetrician/gynecologist is an ideal time to screen women for menstrual migraine. Triptans are effective in the acute treatment of menstrual migraine. Naratriptan and frovatriptan also have been evaluated for prophylactic efficacy. Both agents were effective in reducing the incidence of menstrual migraine. Frovatriptan also reduced the severity and duration of breakthrough headaches. Acute treatment is typically the same for menstrual and nonmenstrual migraine, involving the use of nonsteroidal antiinflammatory agents (NSAIDs), triptans or, rarely, ergot derivatives. In addition, NSAIDs, magnesium supplementation, estrogen therapy and triptans have been proven effective for short-term prevention of menstrual migraine. In some patients, continuous estrogen therapy may be necessary to control these headaches. Improved diagnosis and treatment of menstrual migraine is critical to decrease the associated disability. Acute and shortterm preventive therapy with triptans is effective; oral contraceptives may be used for long-term preventive therapy.

Silberstein SD, Ruoff G. · No affiliation provided · Postgrad Med. · Pubmed #17960687 No free full text.

Abstract: Combination therapy is used to treat many disorders; for some conditions, it has become first-line treatment or the standard of care. The development and use of novel drug combinations will grow as the understanding of disease pathophysiology and drug pharmacokinetics and pharmacodynamics progresses. In the acute management of migraine, existing drug combinations have proven to be effective, safe, and tolerable. They may offer distinct advantages compared with monotherapy, including both enhanced therapeutic benefits and fewer adverse events (AEs). This article discusses the types of interactions that can occur with combination therapy and their potential effects on efficacy and tolerability. The rationale for using combination therapy will first be discussed within the context of clinical conditions in which it is already the standard of care. This will be followed by a discussion of the rationale for use in migraine.

Silberstein SD, Dodick D, Freitag F, Pearlman SH, Hahn SR, Scher AI, Lipton RB. · Thomas Jefferson University, Philadelphia, PA 19107, USA. · Headache. · Pubmed #17445108 No free full text.

Abstract: Comorbidity is defined as an illness that occurs more frequently in association with a specific disorder than would be found as a coincidental association in the general population. Conditions that are frequently comorbid with migraine include depression, anxiety, stroke, epilepsy, sleep disorders, and other pain disorders. In addition, many common illnesses occur concomitantly (at the same time) with migraine and influence the treatment choice. Migraine management, and especially migraine prevention, can be challenging when patients have comorbid or concomitant illnesses. The objectives of this initiative are to review the literature on managing patients who have migraine and common comorbidities, present additional clinical approaches for care of these difficult patients, and evaluate the areas in which research is needed to establish evidence-based guidelines for the management of migraine with associated comorbid conditions.

Silberstein SD. · Jefferson Headache Center, 111 South 11th Street, Suite 8130, Philadelphia, PA 19107, USA. · Trends Pharmacol Sci. · Pubmed #16820222 No free full text.

Abstract: Migraine is a common episodic pain disorder, the treatment of which can be acute to stop an attack or preventive to reduce the frequency, duration or severity of attacks. Preventive treatment is used when attacks are frequent or disabling. Many different medication groups are used for preventive treatment, including beta-blockers, antidepressants and antiepileptic drugs. Their mechanisms of action include raising the threshold to migraine activation, enhancing antinociception, inhibiting cortical spreading depression, inhibiting peripheral and central sensitization, blocking neurogenic inflammation and modulating sympathetic, parasympathetic or 5-HT tone. In this article, I review evidence of the effectiveness of migraine preventive drugs. I also discuss the setting of treatment priorities.

Silberstein SD. · Department of Neurology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA. · Rev Neurol Dis. · Pubmed #16622394 No free full text.

Abstract: Migraine preventive therapy, even in the absence of a headache, is given in an attempt to reduce the frequency, duration, or severity of attacks. Circumstances that might warrant preventive treatment include disabling migraine attacks, the overuse of acute medications or failure of or contraindication to acute medications, troublesome side effects from medication, hemiplegic migraine, or very frequent headaches (more than 2 a week). The major medication groups for preventive treatment include anticonvulsants, antidepressants, b-adrenergic blockers, calcium channel antagonists, serotonin antagonists, neurotoxins, nonsteroidal anti-inflammatory drugs, and others. If preventive medication is indicated, the agent preferentially should be chosen from one of the first-line categories, based on the drug's side-effect profile and the patient's coexistent and comorbid conditions.

Silberstein SD. · Department of Neurology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA. · Rev Neurol Dis. · Pubmed #16400273 No free full text.

Abstract: The case presented underscores the complexities encountered in diagnosing and managing patients with a long-standing history of headache and some of the difficulties in classifying patients according to the new International Headache Society (IHS) criteria. A 42-year-old nurse with 4 children whose headaches began at age 24 years developed continuous headaches of varying intensity, regularly so debilitating that she was unable to get out of bed and occasionally so disabling that she required an injection of meperidine from her physician. Management strategies are presented and the revised IHS criteria are discussed.

Martelletti P, Haimanot RT, Láinez MJ, Rapoport AM, Ravishankar K, Sakai F, Silberstein SD, Vincent M, Steiner TJ. · ITSE 2nd School of Medicine, Rome University La Sapienza, Via Vitorchiano 81, I-00189, Rome, Italy. · J Headache Pain. · Pubmed #16362681 No free full text.

Abstract: The social perception of headache, everywhere at low levels in industrialised countries, becomes totally absent in developing ones. Headache disorders came into the World Health Organization's strategic priorities after publication of the 2001 World Health Report. Among the leading causes of disability, migraine was ranked 19th for adults of both sexes together and 12th for females. The Global Campaign (GC) to Reduce the Burden of Headache Worldwide was planned by the major international headache organizations together with WHO in order to identify and remove those cultural, social and educational barriers recognised as responsible factors for the inadequate treatment of headache disorders worldwide. Within the GC activities, the education of the medical body will represents a central pillar. An International Team for Specialist Education (ITSE) has been created to train physicians from all over the world through the acquisition of a university level Master Degree in Headache Medicine. Once trained as headache specialists, physicians will become trainers, offering education in this field to other health care providers in their own countries. In this way they will give life to a cultural chain raising awareness locally of headache, its burden and its medical control.

Silberstein SD, Dodick D, Kesslick J. · Jefferson Headache Center, Philadelphia, PA 19107, USA. · Headache. · Pubmed #16178957 No free full text.

Abstract: The main goals in the pharmacologic management of migraine headache are to avert or relieve debilitating pain, prevent escalating acute medication use, and improve day-to-day functioning. This review will examine the evidence supporting the early use of acute medication, usually when pain is mild, to enhance patient outcomes. We will also discuss imposed quantity limits as a practical impediment to the implementation of this strategy in the managed care setting, and will identify strategies for overcoming this barrier to effective care. Quantity limits imposed on triptan therapy by health plans can hinder the optimal acute treatment of migraine. A standard triptan quantity limit sufficient to permit early migraine treatment and a movement by manufacturers to provide blister packs consistent with a standard quantity limit should reduce patients costs, permit brand mobility when appropriate, and bolster long-term cost effectiveness by removing an important impediment to the use of triptans when they are most effective, early in the migraine attack when pain is often still mild.

Silberstein SD. · Jefferson Headache Center, Thomas Jefferson University Hospital, 111 S 11th Street, Gibbon Bldg, Suite 8130, Philadelphia, PA 19107-4824, USA. · J Am Osteopath Assoc. · Pubmed #15928350 links to  free full text

Abstract: Chronic daily headache represents a range of disorders characterized by the occurrence of long-duration headache 15 or more days per month. The classification of these disorders continues to undergo revision to make them more clinically relevant, such as that which has been most controversial, the classification of chronic migraine. The role of medication overuse in what has commonly been known as rebound headache can have a significant influence on these disorders. The diagnosis of the chronic daily headaches, including chronic migraine and chronic tension-type headache, truly cannot be made if patients are having medication-overuse headache. This article reviews the criteria for medication-overuse headache and the subset of headaches making up chronic daily headache, as well as the epidemiologic and therapeutic aspects of these disorders.

Silberstein SD. · Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. · Curr Opin Neurol. · Pubmed #15891414 No free full text.

Abstract: PURPOSE OF REVIEW: To review recent advances in preventive headache treatment. RECENT FINDINGS: Migraine may be a progressive disorder. Aggressive treatment may stop progression. Propranolol, the beta-blocker, and the anticonvulsant topiramate are effective for migraine prevention. Feverfew, montelukast and acupuncture have not proven effective. SUMMARY: New drugs and other treatment strategies expand the spectrum of preventive migraine treatments.

Siow HC, Young WB, Silberstein SD. · National Neuroscience Institute, Neurology, Singapore. · Headache. · Pubmed #15836574 No free full text.

Abstract: OBJECTIVES: To review the mechanism of action of neuroleptics, the evidence for their efficacy, and their clinical use in headache treatment. BACKGROUND: Neuroleptics and antiemetics have long been used for headache treatment; however, they have not been widely utilized because of general unfamiliarity with them and concerns about their adverse events. With the recent advent of the atypical neuroleptics and their improved adverse event profile, our armamentarium for headache treatment has expanded. In this review, we explore the mechanism of action of these classes of drugs, their adverse events, and the evidence for their efficacy. We also detail our experience with the different drugs and how we use them as both acute and preventive headache therapy. DESIGN: A review of published literature was obtained through a MEDLINE search on the use of neuroleptics in headache therapy. CONCLUSION: Neuroleptics have widespread evidence supporting their use in headache treatment and present an important part of the armaterium against headache.

Silberstein SD. · Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. · Headache. · Pubmed #15833091 No free full text.

Abstract: The efficacy of topiramate in migraine prevention (prophylaxis) was established in two multicenter, randomized, double-blind, placebo-controlled, pivotal trials. Topiramate has received regulatory approval for use in adults for migraine prophylaxis (prevention) in the US and numerous other countries, including France, Ireland, Switzerland, Brazil, Taiwan, Spain, and Australia. Treatment with 100 or 200 mg per day of topiramate was associated with significant reductions in the frequency of migraine headaches, number of migraine days, and use of acute medications. No increase in efficacy was observed between 100 and 200 mg per day of topiramate. Based on efficacy and tolerability, 100 mg per day of topiramate should be the initial target dose for most patients. The most common adverse events were paresthesia, fatigue, decreased appetite, nausea, diarrhea, weight decrease, and taste perversion. Topiramate is a first-line migraine preventive drug and should especially be considered as a preferred treatment for all patients who are concerned about gaining weight, who are currently overweight, or who have coexisting epilepsy.

Silberstein SD, Ben-Menachem E, Shank RP, Wiegand F. · Thomas Jefferson University, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA. · Clin Ther. · Pubmed #15811478 No free full text.

Abstract: OBJECTIVES: The purposes of this review were to assess the efficacy of topiramate as monotherapy for epilepsy and migraine prevention, describe how it should be used, and give clinical advice on how to manage the practical aspects of dosing, titration, and possible adverse events in these 2 indications. METHODS: We searched the PubMed and BIOSIS databases using the key words topiramate, epilepsy, and migraine from the year 1987 onward, and subsequently focused the search on larger controlled trial studies of topiramate as monotherapy. RESULTS: Studies have evaluated the use of topiramate as monotherapy in the treatment of partial-onset and generalized seizures and in the prevention of migraine. In a randomized study, 75% of epilepsy patients treated with 400 mg/d topiramate remained seizure free at 1 year. Patients in the same study treated with a lower dose of topiramate (50 mg/d) also experienced notable seizure reductions, with 59% of patients free of seizures at 1 year. A comparison trial of topiramate (100 or 200 mg/d), valproate, and carbamazepine found that topiramate was associated with a similar time to first posttreatment seizure as the other 2 agents (P = NS). Trials of topiramate monotherapy in migraine prevention found that 100 mg/d was associated with a > or =50% reduction in monthly migraine frequency in 49% to 54% of patients. The migraine prevention trials typically used a starting dose of 25 mg/d, with weekly increases of 25 mg and an initial monotherapy target dose of 100 mg/d. The most common adverse events associated with topiramate are paresthesia, weight loss, and other centrally mediated symptoms, many of which may be ameliorated by proper titration and dosing and by good communication between physician and patient. CONCLUSIONS: Data from controlled trials suggest that 100 mg/d topiramate as monotherapy is effective in the treatment of partial-onset and generalized seizures and in the prevention of migraine.

Silberstein SD. · Jefferson Headache Center, Philadelphia, PA, USA. · Cephalalgia. · Pubmed #15595988 No free full text.

Abstract: The vascular hypothesis of migraine has now been superseded by a more integrated theory that involves both vascular and neuronal components. It has been demonstrated that the visual aura experienced by some migraineurs arises from cortical spreading depression, and that this neuronal event may also activate perivascular nerve afferents, leading to vasodilation and neurogenic inflammation of the meningeal blood vessels and, thus, throbbing pain. The involvement of the parasympathetic system supplying the meninges also causes increased vasodilation and pain. As an acute attack progresses, sensory neurones in the trigeminal nucleus caudalis become sensitized, resulting in the phenomenon of cutaneous allodynia. Triptans may act at several points during the progression of a migraine attack. However, the development of central sensitization impacts upon the effectiveness of triptan therapy.

Silberstein SD. · Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA. · Neurol Clin. · Pubmed #15474764 No free full text.

Abstract: Migraine and TTH are primary headache disorders that occur commonly during pregnancy. Migraine sometimes occurs for the first time with pregnancy. The majority of migraineurs improve while pregnant; however, migraine often recurs post partum. Some disorders that produce, headache, such as stroke, cerebral venous thrombosis, eclampsia, and SAH, occur more frequently during pregnancy. Diagnostic testing serves to exclude organic causes of headache, to confirm the diagnosis, and to establish a baseline before treatment. If neurodiagnostic testing is indicated, the study that provides the most information with the least fetal risk is the study of choice. Drugs commonly are used during pregnancy despite insufficient knowledge about their effects on the growing fetus. Most drugs are not teratogenic. Adverse effects, such as spontaneous abortion, developmental defects, and various postnatal effects, depend on the dosage and route of administration and the timing of the exposure relative to the period of fetal development. Although medication use should be limited, it is not absolutely contraindicated in pregnancy. In migraine, the risk for status migrainosus may be greater than the potential risk of the medication used to treat the pregnant patient. Nonpharmacologic treatment is the ideal solution; however, analgesics, such as acetaminophen and narcotics, can be used ona limited basis. Preventive therapy is a last resort.