المؤلفون: Kuruvilla, Deena E., Natbony, Lauren, Chandwani, Brijesh, Jann, Adelene, Bradley, Brooklyn A., Zhang, Niushen

المصدر: Current Pain & Headache Reports; Apr2024, Vol. 28 Issue 4, p195-203, 9p

مستخلص: Purpose of Review: Trigeminal neuralgia (TN) and trigeminal autonomic cephalalgias (TACs) are both painful diseases which directly impact the branches of the trigeminal nerve, which supply the face. Patients who have experienced adverse effects, have not responded to mainstream treatments, or have a personal preference for nonmedication options, often turn to complementary and integrative medicine (CIM). The aim of this review is to discuss the efficacy and safety of CIM therapies available for the treatment of TN and TACs. Recent Findings: Not only are there limited therapeutic options for TN and TAC patients, but also is there a proportion of patients who are intolerant to standard medical treatments. Recent findings have illustrated that 86% of patients with headache disorders utilize CIM modalities in combination with mainstream medical therapy. Summary: CIM modalities can be helpful for these diseases and have primarily been studied in combination with standard medical therapy. There is limited evidence for CIM and behavioral therapies in managing these conditions, and more research is needed to confirm which therapies are safe and effective. [ABSTRACT FROM AUTHOR]

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المؤلفون: Blumenfeld, Andrew M., Lipton, Richard B., Silberstein, Stephen, Tepper, Stewart J., Charleston IV, Larry, Landy, Stephen, Kuruvilla, Deena E., Manack Adams, Aubrey

المصدر: Neurology & Therapy; Oct2023, Vol. 12 Issue 5, p1533-1551, 19p

مصطلحات موضوعية: MIGRAINE, NEUROLOGICAL disorders, MEDICATION abuse, COMBINED modality therapy, PAIN management, CLUSTER headache

مستخلص: Migraine is a neurologic disease with a complex pathophysiology that can be controlled with current treatment options but not cured. Therefore, treatment expectations are highly variable. The concept of migraine freedom was recently introduced and can mean different things, with some, for example, expecting complete freedom from headache and associated symptoms and others accepting the occasional migraine attack if it does not impact functioning. Therefore, migraine management should be optimized so that patients can have the best opportunity to achieve their optimal treatment goals. With migraine freedom as a goal and, given the complex pathophysiology of migraine and the high incidence of comorbidities among individuals with migraine, treatment with a single modality may be insufficient, as it may not achieve migraine freedom in those with more frequent or disabling attacks. In this clinical perspective article, we have identified four key, partially overlapping principles of multimodal migraine treatment: (1) manage common comorbidities; (2) control modifiable risk factors for progression by addressing medication and caffeine overuse; (3) diagnose and treat secondary causes of headache, if present; and (4) individualize acute and preventive treatments to minimize pain, functional disability, and allodynia. There are many barriers to pursuing migraine freedom, and strategies to overcome them should be optimized. Migraine freedom should be an aspirational goal both at the individual attack level and for the disease overall. We believe that a comprehensive and multimodal approach that addresses all barriers people with migraine face could move patients closer to migraine freedom. [ABSTRACT FROM AUTHOR]

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المؤلفون: Tepper, Stewart J., Grosberg, Brian, Daniel, Oved, Kuruvilla, Deena E., Vainstein, Gabriel, Deutsch, Lisa, Sharon, Roni

المصدر: Headache: The Journal of Head & Face Pain; Sep2022, Vol. 62 Issue 8, p989-1001, 13p

مصطلحات موضوعية: MIGRAINE prevention, RESEARCH, PAIN, CONFIDENCE intervals, MIGRAINE, TRIGEMINAL nerve, RANDOMIZED controlled trials, ELECTRIC stimulation, BLIND experiment, ELECTROTHERAPEUTICS, STATISTICAL sampling, PATIENT safety

مستخلص: Objective: To evaluate the efficacy and safety of concurrent non‐invasive stimulation of occipital and trigeminal nerves in acute treatment of migraine with or without aura. Background: Non‐invasive neuromodulation devices stimulating a single peripheral nerve or anatomic distribution are routinely used by patients with migraine refractory to the first‐line drugs or those who opt out of pharmaceutical treatment. Concurrent occipital and trigeminal stimulation was described in an invasive setting, and its safety cost outweighed its efficacy gain. This study evaluated the efficacy and safety of an external concurrent occipital and trigeminal device in acute treatment of migraine. Design and Methods: This was a randomized, sham‐controlled, double‐blind, multi‐center trial. Patients 18 years of age or older who met the International Classification of Headache Disorders (2018) diagnostic criteria for migraine with or without aura, reported 1–6 migraine attacks per month, and other headaches no more than 6 days per month were enrolled. Of 131 intention‐to‐treat participants (67 and 64 in the active and sham groups, respectively), 109 (50 and 59 in the active and sham groups, respectively) treated at least one migraine episode. Reduction of migraine headache (pain relief) 2 h after treatment initiation was the primary efficacy endpoint. Pain relief at 1 h, and pain freedom and relief in most bothersome symptom at 2 h after treatment initiation were the secondary endpoints. Freedom from most bothersome symptom at 2 h and sustained pain freedom 24 h after treatment initiation were among the exploratory endpoints. Results: Sixty percent of participants (30/50) in the active arm reported pain relief at 2 h after initiation of the first eligible treatment (primary outcome) compared to 37% (22/59) in the control arm (difference, 23%; 95% confidence interval [CI], 2%–41%; p = 0.018). Pain freedom at 2 h without rescue medication was reported by 46% (23/50) of participants in the active arm and by 12% (7/59) of participants in the sham arm (p < 0.001). Pain freedom 2 h after the treatment and, subsequently, at 24 h, was reported by 4.25 times more participants in the active arm (36%; 18/50) than in the sham arm (8%; 5/59). The 28% difference was statistically significant (95% CI, 1%–43%; p < 0.001). A 4.25‐fold difference was also observed comparing the proportion of participants free from pain and most bothersome symptom 2 h after the stimulation (47% [17/36] and 11% [5/45] in the active and sham arms, respectively; 95% CI, 14%–54%; p < 0.001). Adverse events were not serious or severe. All study‐related events resolved without treatment. Conclusion: External concurrent occipital and trigeminal neurostimulation is a well‐tolerated, safe, and effective migraine treatment that provided a fast and durable relief and freedom from migraine pain and associated symptoms in a randomized setting. The observed safety and performance suggest external concurrent occipital and trigeminal neurostimulation is a viable alternative to the currently available acute migraine treatments. Trial registration: clinicaltrials.gov identifier NCT03631550. [ABSTRACT FROM AUTHOR]

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المؤلفون: Holdridge, Ashley, Donnelly, Megan, Kuruvilla, Deena E.

المصدر: Current Pain & Headache Reports; Apr2022, Vol. 26 Issue 4, p323-330, 8p

مستخلص: Purpose of Review: While most women with migraine improve during pregnancy, a subset may remain unchanged or even become more severe. Given the limited evidence for the use of prescription medications during pregnancy, many look to other treatment modalities. We seek to review complementary and integrative medicine, procedural interventions, and neurostimulation to empower women with safe and effective treatment options during pregnancy. Recent Findings: Migraine treatment during pregnancy remains controversial. While evidence is limited, prospective and retrospective reviews, as well as clinical experience support the use of nutraceuticals, procedural interventions, and neurostimulation during pregnancy when the appropriate risks and benefits are weighed. Summary: Empowering patients with information on complementary and integrative medicine, as well as non-systemic and interventional treatments, may help to reduce anxiety and headache burden during pregnancy. Various nutraceuticals have shown promise for the preventive management of migraine. Non-systemic interventions such as trigger point injections and peripheral and sphenopalatine nerve blocks offer effective treatment options with minimal side-effects. Options for neurostimulation have expanded in recent years and may offer safe and effective non-pharmacologic options for the management of migraine. It is imperative that providers do not minimize migraine during pregnancy and become aware of the treatment modalities available to help guide women through this experience. [ABSTRACT FROM AUTHOR]

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المؤلفون: Kuruvilla, Deena E., Mann, Joseph I., Tepper, Stewart J., Starling, Amaal J., Panza, Gregory, Johnson, Michael A. L.

المصدر: Scientific Reports; 3/24/2022, Vol. 12 Issue 1, p1-11, 11p

مصطلحات موضوعية: MIGRAINE, ANALGESIA, CLINICAL trials, NEUROLOGICAL disorders, TRIGEMINAL nerve, SPREADING cortical depression, TRANSCRANIAL direct current stimulation

مستخلص: Migraine is one of the most common and debilitating neurological disorders worldwide. External Trigeminal Nerve Stimulation (e-TNS) is a non-pharmacological, non-invasive therapeutic alternative for patients with migraine. The TEAM study was a prospective, multicenter, randomized, double-blind, sham-controlled, Phase 3 trial for 2-h, continuous, e-TNS treatment of a single moderate or severe migraine attack at home. A total of 538 adults meeting the International Classification of Headache Disorders 3rd edition criteria for 2–8 migraine headache days per month were recruited and randomized in a 1:1 ratio to 2-h active or sham stimulation. Migraine pain levels and most bothersome migraine-associated symptoms (MBS) were recorded at baseline, 2 h, and 24 h using a paper diary. The primary endpoints for the study were pain freedom at 2 h and freedom from the MBS at 2 h. The secondary endpoints were pain relief at 2 h, absence of most bothersome migraine-associated symptoms (MBSs) at 2 h, acute medication use within 24 h after treatment, sustained pain freedom at 24 h, and sustained pain relief at 24 h. Adverse event data was also collected and compared between groups. Five hundred thirty-eight patients were randomized to either the verum (n = 259) or sham (n = 279) group and were included in an intention-to-treat analysis. The percentage of patients with pain freedom at 2 h was 7.2% higher in verum (25.5%) compared to sham (18.3%; p = 0.043). Resolution of most bothersome migraine-associated symptom was 14.1% higher in verum (56.4%) compared to sham (42.3%; p = 0.001). With regards to secondary outcomes, pain relief at 2 h was 14.3% higher in verum (69.5%) than sham (55.2%; p = 0.001), absence of all migraine-associated symptoms at 2 h was 8.4% higher in verum (42.5%) than sham (34.1%; p = 0.044), sustained pain freedom and pain relief at 24 h was 7.0% and 11.5% higher in verum (22.8 and 45.9%) than sham (15.8 and 34.4%; p = 0.039 and.006, respectively). No serious adverse events were reported. Treatment with 2-h e-TNS is a safe and effective, non-invasive, and non-pharmacological alternative for the acute treatment of migraine attacks in an at-home setting. Trial registration Clinicaltrials.gov Identifier: NCT03465904. Registered 14/03/2018. https://www.clinicaltrials.gov/ct2/show/record/NCT03465904. [ABSTRACT FROM AUTHOR]

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المؤلفون: Goldman, Roberta E., Damush, Teresa M., Kuruvilla, Deena E., Lindsey, Hayley, Baird, Sean, Riley, Samantha, Burrone BS, Laura, Grinberg, Amy S., Seng, Elizabeth K., Fenton, Brenda T., Sico, Jason J.

المصدر: Headache: The Journal of Head & Face Pain; Mar2022, Vol. 62 Issue 3, p306-318, 13p

مصطلحات موضوعية: HEADACHE treatment, CHRONIC pain, NEUROLOGISTS, HEALTH services accessibility, RESEARCH methodology, PHYSICIAN-patient relations, PHYSICIANS' attitudes, PAIN clinics, INTERVIEWING, SOCIAL stigma, QUALITATIVE research, HEALTH care teams, SOUND recordings, JUDGMENT sampling, THEMATIC analysis, HEADACHE, COMORBIDITY

مصطلحات جغرافية: UNITED States

مستخلص: Background and Objective: Comprehensive headache care involves numerous specialties and components that have not been well documented or standardized. This study aimed to elicit best practices and characterize important elements of care to be provided in multidisciplinary headache centers. Methods: Qualitative, semi‐structured telephone interviews with a purposive sample of headache neurology specialists from across the US, using open‐ended questions. Interviews were recorded, transcribed, and coded. Coded data were further analyzed using immersion/crystallization techniques for final interpretation. Results: Mean years providing headache care was 17.7 (SD = 10.6). Twelve of the 13 participants held United Council for Neurologic Subspecialties headache certification. Six described their practice site as providing multidisciplinary headache care. Participants explained most of their patients had seen multiple doctors over many years, and had tried numerous unsuccessful treatments. They noted patients with chronic headache frequently present with comorbidities and become stigmatized. All participants asserted successful care depends on taking time to talk with and listen to patients, gain understanding, and earn trust. All participants believed multidisciplinary care is essential within a comprehensive headache center, along with staffing enough headache specialists, implementing detailed headache intake and follow‐up protocols, and providing the newest medications, neuromodulation devices, botulinum toxin injections, monoclonal antibodies, nerve blocks and infusions, and treatment from a health psychologist. Other essential services for a headache center are other behavioral health practitioners providing cognitive behavioral therapy, mindfulness, biofeedback and pain management; and autonomic neurology, neuropsychology, vestibular audiology, sleep medicine, physical therapy, occupational therapy, exercise physiology, speech therapy, nutrition, complementary integrative health modalities, and highly trained support staff. Conclusion: While headache neurology specialists form the backbone of headache care, experts interviewed for this study maintained their specialty is just one of many types of care needed to adequately treat patients with chronic headache, and this is best provided in a comprehensive, multidisciplinary center. [ABSTRACT FROM AUTHOR]

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المؤلفون: Kuruvilla, Deena E., Bilchik, Tanya

المصدر: Current Pain & Headache Reports; Mar2022, Vol. 26 Issue 3, p253-258, 6p

مستخلص: Purpose of Review: To evaluate the evidence regarding acute migraine treatment optimization to prevent the progression of episodic migraine to chronic migraine. This review also provides a summary of evidence-based acute migraine treatments and how to tailor a regimen based on an individual patient's needs. Recent Findings: Several acute migraine treatments have been food and drug administration (FDA)-approved since 2020. This review summarizes pain freedom data at 2 h for these medications and devices and examines the classic acute migraine treatments. Summary: This review presents the existing data about acute treatment optimization and its preventive role in the progression of episodic migraine to chronic migraine. We present updated clinical trial efficacy endpoints from the American Headache Society (AHS) and the FDA and review the evidence for acute migraine treatments currently available in clinical practice. [ABSTRACT FROM AUTHOR]

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المؤلفون: Kuruvilla, Deena E., Lindsey, Hayley, Grinberg, Amy S., Goldman, Roberta E., Riley, Samantha, Baird, Sean, Fenton, Brenda T., Sico, Jason J., Damush, Teresa M.

المصدر: BMC Complementary Medicine & Therapies; 1/25/2022, Vol. 22 Issue 1, p1-10, 10p, 1 Diagram, 2 Charts

مصطلحات موضوعية: CHRONIC disease treatment, HEADACHE treatment, RESEARCH, VETERANS' hospitals, HEALTH services accessibility, PATIENT autonomy, ACQUISITION of data methodology, ATTITUDE (Psychology), INTEGRATIVE medicine, RESEARCH methodology, TELEPHONES, MEDICAL personnel, INTERVIEWING, LABOR demand, PSYCHOLOGY of veterans, PATIENTS' attitudes, QUALITATIVE research, SELF-efficacy, MEDICAL records, HEALTH care teams, CLINICAL competence, RESEARCH funding, ALTERNATIVE medicine, THEMATIC analysis, JUDGMENT sampling, ELECTRONIC health records, DATA analysis software, MEDICAL care of veterans

مستخلص: Objective: To evaluate veteran patient and provider perceptions and preferences on complementary and integrative medicine (CIM) for headache management. Background: The Veterans Health Administration (VHA) has spearheaded a Whole Health system of care focusing on CIM-based care for veteran patients. Less is known about patients' and providers' CIM perceptions and preferences for chronic headache management. Methods: We conducted semi-structured interviews with 20 veteran patients diagnosed with headache and 43 clinical providers, across 12 VHA Headache Centers of Excellence (HCoE), from January 2019 to March 2020. We conducted thematic and case comparative analyses. Results: Veteran patients and VHA clinical providers viewed CIM favorably for the treatment of chronic headache. Specific barriers to CIM approaches included: (1) A lack of personnel specialized in specific CIM approaches for timely access, and (2) variation in patient perceptions and responses to CIM treatment efficacy for headache management. Conclusion: Veteran patients and VHA clinical providers in this study viewed CIM favorably as a safe addition to mainstream headache treatments. Advantages to CIM include favorable adverse effect profiles and patient autonomy over the treatment. By adding more CIM providers and resources throughout the VHA, CIM modalities may be recommended more routinely in the management of veterans with headache. [ABSTRACT FROM AUTHOR]

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المؤلفون: Zubair, Adeel S, Sico, Jason J, Kuruvilla, Deena E

المصدر: Pain Medicine; Sep2021, Vol. 22 Issue 9, p2135-2138, 4p

مصطلحات موضوعية: NEUROLOGISTS, PATIENT participation, MIGRAINE, ATTITUDE (Psychology), MEDICAL care, PATIENTS, SOCIAL stigma, MEDICAL personnel, PATIENT education, PSYCHOLOGICAL resilience

مستخلص: The article presents the Presence of Stigma in the Treatment of Patients With Migraine Among Neurologists. Topics discussed include Stigma is a construct in the social sciences, which describes a trait, characteristic, or diagnosis that discredits individuals and elicits prejudice, discrimination, and loss of status; and Migraine is the third most prevalent illness in the world, with roughly 12% of the US population suffering from the condition.

المؤلفون: Kuruvilla, Deena E., Mehta, Amit, Ravishankar, Nidhi, Cowan, Robert P.

المصدر: BMC Complementary Medicine & Therapies; 2/10/2021, Vol. 21 Issue 1, p1-7, 7p, 2 Charts

مصطلحات موضوعية: MEDICAL marijuana, ALTERNATIVE medicine, MIGRAINE, QUESTIONNAIRES, SURVEYS, SOCIAL media, CROSS-sectional method, PATIENTS' attitudes, DESCRIPTIVE statistics

مستخلص: To survey persons with migraine who use social media about Complementary and Integrative Medicine (CIM) for the treatment of migraine. Background: CIM encompasses medical treatments that are not part of but are used in concert with mainstream medicine. Between 28 and 82% of people with migraine use non-drug approaches, and approximately 50% of people with migraine do not discuss non-drug treatments with their healthcare providers (HCPs). It is important for providers to be conversant with CIM treatments and the available evidence-based data. To further this effort, people with migraine were surveyed directly through social media to identify CIM practices in which they engage. Methods: In collaboration with the American Migraine foundation (AMF) and Yakkety Yak, a digital marketing agency, we conducted a cross-sectional survey study. Participants were recruited from the Move Against Migraine (MAM) Facebook group which has 20,000+ members. The goals of the survey were to assess the attitudes toward CIM among this group, to identify which CIM modalities are being used and to determine what patients considered to be the most effective CIM modalities. While Yakkety Yak posted the survey link on the group page, the survey itself was hosted on Qualtrics, a confidential survey service. Results: 372 MAM members (approximately 2%) responded to the questionnaire, of which 335 reported using CIM; between 114 and 139 (34–42%) found CIM modalities to be at least mildly effective. Of note, 164 (49%) reported using cannabis derivatives or cannabinoids, specifically with, 64/164 (39%) reporting that cannabis was not effective for them. Conclusions: This study provides an initial investigation into the demographic and practice patterns of migraine patients who use CIM. While this sampling may not reflect CIM use across all individuals with migraine, it does strongly suggest the need for better education on the role of, and evidence for, CIM among headache care providers, and the need to ask patients specifically about their use of and interest in CIM. [ABSTRACT FROM AUTHOR]

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