Recent Advances in Pharmacotherapy of Migraine
- Migraine is a neurological disorder characterized by recurrent headache attacks associated with nausea, vomiting, and sensitivity to light and sound.
- New acute and preventive treatment options include CGRP antagonists, 5-HT1F agonists, glutamate receptor antagonists, and orexin receptor antagonists.
- Existing drugs such as dexamethasone, carvedilol, tiagabine, levetiracetam, zonisamide, and tizanidine have shown promise for preventive treatment when used off-label.
- Medical devices like Cerena, Cefaly, and Gamma Core provide non-drug options for acute or
learning objective includes : pathogenesis,clinical features, classification of migraine, pharmacology about specific antimigraine drugs, coverage to newer triptan- Lasmiditan and newer prophylactic drug Erenumab a CGRP receptor antagonist.
learning objective includes : pathogenesis,clinical features, classification of migraine, pharmacology about specific antimigraine drugs, coverage to newer triptan- Lasmiditan and newer prophylactic drug Erenumab a CGRP receptor antagonist.
Migraine pathophysiology, diagnosis and treatmentsYung-Tsai Chu
Introduction of migraine, including symptoms, epidemiology, pathophysiology(neurotransmitter, neural network, channel, CGRP), diagnostic criteria and treatment (oral, intravenous therapy at ED and long-term prevention)
A description of Brivaracetam, a novel SV2A ligand, an anti-epileptic with greater potency and significantly reduced behavioural adverse effects compared to Levetiracetam .
Migraine pathophysiology, diagnosis and treatmentsYung-Tsai Chu
Introduction of migraine, including symptoms, epidemiology, pathophysiology(neurotransmitter, neural network, channel, CGRP), diagnostic criteria and treatment (oral, intravenous therapy at ED and long-term prevention)
A description of Brivaracetam, a novel SV2A ligand, an anti-epileptic with greater potency and significantly reduced behavioural adverse effects compared to Levetiracetam .
Right therapeutic approach for migraine Sudhir Kumar
Migraine is a common disease and about 15-20% of population suffers from it. Every physician needs to know the principles of migraine management. The current article describes the diagnostic criteria and treatment of migraine.
Similar to Recent Advances in Pharmacotherapy of Migraine (20)
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
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CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
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2. Migraine
• Migraine is a chronic neurological disorder
characterized by recurrent attacks of
headache widely variable in intensity,
frequency and duration
• Attacks are commonly unilateral and are
usually associated with anorexia, nausea and
vomiting
3. Simplified Diagnostic Criteria for
Migraine
• ≥5 attacks lasting 4-72 hrs
• ≥2 of the following
– Unilateral
– Throbbing
– Moderate or severe intensity
– Aggravation by routine physical activity
• ≥1 of the following
– Nausea/vomiting
– Photophobia and phonophobia
• Not attributable to another disorder
4. Two major types
Migraine without aura (common migraine)
• Headache with specific features and
associated symptoms
Migraine with aura (classic migraine)
• Focal neurological symptoms that usually
precede or sometimes accompany the
headache.
• Some experience premonitory phase,
occurring hours or days before the headache,
and a headache resolution phase
5. Classification depending on severity
Mild Moderate Severe
Attack 1 ≤ per month ≥1 per month
≥2-3 per
month
Headache
Throbbing but
tolerable
More intense
& Throbbing
Severe
throbbing
Duration Upto 8 hrs 6-24 hrs 12-48 hrs
Incapacitation No
Functionally
impaired
Incapacitated
Other features
Nausea/
vomiting
Prominent
Nausea/
Vomiting
Vomiting &
Vertigo
7. Pathogenesis
Neurogenic theory
Spreading depression of cortical electrical
activity
Vascular phenomena
• Neurogenic inflammation of affected blood
vessel wall
• Amplified by retrograde transmission in
afferent nerves and release of mediators like
5-HT, neurokinin, substance P, calcitonin gene
related peptide (CGRP), nitric oxide
9. Acute Attack Therapies
• Anti-inflammatory agents
• 5HT1B/1D receptor agonists
• Dopamine receptor antagonists
• Must be individualized: standard approach for
all patients is not possible
18. Recent Advances
• Novel acute and preventive treatments
• New uses of existing drugs
• New devices
19. Calcitonin gene-related peptide
antagonists (gepants)
• Calcitonin gene-related peptide (CGRP) is a
neuropeptide implicated in pathophysiology
of migraine
• CGRP blockers known as gepants or
monoclonal antibodies
• First non-serotoninergic, migraine-specific
drugs without a vasoconstrictor action
Novel acute and preventive treatments
20. Calcitonin gene-related peptide
antagonists (gepants)
• Suitable for patients with vascular disease
• Telcagepant, Olcagepant, MK-3207, BMS-
927711, BI44370TA, NCT01613248 showed
proof of efficacy for the treatment of migraine
• Trials discontinued due to risk of liver toxicity
• ALD-403, LY-2951742, LBR-101 – phase I and II
studies show efficacy in episodic and chronic
migraine
21. Serotonin 5HT1F agonists (ditans)
• Lasmiditan (COL-144) – selective 5-HT1F
agonist
• Good efficacy and tolerability as an acute
treatment
• Now in Phase III trials
22. Glutamate receptor antagonist
• Glutamate released from neurons expressing
5-HT1B/1D/1F receptors in trigeminal ganglia,
is implicated in aspects of both migraine and
migraine aura pathophysiology
• Tezampanel (LY-293558), Raseglurant
(ADX10059) showed effectiveness in acute
treatment of migraine without aura
• Phase II trials discontinued due to the
observation of possible predictive signs of
hepatotoxicity
23. Orexin receptor antagonists (rexants)
• Orexin A & B – neuropeptides synthesized in
hypothalamus are thought to play a role in
nociception
• Filorexant – dual orexin receptor antagonist
• Completed phase II trials
24. BOTOX® (OnabotulinumtoxinA)
• OnabotulinumtoxinA inhibits the release of
excitatory neurotransmitters from both motor
and sensory neurons
• Botox inj: prevent headaches in adult patients
with chronic migraine.
• Every 12 weeks as multiple injections around
the head and neck
• ADR: neck pain and headache.
26. Transdermal patch: Sumatriptan
• In January 2013, FDA approved acute
medication sumatriptan delivery by new
mechanism (transdermal patch)
• Temporarily suspended due to reported cases
of serious application site reactions
(burn/scar)
27. New uses of existing drugs
Dexamethasone addition to standard acute
therapy
• Proposed to prevent recurrence of migraine
through its prevention of neurogenic
inflammation
• Less likely to experience recurrent headache
within 24 to 72 hours
• Appears to be safe and modestly effective
addition to standard migraine abortive therapy
for the prevention of migraine recurrence
28. Carvedilol
• Additional alpha-1 blocking and antioxidant
properties
• A very favourable adverse event profile
• 50% reduction in monthly migraine attack
frequency at the third month of treatment
29. Tiagabine (TGB)
• Inhibits the neuronal and glial reuptake of
GABA and therefore enhances GABA-
mediated inhibition
• At least a 50% reduction in their attacks
• Risk of new onset seizures and status
epilepticus in patients without a history of
epilepsy
30. Levetiracetam
• Promising drug for the treatment of
transformed migraine
• At least 50% reduction in headache frequency
and severity with improved quality of life
• Used off-label for migraine prophylaxis
31. Zonisamide
• Significant reduction in frequency and severity
of migraine in patients with refractory
migraine
• Side effects reported included paraesthesia,
fatigue, anxiety, and weight loss
32. Tizanidine hydrochloride
• Alpha-2-adrenergic presynaptic agonist that
inhibits the release of norepinephrine in the
brainstem and spinal cord
• Effective prophylactic adjunct for chronic daily
headache
33. Medical Devices
Cerena
• 13 December 2013: FDA allows marketing of
first device to relieve migraine headache pain
(Cerena)
• Device delivers single pulse transcranial
magnetic stimulation
• Disrupts cortical spreading depression (CSD),
the underlying cause of migraine aura and pain
34. Cefaly
• 11 March 2014: USFDA approved
device for preventing migraine
• Transcutaneous electrical nerve stimulator to
treat Headache
• Warnings: Indicated for use by adults and
should only be used for 20 minutes/day,
• ADR: Tingling or massaging sensation where
electrode applied
35. Gamma core
• Delivers transcutaneous
vagal nerve stimulation
(VNS) by generating an electrical signal
• Suppress high glutamate levels
• For acute and preventive treatment of
migraine
The mechanisms of action of this drug remain still largely unknown, although some evidence has recently been reported that Levetiracetam is able to induce inhibitory effects on neuronal (N)-type high-voltage calcium channels.
(Antiepileptic drugs)
Although precise mechanisms of action remain unknown, they seem to be very similar to those of topiramate: blockade of voltage-gated sodium channels, inhibition of carbonic anhydrase, enhancement of the release of GABA, facilitation of serotoninergic and dopaminergic
neurotransmission, and inhibition of potassium-mediated release
of glutamate. Zonisamide, and not topiramate, also seems to
reduce ion flow through T-type calcium channels.
Tizanidine is an alpha2-adrenergic agonist that inhibits the release of norepinephrine at both the spinal cord and brain, with antinociceptive effects that are independent of the endogenous opioid system.
(pg 358)
From KDT
It may facilitate inhibitory transmitter glycine as well. Polysynaptic reflexes inhibition results in decrease muscle tone and frequency of muscle spasms without reducing muscle strength
seizurelike phenomenon in the brain known as cortical spreading depression (CSD) is the underlying cause of both migraine auras and migraine pain. CSD, explains Kraig, “is a spreading wave of electrical silence in which cortical neurons go quiet.
Most headaches and migraines involve the trigeminal nerve. Its superior branch ends at the exit of the eye socket, underneath the skin of the forehead.
An adhesive electrode is positioned on the forehead and Cefaly connects to this. Through the electrode, Cefaly generates precise micro-impulses in order to stimulate the nerve endings of the trigeminal nerve.
Neurostimulation of the trigeminal nerve with Cefaly® produces a relaxing effect. Regular repetition of this relaxing effect helps reduce the number of attacks of headache and migraine.
Cefaly is the first external trigeminal neurostimulator. Cefaly works by stimulating the trigeminal nerve utiliz- ing an electrode that is applied to the forehead. This is where the two essential branches of the trigeminal nerve (supratrochlear and supraorbital) extend fur- thest to the surface of the skin.
data suggest that it may work by sending signals into the brain that reduce the amount of a substance, called glutamate, that has been associated with headache symptoms.*
Very rarely, you may experience hoarseness, shortness of breath,
or change in voice. A tingling/pricking feeling where the device is
applied is normal but should not cause major discomfort. These
effects usually stop right away once the treatment is completed.