Quality-of-Life Differences Between Patients With Episodic and Transformed Migraine

OBJECTIVE: To determine whether there are any differences in health-related quality of life between patients with migraine and those with transformed migraine. BACKGROUND: There are no published reports comparing the health-related quality of life between patients with migraine and patients with transformed migraine. METHODS: We conducted a retrospective analysis examining the health-related quality of life of patients with transformed migraine and migraine seen at a specialty headache clinic. Data collected included the Short Form-36 (SF-36) and the Migraine Disability Assessment questionnaires as well as demographic information. Both of these forms are part of the initial evaluation at the headache clinic. A t test with Bonferroni correction was used to test for significant differences in the SF-36 domains between the groups. RESULTS: Data were collected for 90 patients, 46 with transformed migraine and 44 with migraine. There were no significant differences between groups with respect to sex, race, or age. Over the last 90 days prior to their first visit, patients with transformed migraine reported having a headache an average of 69 days compared with patients with migraine who averaged 18 days with headache (P<.05). Compared with patients with migraine, patients with transformed migraine had statistically (P<.05) and clinically significant (difference >5 points) lower mean scores on seven of the eight SF-36 domains and both the mental and physical summary scores of the SF-36. CONCLUSIONS: The results of this study suggest that patients with transformed migraine have a lower health-related quality of life than patients with migraine. These findings indicate that the headache chronicity associated with transformed migraine has a significant influence on quality of life. The results highlight the importance of effective management of headaches to avoid the progression of migraine to the more disabling transformed migraine.     

Economic Burden of Transformed Migraine: Results From the American Migraine Prevalence and Prevention (AMPP) Study

Objective.— To evaluate the impact of incident transformed migraine on health care resource utilization, medication use, and productivity loss. In addition, the study estimates the total direct and indirect costs associated with transformed migraine. Background.— Emerging evidence indicates that migraine may be a chronic progressive disorder characterized by escalating frequency of headache attacks, often termed transformed migraine. Little is known about the economic impact of transformed migraine. Methods.— AMPP is a 5‐year, national, longitudinal survey study of headache in the US. The study utilized data from the 2006 follow‐up survey based on an initial sample of 14,544 adults identified as having migraine in either the 2004 screening or 2005 baseline survey. A diagnosis of migraine was assigned based on criteria proposed by the International Classification of Headache Disorders, 2nd Edition. Participants completed self‐administered, validated questionnaires on headache features, frequency, impairment, resource use, medication use, and productivity loss. Direct and indirect headache‐related costs were estimated using unit cost assumptions from the PharMetrics Patient‐Centric database, wholesale acquisition costs (Red Book), and wage data from the US Bureau of Labor Statistics. Those who developed transformed migraine were compared with those who did not develop transformed migraine in the 1‐2 year interval between screening/baseline and follow‐up. Results.— A total of 7796 (54%) identified migraine cases completed the 2006 follow‐up survey. Of those cases, 359 (4.6%) developed transformed migraine. Participants who developed transformed migraine reported significantly more primary care visits, neurologist or headache specialist visits, pain clinic visits, and emergency room visits compared with participants whose migraine remained episodic. Hospital nights and urgent care visits did not reach statistical significance. Transformed migraine participants reported significantly more time missed at work or school because of headaches and more time where work or school productivity was reduced by >50% in the previous 3 months because of headaches. Average per‐person annual total costs, including direct and indirect costs, were 4.4‐fold greater for those who developed transformed migraine ($7750) compared with those who remained episodic ($1757). Conclusion.— Transformed migraine exacts a significantly higher economic toll on patients and health care systems compared with other forms of migraine. Our findings support the need to prevent migraine progression and to provide appropriate management and treatment of transformed migraine.     

Ophthalmoplegic Migraine: Ischemic or Compressive Neuropathy?

SYNOPSIS
It is currently believed that the ophthalmoplegia in ophthalmoplegic migraine (O.M.) is due to compression of the cranial nerves by dilated and swollen carotid or basilar arteries. One of our patients seen recently did not fit the pattern of a compressive neuropathy because the pupil was spared during three episodes of O.M. A review of the literature revealed that contrary to common belief, the pupils are involved completely in only 33% of patients with O.M. Analysis of the clinical features and the relevant anatomy of the vascular supply of the third cranial nerve suggest that the ophthalmoplegia is due to a delayed ischemic neuropathy leading to border zone infarction of the nerve rather than direct compression due to an enlarged vessel.     

典型偏头痛和普通型偏头痛TCD检查对照研究

对２０例典型偏头痛和４０例普通型偏头痛的ＴＣＤ进行对照研究，发现典型偏头痛发作期ＭＣＡ和ＰＣＡ在头痛侧平均血流速度明显加快，存在血管痉挛，普通型偏头痛发作期头痛侧与无症状侧平均血流速度无显著差异，提示典型与普通型偏头痛的发病机理可能存在本质区别，前者多数由血管因素所致。     

Up-regulation of 5-HT2 Serotonin Receptor: A Possible Mechanism of Transformed Migraine

SYNOPSIS
Transformation of episodic migraine to chronic daily headache (so called transformed migraine) ia now a well recognized phenomenon. Although several factors, i.e. analgesic overuse, increasing age, psychiatric disorders are reported to play some roles in this transformation, the precise cascade is still unclear. Further suppression of an already abnormal antinociceptive system with up-regulation of post-synaptic receptors is one of the possible explanation. In order to understand the mechanism underlying this condition, 5-HT₂ serotonin receptors on platelets were assayed by the radioligand binding technique. Six transformed migraine patients (67.67 ± 1.52 years) and seven healthy controls (72.86 ± 1.82 years) were studied. [³H]-spiperone and ketanserin were used to determine the specific binding. We found a significant increase (P <0.05) in the maximal receptor numbers (B_max ) on platelet membrane of the migraine patients when compared to the controls (64.31 ± 11.06 end 39.96 ± 5.42 fmol/mg protein, respectively), whereas the dissociation equilibrium constant (K D ) values remained unchanged (3.63 ± 0.78 nM and 2.84 ± 0.48 nM for the migraine patients and controls, respectively). The up-regulation of serotonin receptors found in this study provided further support to the "serotonergic hypofunction" theory of migraine pathogenesis and may explain the unusual loss of episodicity seen in the transformed migraine patients.     

Monoclonal Antibodies to CGRP or Its Receptor for Migraine Prevention

Migraine is a highly prevalent, disabling neurological disease that significantly affects patients’ quality of life. There are significant unmet needs in the treatment of migraine, which is often misdiagnosed and undertreated. Monoclonal antibodies targeting the calcitonin gene-related peptide pathway, either the ligand or its receptor, are promising new drugs for the prevention of episodic and chronic migraine. We review the current evidence for these new monoclonal antibodies.