Andrew Blumenfeld

Disability, HRQoL and resource use among chronic and episodic migraineurs: Results from the International Burden of Migraine Study (IBMS)

Background: Migraine imposes significant burden on patients, their families and health care systems. In this study, we compared episodic to chronic migraine sufferers to determine if migraine status predicted headache-related disability, health-related quality of life (HRQoL) and health care resource utilization. Methods: A Web-based survey was administered to panelists from nine countries. Participants were classified as having chronic migraine (CM), episodic migraine (EM) or neither using a validated questionnaire. Data collected and then analyzed included sociodemographics, clinical characteristics, Migraine Disability Assessment, Migraine-Specific Quality of Life v2.1, Patient Health Questionnaire and health care resource utilization. Findings: Of the respondents, 5.7% had CM and 94.3% had EM, with CM patients reporting significantly more severe disability, lower HRQoL, higher levels of anxiety and depression and greater health care resource utilization compared to those with EM. Interpretation: These results provide evidence that will enhance our understanding of the factors driving health care costs and will contribute to development of cost-effective health care strategies.

Method of Injection of OnabotulinumtoxinA for Chronic Migraine: A Safe, Well‐Tolerated, and Effective Treatment Paradigm Based on the PREEMPT Clinical Program

Chronic migraine (CM) is a prevalent and disabling neurological disorder. Few prophylactic treatments for CM have been investigated. OnabotulinumtoxinA, which inhibits the release of nociceptive mediators, such as glutamate, substance P, and calcitonin gene‐related peptide, has been evaluated in randomized, placebo‐controlled studies for the preventive treatment of a variety of headache disorders, including CM. These studies have yielded insight into appropriate patient selection, injection sites, dosages, and technique. Initial approaches used a set of fixed sites for the pericranial injections. However, the treatment approach evolved to include other sites that corresponded to the location of pain and tenderness in the individual patient in addition to the fixed sites. The Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) injection paradigm uses both fixed and follow‐the‐pain sites, with additional specific follow‐the‐pain sites considered depending on individual symptoms. The PREEMPT paradigm for injecting onabotulinumtoxinA has been shown to be safe, well‐tolerated, and effective in well‐designed, controlled clinical trials and is the evidence‐based approach recommended to optimize clinical outcomes for patients with CM.

Cost of health care among patients with chronic and episodic migraine in Canada and the USA: results from the International Burden of Migraine Study (IBMS).

(Headache 2011;51:1058‐1077)

A combination of riboflavin, magnesium, and feverfew for migraine prophylaxis: A randomized trial

Objective.—To determine the efficacy for migraine prophylaxis of a compound containing a combination of riboflavin, magnesium, and feverfew.

Botulinum Toxin Type A as an Effective Prophylactic Treatment in Primary Headache Disorders

Objective.—To measure the effect of botulinum toxin type A (Botox, Allergan, Inc, Irvine, CA) treatment in 271 patients diagnosed with headache in accordance with International Headache Society (IHS) criteria.

OnabotulinumtoxinA for treatment of chronic migraine: PREEMPT 24-week pooled subgroup analysis of patients who had acute headache medication overuse at baseline

Acute headache medication overuse (MO) is common in patients with chronic migraine (CM). We evaluated safety and efficacy of onabotulinumtoxinA as preventive treatment of headache in CM patients with baseline MO (CM+MO) in a planned secondary analysis from two similarly designed, randomized, placebo-controlled, parallel, Phase III trials. Patients were randomized to treatment groups (155-195 U of onabotulinumtoxinA or placebo) using MO (patient-reported and diary-captured frequency of intake) as a stratifying variable. Of 1384 patients, 65.3% (n=904) met MO criteria (onabotulinumtoxinA: n=445, placebo: n=459). For the CM+MO subgroup at Week 24, statistically significant between-treatment group mean changes from baseline favoring onabotulinumtoxinA versus placebo were observed for headache days (primary endpoint: -8.2 vs. -6.2; p<0.001) and other secondary endpoints: frequencies of migraine days (p<0.001), moderate/severe headache days (p<0.001), cumulative headache hours on headache days (p<0.001), headache episodes (p=0.028), and migraine episodes (p=0.018) and the percentage of patients with severe Headache Impact Test-6 category (p<0.001). At Week 24, change from baseline in frequency of acute headache medication intakes (secondary endpoint) was not statistically significant (p=0.210) between groups, except for triptan intakes (p<0.001), where the onabotulinumtoxinA-treated group was favored. OnabotulinumtoxinA was effective and well tolerated as headache prophylaxis in CM+MO patients.

A Multi-Center Double-Blind Pilot Comparison of OnabotulinumtoxinA and Topiramate for the Prophylactic Treatment of Chronic Migraine

(Headache 2011;51:21‐32)

Expert consensus recommendations for the performance of peripheral nerve blocks for headaches - A narrative review

To describe a standardized methodology for the performance of peripheral nerve blocks (PNBs) in the treatment of headache disorders.

Peripheral Nerve Blocks and Trigger Point Injections in Headache Management – A Systematic Review and Suggestions for Future Research

(Headache 2010;50:943‐952)

Procedures for Administering Botulinum Toxin Type A for Migraine and Tension-type Headache

Headache can be debilitating, causing lost productivity at work or school, impaired quality of life, and disruptions in family and social life.1,2 The limited clinical efficacy of current preventive therapies for headache, coupled with the substantial side effects of these treatments, indicate that headache prevention is an area of unmet medical need. Botulinum toxin type A (BoNT-A) is used to treat a variety of overactive muscle and pain disorders.3-5 Intramuscular injections of BoNT-A may provide an effective, long-lasting, and well-tolerated new approach to headache prevention and management for selected patients. Investigators have used injection techniques with differing anatomical injection sites, doses, and concentrations of BoNT-A. The method of administering BoNT-A for headache therapy will determine, in part, the overall clinical outcome. Optimizing the protocol for clinical use of BoNT-A is, therefore, likely to improve the outcomes of therapy. This article provides a review of current practical procedures for adminis-