Transformed Migraine

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Abouch Valenty Krymchantowski - One of the best experts on this subject based on the ideXlab platform.

  • Migraine tension type headache and Transformed Migraine
    Current Pain and Headache Reports, 2007
    Co-Authors: Mario F.p. Peres, Andre Leite Goncalves, Abouch Valenty Krymchantowski
    Abstract:

    Migraine and tension-type headache (TTH) are highly prevalent primary headaches that remain underdiagnosed and undertreated in clinical practice. The similarities and differences between Migraine and TTH may impose diagnostic challenges as well as management difficulties. In addition, the possibility of Migraine chronification or transformation in daily or near-daily headache raises the potential level of interaction between pathophysiologic mechanisms of TTH and Migraine. The continuum concept is a possible key to the understanding of this association. Future studies are necessary to clarify epidemiology, pathophysiology, and management of these two most prevalent headaches.

  • chronic Transformed Migraine and medication overuse to withdraw or not
    Expert Review of Neurotherapeutics, 2007
    Co-Authors: Abouch Valenty Krymchantowski, Carla Da Cunha Jevoux
    Abstract:

    Migraine is a prevalent, disabling, undiagnosed and undertreated disease in neurological practice [1]. It is a primary disorder with a clear genetic basis [2,3]. For some uncommon forms of Migraine...

  • Overuse of symptomatic medications among chronic (Transformed) Migraine patients: profile of drug consumption
    Arquivos de neuro-psiquiatria, 2003
    Co-Authors: Abouch Valenty Krymchantowski
    Abstract:

    Chronic daily headache and chronic (Transformed) Migraine (TM) patients represent more than one third of the subjects seen in specialized headache centers. Most of these patients may overuse symptomatic medications (SM) taken on a daily basis to relieve headache and associated symptoms. The conversion to the daily or near-daily pattern of headache presentation is thought to be related to the medication overuse. The aim of this study was to evaluate the profile of SM consumption among Transformed Migraine patients attending a tertiary center. One hundred thirty three consecutive patients (22 men and 111 women, ages 17 to 80) with TM and overuse of SM according to the proposed criteria of Silberstein et al (1994, 1996) were prospectively studied. None of the patients were under treatment for other conditions. Among them, 73 (54.9%) were using one category of SM, while 55 (41.3%) and 5 (3.8%) patients were taking simultaneously two and three categories of SM respectively. The categories of overused symptomatic medications varied from simple analgesics to narcotics, triptans and combinations of ergot derivatives and caffeine and of analgesics and caffeine. The average intake per patient per day was of 3 to 4 tablets and mostly of the patients overused simple analgesics (isolated or in combination with other substances) (75.2%), caffeine containing drugs (71.4%), drugs containing ergotamine derivatives (26.1%), triptans (alone or combined) (15.5%), drugs with narcotics or ansiolitics (13%) and anti-inflammatory drugs (3.7%). The mechanisms by which the overuse of symptomatic medications may play a role in this transformation are uncertain but despite of the necessity of controlled trials to demonstrate the real role of such compounds in the development of Transformed Migraine, this study emphasizes the necessity for more rigorous prescribing guidelines for patients with frequent headaches.

  • Overuse of symptomatic medications among chronic (Transformed) Migraine patients: profile of drug consumption Uso excessivo de medicações sintomáticas em pacientes com migrânea crônica (transformada): perfil de consumo medicamentoso
    Academia Brasileira de Neurologia (ABNEURO), 2003
    Co-Authors: Abouch Valenty Krymchantowski
    Abstract:

    Chronic daily headache and chronic (Transformed) Migraine (TM) patients represent more than one third of the subjects seen in specialized headache centers. Most of these patients may overuse symptomatic medications (SM) taken on a daily basis to relieve headache and associated symptoms. The conversion to the daily or near-daily pattern of headache presentation is thought to be related to the medication overuse. The aim of this study was to evaluate the profile of SM consumption among Transformed Migraine patients attending a tertiary center. One hundred thirty three consecutive patients (22 men and 111 women, ages 17 to 80) with TM and overuse of SM according to the proposed criteria of Silberstein et al (1994, 1996) were prospectively studied. None of the patients were under treatment for other conditions. Among them, 73 (54.9%) were using one category of SM, while 55 (41.3%) and 5 (3.8%) patients were taking simultaneously two and three categories of SM respectively. The categories of overused symptomatic medications varied from simple analgesics to narcotics, triptans and combinations of ergot derivatives and caffeine and of analgesics and caffeine. The average intake per patient per day was of 3 to 4 tablets and mostly of the patients overused simple analgesics (isolated or in combination with other substances) (75.2%), caffeine containing drugs (71.4%), drugs containing ergotamine derivatives (26.1%), triptans (alone or combined) (15.5%), drugs with narcotics or ansiolitics (13%) and anti-inflammatory drugs (3.7%). The mechanisms by which the overuse of symptomatic medications may play a role in this transformation are uncertain but despite of the necessity of controlled trials to demonstrate the real role of such compounds in the development of Transformed Migraine, this study emphasizes the necessity for more rigorous prescribing guidelines for patients with frequent headaches.Os pacientes com cefaléia crônica diária e migrânea crônica (transformada) (MT) representam mais de um terço dos pacientes vistos em centros especializados. Muitos destes pacientes abusam de medicações sintomáticas (MS) tomadas em caráter diário para aliviar a cefaléia e/ou os sintomas associados. A conversão para o padrão de apresentação diário ou quase diário parece ser relacionada ao uso excessivo de MS. O objetivo deste estudo foi avaliar o perfil de consumo de medicações sintomáticas em pacientes sendo atendidos em centro terciário de cefaléias. Cento e trinta e três pacientes (22 homens e 111 mulheres, com idades entre 17 e 80 anos) consecutivos preenchendo os critérios propostos por Silberstein e col. (1994, 1996) para MT e uso excessivo de MS foram estudados prospectivamente. Nenhum dos pacientes encontrava-se sob tratamento regular para outras doenças. Entre eles, 73 pacientes (54,9%) estavam utilizando uma categoria de MS enquanto 55 (41,3%) e 5 (3,8%) encontravam-se sob uso de duas e três categorias de MS, respectivamente. As categorias de medicações sintomáticas utilizadas em excesso variaram de analgésicos simples a triptanos e combinações de ergóticos e analgésicos com cafeína. A ingestão média por paciente por dia foi de 3 a 4 comprimidos e os compostos mais usados foram analgésicos simples (isolados ou em combinações) por 75,2% dos pacientes, drogas com cafeína por 71,4%, derivados da ergotamina por 26,1%, triptanos por 15,5%, medicamentos com narcóticos ou ansiolíticos por 13% e antinflamatórios não esteroidais por 3,8% dos pacientes. Os mecanismos pelos quais o uso excessivo de MS exerce um papel nesta transformação de padrão doloroso são incertos mas a despeito da necessidade de realização de estudos controlados para comprovar o verdadeiro papel desempenhado pelas MS no desenvolvimento da migrânea transformada, este estudo enfatiza a necessidade de se estabelecer diretrizes mais rigorosas no padrão de prescrição de sintomáticos em pacientes com cefaléias frequentes

  • amitriptyline versus amitriptyline combined with fluoxetine in the preventative treatment of Transformed Migraine a double blind study
    Headache, 2002
    Co-Authors: Abouch Valenty Krymchantowski, Jackeline Soraya Barbosa, Marcus Tulius Teixeira Da Silva, Luiz Anastacio Alves
    Abstract:

    Background and Objectives.—Antidepressants are often used to treat chronic daily headache disorders such as Transformed Migraine, in part because of the high prevalence of associated mood disorder. We conducted this study to evaluate the efficacy and tolerability of combined treatment with amitriptyline and fluoxetine compared with amitriptyline alone for chronic daily headache due to Transformed Migraine. Patients and Methods.—Thirty-nine patients, 26 women and 13 men, aged 20 to 69 years (mean, 36.4; SD, 2.5) who fulfilled criteria for Transformed Migraine proposed by Silberstein et al were studied prospectively. Amitriptyline was dosed as follows: 8 mg/day for 6 days, 8 mg twice a day for 6 days, 20 mg/day for 6 days, and 20 mg twice a day for 45 days. In the group receiving combination therapy, fluoxetine was dosed and administered identically. The initial and end of the study (9 weeks) headache indices (frequency × intensity) were compared between groups. Results.—Twenty-seven patients completed the study, 13 in the amitriptyline-alone group (group 1) and 14 in the combination-therapy group (group 2). The most frequent adverse event in both groups was dry mouth, and there was no significant difference in the occurrence of this or other adverse events between the two groups. Initial headache indices were similar for groups 1 and 2. The mean difference between the initial and final headache index for group 1 was 513.5 (P .207). Conclusions.—We were unable to demonstrate any significant benefit from amitriptyline plus fluoxetine over amitriptyline alone in the treatment of chronic daily headache/Transformed Migraine. Because of the small number of subjects involved and the short duration of our study, a type II error cannot be excluded.

Richard B Lipton - One of the best experts on this subject based on the ideXlab platform.

  • assessing barriers to chronic Migraine consultation diagnosis and treatment results from the chronic Migraine epidemiology and outcomes cameo study
    Headache, 2016
    Co-Authors: David W Dodick, Elizabeth Loder, Aubrey Manack Adams, Dawn C Buse, Kristina M Fanning, Michael L Reed, Richard B Lipton
    Abstract:

    Objective To assess the rates and predictors of traversing steps essential to good medical care for chronic Migraine, including: (1) medical consultation, (2) accurate diagnosis, and (3) minimal pharmacologic treatment. Candidate predictors included socioeconomic, demographic, and headache-specific variables. Background Previous research has established that barriers to effective management for episodic Migraine include the absence of health insurance, lack of appropriate medical consultation, failure to receive an accurate diagnosis, and not being offered a regimen with acute and preventive treatments. Methods/Design The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, a longitudinal web-based panel study of Migraine, included a cross-sectional module focused on patterns of and barriers to medical care. Participants eligible for this analysis met the study criteria for chronic Migraine, had evidence of headache-related disability, and provided data on health insurance status. The main outcomes in the current analysis included the proportion of respondents who sought consultation for headache with a designated healthcare professional, self-reported receiving a diagnosis of chronic or Transformed Migraine, and received minimal pharmacologic treatment for headache with a focus on prescribed acute and preventive treatments. Results In the CaMEO Study, 80,783 respondents provided study data, 16,789 (20.8% of respondents) met criteria for Migraine, and 1476 (8.8% of those with Migraine) met chronic Migraine criteria. In total, 1254 participants (85.0% of those with chronic Migraine) met inclusion criteria for this analysis. Of those, 512 respondents (40.8%) reported currently consulting with a healthcare professional for headache. Odds of consulting increased with increasing age (OR 1.02; 95% CI 1.01–1.03), body mass index (BMI) (OR 1.01; 95% CI 1.00–1.03), Migraine-related disability (OR 1.02; 95% CI 1.00–1.04), and Migraine severity (OR 1.16; 95% CI 1.11–1.22) and presence of health insurance (OR 4.61; 95% CI 3.05–6.96). Among those consulting a healthcare professional, 126 (24.6%) received an accurate diagnosis and 56 of those with a correct diagnosis (44.4%) received both acute and preventive pharmacologic treatments; odds of a CM diagnosis were higher for women (OR 1.93; 95% CI 1.03–3.61), those with greater Migraine severity (OR 1.25; 95% CI 1.14–1.37), and those currently consulting a specialist (OR 2.38; 95% CI 1.54–3.69). No predictors of receiving appropriate treatment were identified among those currently consulting. Among our sample of people with chronic Migraine, only 56 (4.5%) individuals successfully traversed the series of 3 barriers to successful chronic Migraine care (ie, consulted a healthcare professional for Migraine, received an accurate diagnosis, and were prescribed minimal acute and preventive pharmacologic treatments). Conclusion Our findings suggest that <5% of persons with chronic Migraine traversed 3 barriers to receiving care for headache (consultation, diagnosis, and treatment), representing a large unmet need for improving care in this population. Predictors of consulting a healthcare professional included age, having health insurance, greater Migraine-related disability, and greater Migraine symptom severity. Among those consulting, predictors of an appropriate diagnosis included consulting a specialist, female sex, and greater Migraine severity. Public health efforts are needed to improve outcomes for patients with chronic Migraine by a range of interventions and educational efforts aimed at improving consultation rates, diagnostic accuracy, and adherence to minimal pharmacologic treatment.

  • economic burden of Transformed Migraine results from the american Migraine prevalence and prevention ampp study
    Headache, 2009
    Co-Authors: Julie Munakata, Elisabeth Hazard, Daniel Serrano, David Klingman, Marcia F T Rupnow, Jonothan C Tierce, Michael D Reed, Richard B Lipton
    Abstract:

    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.

  • acute Migraine medications and evolution from episodic to chronic Migraine a longitudinal population based study
    Headache, 2008
    Co-Authors: Marcelo E Bigal, Dawn C Buse, Daniel Serrano, Ann I Scher, Walter F Stewart, Richard B Lipton
    Abstract:

    Background.—Though symptomatic medication overuse is believed to play a major role in progression from episodic to chronic or Transformed Migraine (TM), population-based longitudinal data on these agents are limited. Objectives.—To assess the role of specific classes of acute medications in the development of TM in episodic Migraine (EM) sufferers after adjusting for other risk factors for headache progression. Methods.—As a part of the American Migraine Prevalence and Prevention study (AMPP), we initially surveyed a population sample of 120,000 individuals to identify a sample of Migraineurs to be followed annually over 5 years. Using logistic and linear regression, we modeled the probability of transition from EM in 2005 to TM in 2006 in relation to medication use status at baseline. Adjustments were made for gender, headache frequency and severity, and prevention medication use. Results.—Of 8219 individuals with EM in 2005, 209 (2.5%) had developed TM by 2006. Baseline headache frequency was a risk factor for TM. Using acetaminophen user as the reference group, individuals who used medications containing barbiturates (OR = 2.06, 95%CI = 1.3-3.1) or opiates (OR = 1.98, 95%CI = 1.4-2.2) were at increased risk of TM. A dose–response relationship was found for use of barbiturates. Use of triptans (OR = 1.25, 95%CI = 0.9-1.7) at baseline was not associated with prospective risk of TM. Overall, NSAIDs (OR = 0.85, 95%CI = 0.63-1.17) were not associated with TM. Indeed, NSAIDs were protective against transition to TM at low to moderate monthly headache days, but were associated with increased risk of transition to TM at high levels of monthly headache days. Conclusion.—EM sufferers develop TM at the rate of 2.5% per year. Any use of barbiturates and opiates was associated with increased risk of TM after adjusting for covariates, while triptans were not. NSAIDs were protective or inducers depending on the headache frequency.

  • prevalence and characteristics of allodynia in headache sufferers a population study
    Neurology, 2008
    Co-Authors: Marcelo E Bigal, Dawn C Buse, Daniel Serrano, M L Reed, Sait Ashina, Rami Burstein, Richard B Lipton
    Abstract:

    Objective: The authors estimated the prevalence and severity of cutaneous allodynia (CA) in individuals with primary headaches from the general population. Methods: We mailed questionnaires to a random sample of 24,000 headache sufferers previously identified from the population. The questionnaire included the validated Allodynia Symptom Checklist (ASC) as well as measures of headache features, disability, and comorbidities. We modeled allodynia as an outcome using headache diagnosis, frequency and severity of headaches, and disability as predictor variables in logistic regression. Covariates included demographic variables, comorbidities, use of preventive medication, and use of opioids. Results: Complete surveys were returned by 16,573 individuals. The prevalence of CA of any severity (ASC score ≥3) varied with headache type. Prevalence was significantly higher in Transformed Migraine (TM, 68.3%) than in episodic Migraine (63.2%, p Conclusions: Cutaneous allodynia (CA) is more common and more severe in Transformed Migraine and Migraine than in other primary headaches. Among Migraineurs, CA is associated with female sex, headache frequency, increased body mass index, disability, and depression.

  • obesity is a risk factor for Transformed Migraine but not chronic tension type headache
    Neurology, 2006
    Co-Authors: Marcelo E Bigal, Richard B Lipton
    Abstract:

    Objective: To assess the influence of the body mass index (BMI) on the prevalence and severity of chronic daily headache (CDH) and its most frequent subtypes, Transformed Migraine (TM) and chronic tension-type headache (CTTH). Methods: The authors gathered information on headache, medical features, height, and weight using a computer-assisted telephone interview. Participants were divided into five categories, based on BMI: underweight ( 35). The prevalence and severity of CDH, TM, and CTTH were assessed. Multivariate analyses modeling these diagnoses as a function of BMI were conducted. Results: Among 30,215 participants, the prevalence of CDH was 4.1%; 1.3% had TM and 2.8% CTTH. In contrast with the normal weight group (3.9%), the prevalence of CDH was higher in obese (5.0% [odds ratio (OR) = 1.3, 95% CI = 1.1–1.6]) and morbidly obese (6.8% [OR = 1.8, 95% CI = 1.4 to 2.2]). BMI had a strong influence on the prevalence of TM, which ranged from 0.9% of the normal weighted to 1.2% of the overweight (OR = 1.4 [1.1 to 1.8]), 1.6% of the obese (OR = 1.7 [1.2 to 2.43]), and 2.5% of the morbidly obese (OR = 2.2 [1.5 to 3.2]). The effects of the BMI on the prevalence of CTTH were just significant in the morbidly obese group. Adjusted analyses showed that obesity was associated with CDH and TM but not CTTH. Conclusions: Chronic daily headache and obesity are associated. Obesity is a stronger risk factor for Transformed Migraine than for chronic tension-type headache.

Marcelo E Bigal - One of the best experts on this subject based on the ideXlab platform.

  • memantine in the preventive treatment of refractory Migraine
    Headache, 2008
    Co-Authors: Marcelo E Bigal, Alan M Rapoport, Fred D Sheftell, Deborah Tepper, Stewart J Tepper
    Abstract:

    Objectives To assess the efficacy and tolerability of memantine(MEM)in the preventive treatment of refractory Migraine. Background Glutamate is of importance in Migraine pathophysiology and may be related to progression from episodic to chronic Migraine. Furthermore, individuals with chronic pain often report cognitive problems. MEM has the potential to address both issues, justifying this pilot study. Methods We included subjects with refractory Migraine (episodic Migraine with 8-14 days of headache per month or Transformed Migraine, who had previously failed at least 2 trials of adequate preventive therapy). Other preventive drugs were allowed if the patient had been on a stable dose for more than 30 days. MEM dose ranged from 10 mg to 20 mg per day. The treatment phase lasted 3 months. The primary endpoint was number of days with headache at month 3. Cognitive performance was assessed with the trail making tests A and B (TMT-A and B). Statistical analyses were performed on the intent-to-treat (ITT) population, using data subjected to the last observation carried forward algorithm.We also conducted per protocol analyses. Results In the ITT population (n = 28), monthly headache frequency was reduced from 21.8 days at baseline to 16.1 (P Conclusion This study offers preliminary evidence for the use of MEM in the prevention of refractory Migraine.Double-blind studies are now required.

  • acute Migraine medications and evolution from episodic to chronic Migraine a longitudinal population based study
    Headache, 2008
    Co-Authors: Marcelo E Bigal, Dawn C Buse, Daniel Serrano, Ann I Scher, Walter F Stewart, Richard B Lipton
    Abstract:

    Background.—Though symptomatic medication overuse is believed to play a major role in progression from episodic to chronic or Transformed Migraine (TM), population-based longitudinal data on these agents are limited. Objectives.—To assess the role of specific classes of acute medications in the development of TM in episodic Migraine (EM) sufferers after adjusting for other risk factors for headache progression. Methods.—As a part of the American Migraine Prevalence and Prevention study (AMPP), we initially surveyed a population sample of 120,000 individuals to identify a sample of Migraineurs to be followed annually over 5 years. Using logistic and linear regression, we modeled the probability of transition from EM in 2005 to TM in 2006 in relation to medication use status at baseline. Adjustments were made for gender, headache frequency and severity, and prevention medication use. Results.—Of 8219 individuals with EM in 2005, 209 (2.5%) had developed TM by 2006. Baseline headache frequency was a risk factor for TM. Using acetaminophen user as the reference group, individuals who used medications containing barbiturates (OR = 2.06, 95%CI = 1.3-3.1) or opiates (OR = 1.98, 95%CI = 1.4-2.2) were at increased risk of TM. A dose–response relationship was found for use of barbiturates. Use of triptans (OR = 1.25, 95%CI = 0.9-1.7) at baseline was not associated with prospective risk of TM. Overall, NSAIDs (OR = 0.85, 95%CI = 0.63-1.17) were not associated with TM. Indeed, NSAIDs were protective against transition to TM at low to moderate monthly headache days, but were associated with increased risk of transition to TM at high levels of monthly headache days. Conclusion.—EM sufferers develop TM at the rate of 2.5% per year. Any use of barbiturates and opiates was associated with increased risk of TM after adjusting for covariates, while triptans were not. NSAIDs were protective or inducers depending on the headache frequency.

  • prevalence and characteristics of allodynia in headache sufferers a population study
    Neurology, 2008
    Co-Authors: Marcelo E Bigal, Dawn C Buse, Daniel Serrano, M L Reed, Sait Ashina, Rami Burstein, Richard B Lipton
    Abstract:

    Objective: The authors estimated the prevalence and severity of cutaneous allodynia (CA) in individuals with primary headaches from the general population. Methods: We mailed questionnaires to a random sample of 24,000 headache sufferers previously identified from the population. The questionnaire included the validated Allodynia Symptom Checklist (ASC) as well as measures of headache features, disability, and comorbidities. We modeled allodynia as an outcome using headache diagnosis, frequency and severity of headaches, and disability as predictor variables in logistic regression. Covariates included demographic variables, comorbidities, use of preventive medication, and use of opioids. Results: Complete surveys were returned by 16,573 individuals. The prevalence of CA of any severity (ASC score ≥3) varied with headache type. Prevalence was significantly higher in Transformed Migraine (TM, 68.3%) than in episodic Migraine (63.2%, p Conclusions: Cutaneous allodynia (CA) is more common and more severe in Transformed Migraine and Migraine than in other primary headaches. Among Migraineurs, CA is associated with female sex, headache frequency, increased body mass index, disability, and depression.

  • obesity is a risk factor for Transformed Migraine but not chronic tension type headache
    Neurology, 2006
    Co-Authors: Marcelo E Bigal, Richard B Lipton
    Abstract:

    Objective: To assess the influence of the body mass index (BMI) on the prevalence and severity of chronic daily headache (CDH) and its most frequent subtypes, Transformed Migraine (TM) and chronic tension-type headache (CTTH). Methods: The authors gathered information on headache, medical features, height, and weight using a computer-assisted telephone interview. Participants were divided into five categories, based on BMI: underweight ( 35). The prevalence and severity of CDH, TM, and CTTH were assessed. Multivariate analyses modeling these diagnoses as a function of BMI were conducted. Results: Among 30,215 participants, the prevalence of CDH was 4.1%; 1.3% had TM and 2.8% CTTH. In contrast with the normal weight group (3.9%), the prevalence of CDH was higher in obese (5.0% [odds ratio (OR) = 1.3, 95% CI = 1.1–1.6]) and morbidly obese (6.8% [OR = 1.8, 95% CI = 1.4 to 2.2]). BMI had a strong influence on the prevalence of TM, which ranged from 0.9% of the normal weighted to 1.2% of the overweight (OR = 1.4 [1.1 to 1.8]), 1.6% of the obese (OR = 1.7 [1.2 to 2.43]), and 2.5% of the morbidly obese (OR = 2.2 [1.5 to 3.2]). The effects of the BMI on the prevalence of CTTH were just significant in the morbidly obese group. Adjusted analyses showed that obesity was associated with CDH and TM but not CTTH. Conclusions: Chronic daily headache and obesity are associated. Obesity is a stronger risk factor for Transformed Migraine than for chronic tension-type headache.

  • When Migraine progresses: Transformed or chronic Migraine.
    Expert Review of Neurotherapeutics, 2006
    Co-Authors: Marcelo E Bigal, Richard B Lipton
    Abstract:

    Migraine may be conceptualized, not just as an episodic disorder, but as a chronic recurrent and sometimes chronic progressive disorder. Transformed Migraine, often referred to as chronic Migraine is the result of Migraine progression. This article will review the clinical features of Transformed Migraine, highlighting that its phenotype varies according to stage. Early in the process of transformation, attacks with Migraine features are very common. As the disease evolves, most attacks lack the Migraine features. The risk factors for Migraine progression and the mechanisms for progression will be discussed. This review concludes with the prospects for treating Transformed Migraine and avoiding Migraine progression.

Stephen D Silberstein - One of the best experts on this subject based on the ideXlab platform.

  • assessment botulinum neurotoxin in the treatment of autonomic disorders and pain an evidence based review report of the therapeutics and technology assessment subcommittee of the american academy of neurology
    Neurology, 2009
    Co-Authors: Markus Naumann, Stephen D Silberstein, C E Argoff, Martin K Childers, Dennis D Dykstra, Gary S Gronseth, Bahman Jabbari, Horacio Kaufmann, Brigitte Schurch, David M Simpson
    Abstract:

    Objective: To perform an evidence-based review of the safety and efficacy of botulinum neurotoxin (BoNT) in the treatment of autonomic and urologic disorders and low back and head pain. Methods: A literature search was performed including MEDLINE and Current Contents for therapeutic articles relevant to BoNT and the selected indications. Authors reviewed, abstracted, and classified articles based on the quality of the study (Class I–IV). Conclusions and recommendations were developed based on the highest level of evidence and put into current clinical context. Results: The highest quality literature available for the respective indications was as follows: axillary hyperhidrosis (two Class I studies); palmar hyperhidrosis (two Class II studies); drooling (four Class II studies); gustatory sweating (five Class III studies); neurogenic detrusor overactivity (two Class I studies); sphincter detrusor dyssynergia in spinal cord injury (two Class II studies); chronic low back pain (one Class II study); episodic Migraine (two Class I and two Class II studies); chronic daily headache (four Class II studies); and chronic tension-type headache (two Class I studies). Recommendations: Botulinum neurotoxin (BoNT) should be offered as a treatment option for the treatment of axillary hyperhidrosis and detrusor overactivity (Level A), should be considered for palmar hyperhidrosis, drooling, and detrusor sphincter dyssynergia after spinal cord injury (Level B), and may be considered for gustatory sweating and low back pain (Level C). BoNT is probably ineffective in episodic Migraine and chronic tension-type headache (Level B). There is presently no consistent or strong evidence to permit drawing conclusions on the efficacy of BoNT in chronic daily headache (mainly Transformed Migraine) (Level U). While clinicians’ practice may suggest stronger recommendations in some of these indications, evidence-based conclusions are limited by the availability of data. Neurology ® 2008;70:1707–1714

  • greater occipital nerve block using local anaesthetics alone or with triamcinolone for Transformed Migraine a randomised comparative study
    Journal of Neurology Neurosurgery and Psychiatry, 2008
    Co-Authors: Avi Ashkenazi, Rebecca Matro, James W Shaw, Muhammad A Abbas, Stephen D Silberstein
    Abstract:

    Objective: To determine whether adding triamcinolone to local anesthetics increased the efficacy of GONB and trigger point injections (TPIs) for Transformed Migraine (TM). Methods: TM patients were randomized to receive GONB and TPIs using lidocaine 2% and bupivacaine 0.5% + either saline or triamcinolone 40 mg. We assessed the severity of headache and associated symptoms before and 20 minutes after injection. Patients documented headache and associated symptoms severity for 4 weeks after injections. Changes in symptom severity were compared between the two groups. Results: Thirty seven patients were included. Twenty minutes after injection, mean headache severity decreased by 3.2 points in group A (p<0.01) and by 3.1 points in group B (p<0.01). Mean neck pain severity decreased by 1.5 points in group A (p<0.01) and by 1.7 points in group B (p<0.01). Mean duration of being headache free was 2.7±3.8 days in group A and 1.0±1.1 days in group B (p=0.67). None of the outcome measures differed significantly between the two groups. Both treatments were well-tolerated. Conclusions: Adding triamcinolone to local anesthetics when performing GONB and TPIs was not associated with improved outcome in this sample of Transformed Migraine patients.

  • zonisamide for Migraine prophylaxis in refractory patients
    Cephalalgia, 2006
    Co-Authors: Avi Ashkenazi, Adam Benlifer, Jason Korenblit, Stephen D Silberstein
    Abstract:

    Zonisamide is a new antiepileptic drug with multiple mechanisms of action and a favourable pharmacokinetic profile. Preliminary data suggest that zonisamide may be effective in Migraine prophylaxis. We evaluated the efficacy and tolerability of zonisamide for Migraine prophylaxis in refractory patients. We reviewed the charts of adult patients with International Headache Society-defined episodic Migraine (EM) or with Transformed Migraine (TM) according to the Silberstein-Lipton criteria, who had been treated with zonisamide at our out-patient clinic for at least 60 days. Demographic data, zonisamide dosage and duration of treatment were collected and analysed. Headache frequency, attack duration, headache severity and headache-related disability before and after treatment initiation with zonisamide were compared. Thirty-three patients were included in the study (average age 43.9 +/- 8.4 years; 23 (70%) with TM and 10 (30%) with EM). The patients had failed an average of 6.2 Migraine prophylactic drugs prior to zonisamide. The average zonisamide daily dose was 337.9 +/- 146.3 mg and the average duration of treatment was 186.4 +/- 174.0 days. The average number of days with headache per month was reduced in the entire study population from 20.7 +/- 9.5 before zonisamide treatment to 18.0 +/- 11.3 after its initiation (P = 0.06) [in TM from 24.7 +/- 7.3 to 21.0 +/- 10.7 (P = 0.06); in EM from 11.6 +/- 7.6 to 11.0 +/- 9.7 (P = NS)]. No significant changes in other headache parameters were found. Fourteen patients (42.4%) reported adverse events (AEs), the most common of which was fatigue. Most patients (12/14, 85.7%) rated AEs as mild or moderate. In this group of refractory Migraine patients, zonisamide therapy did not result in a statistically significant beneficial effect on headache or on associated symptoms.

  • Fibromyalgia is common in patients with Transformed Migraine
    Neurology, 2001
    Co-Authors: Mario F.p. Peres, William B Young, A. O. Kaup, E Zukerman, Stephen D Silberstein
    Abstract:

    Fibromyalgia (FM) and Transformed Migraine (TM) are common chronic pain disorders. The authors estimated the prevalence of FM in 101 patients with TM, and analyzed its relationship to depression, anxiety, and insomnia. FM was diagnosed in 35.6% of cases. Patients with FM had more insomnia, were older, and had headaches that were more incapacitating than patients without FM. Insomnia and depression predicted FM in patients with TM.

  • idiopathic intracranial hypertension without papilledema a case control study in a headache center
    Neurology, 1998
    Co-Authors: Shuujiun Wang, Stephen D Silberstein, Stephanie Patterson, William B Young
    Abstract:

    Objective: To compare the clinical features of patients with chronic daily headache(CDH) with idiopathic intracranial hypertension without papilledema (IIHWOP) to those with normal CSF pressure. Methods: A case-control study was conducted at a tertiary headache center. Cases consisted of 25 consecutive patients (24 women, 1 man, 38 ± 6 years) with IIHWOP diagnosed between June 1989 and June 1996. IIHWOP was diagnosed if pressure was 200 mm CSF on two occasions and there was no papilledema. Control subjects consisted of patients with refractory CDH who had normal CSF pressure on lumbar puncture performed between June 1992 and June 1996 (n = 60, 50 women, 10 men, 36 ± 11 years). A structured telephone follow-up was done from July 1996 to March 1997. Comparisons made between the two groups included demographics and headache profiles, both at the initial evaluation and at follow-up. Results: The initial headache characteristics did not differ between the two groups: most had Transformed Migraine with analgesic overuse. Significant predictors of IIHWOP included pulsatile tinnitus (odds ratio [OR] = 13.0) and obesity (OR = 4.4). Visual symptoms did not differ significantly. The prognosis of the two groups of patients was similar. Conclusions: Pulsatile tinnitus and obesity suggest possible IIHWOP in patients with CDH. Treatment of patients with increased intracranial pressure was not satisfactory.

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  • comparison of dynamic brush and static pressure mechanical allodynia in Migraine
    Cephalalgia, 2006
    Co-Authors: C Lopinto, William B Young, Avi Ashkenazi
    Abstract:

    Allodynia has been described in Migraine but has not been fully investigated for the different sensory modalities. The aim of this study was to compare the prevalence of dynamic (brush) and static (pressure) mechanical allodynia in Migraine patients and to suggest a practical method of testing them in a clinical setting. Patients with International Headache Society-defined episodic Migraine (EM) or with Transformed Migraine (TM) as defined by Silberstein and Lipton were prospectively recruited from the Jefferson Headache Center out-patient clinic. A questionnaire of Migraine features and symptoms of allodynia was administered. Brush allodynia (BA) was tested by cutaneous stimulation with a gauze pad and pressure allodynia (PA) was tested using von Frey hairs (VFH). The prevalence of BA and PA in all patients and in the different subgroups was calculated and correlated with Migraine features. We recruited 55 Migraine patients. Twenty-five had EM and 30 had TM. BA was present in 18 (32.7%) patients and PA in 18-24 (32.7-43.6%). Allodynia to both brush and pressure was found in 13-17 (23.6-30.9%) patients. If a patient had allodynia to one modality only, it was more likely to be PA than BA. Both BA and PA were more common in patients with TM compared with those with EM [BA 46.7% vs. 16.0%; PA (differences significant for the medium and thick VFHs) 50% vs. 20% and 50% vs. 12%, respectively]. Both types of allodynia were also more common in patients with Migraine with aura compared with those with Migraine without aura (BA 57.1% vs. 17.6%; PA 57.1-61.9% vs. 17.6-32.7%). There was a positive correlation between allodynia score (as obtained by examination) and allodynia index (as obtained by history) for both BA and PA. The incomplete, although considerable, overlap between BA and PA suggests that allodynia to different sensory modalities is associated with sensitization of different neuronal populations. Because PA was more common than BA, it may be a more sensitive indicator of allodynia in Migraine. PA can be tested clinically in a practical and systematic manner.

  • Fibromyalgia is common in patients with Transformed Migraine
    Neurology, 2001
    Co-Authors: Mario F.p. Peres, William B Young, A. O. Kaup, E Zukerman, Stephen D Silberstein
    Abstract:

    Fibromyalgia (FM) and Transformed Migraine (TM) are common chronic pain disorders. The authors estimated the prevalence of FM in 101 patients with TM, and analyzed its relationship to depression, anxiety, and insomnia. FM was diagnosed in 35.6% of cases. Patients with FM had more insomnia, were older, and had headaches that were more incapacitating than patients without FM. Insomnia and depression predicted FM in patients with TM.

  • quality of life differences between patients with episodic and Transformed Migraine
    Headache, 2001
    Co-Authors: Dennis M Meletiche, Jennifer H Lofland, William B Young
    Abstract:

    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 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.

  • idiopathic intracranial hypertension without papilledema a case control study in a headache center
    Neurology, 1998
    Co-Authors: Shuujiun Wang, Stephen D Silberstein, Stephanie Patterson, William B Young
    Abstract:

    Objective: To compare the clinical features of patients with chronic daily headache(CDH) with idiopathic intracranial hypertension without papilledema (IIHWOP) to those with normal CSF pressure. Methods: A case-control study was conducted at a tertiary headache center. Cases consisted of 25 consecutive patients (24 women, 1 man, 38 ± 6 years) with IIHWOP diagnosed between June 1989 and June 1996. IIHWOP was diagnosed if pressure was 200 mm CSF on two occasions and there was no papilledema. Control subjects consisted of patients with refractory CDH who had normal CSF pressure on lumbar puncture performed between June 1992 and June 1996 (n = 60, 50 women, 10 men, 36 ± 11 years). A structured telephone follow-up was done from July 1996 to March 1997. Comparisons made between the two groups included demographics and headache profiles, both at the initial evaluation and at follow-up. Results: The initial headache characteristics did not differ between the two groups: most had Transformed Migraine with analgesic overuse. Significant predictors of IIHWOP included pulsatile tinnitus (odds ratio [OR] = 13.0) and obesity (OR = 4.4). Visual symptoms did not differ significantly. The prognosis of the two groups of patients was similar. Conclusions: Pulsatile tinnitus and obesity suggest possible IIHWOP in patients with CDH. Treatment of patients with increased intracranial pressure was not satisfactory.

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