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Low-dose methadone for refractory chronic migraine accompanied by medication-overuse headache: a prospective cohort study
OBJECTIVES: A refractory chronic migraine (RCM) accompanied by medication-overuse headache (MOH) is an extremely disabling disease. Evidence suggests that in selected patients, chronic opioids may be a valuable therapeutic option for RCM. The aim of the present study was to evaluate the effectivenes...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870632/ https://www.ncbi.nlm.nih.gov/pubmed/32691178 http://dx.doi.org/10.1007/s10072-020-04602-3 |
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author | Benemei, Silvia Lupi, Chiara De Cesaris, Francesco Lombardi, Niccolò Bettiol, Alessandra Chiarugi, Alberto Geppetti, Pierangelo Galli, Valentina Pracucci, Chiara Occupati, Brunella Mannaioni, Guido |
author_facet | Benemei, Silvia Lupi, Chiara De Cesaris, Francesco Lombardi, Niccolò Bettiol, Alessandra Chiarugi, Alberto Geppetti, Pierangelo Galli, Valentina Pracucci, Chiara Occupati, Brunella Mannaioni, Guido |
author_sort | Benemei, Silvia |
collection | PubMed |
description | OBJECTIVES: A refractory chronic migraine (RCM) accompanied by medication-overuse headache (MOH) is an extremely disabling disease. Evidence suggests that in selected patients, chronic opioids may be a valuable therapeutic option for RCM. The aim of the present study was to evaluate the effectiveness and safety of prophylaxis with low-dose methadone (LDM) in patients affected by RCM with continuous headache and MOH. METHODS: A prospective cohort study was performed between May 2012 and November 2015 at the Headache Center and Toxicology Unit of the Careggi University Hospital. Eligible patients were treated with prophylactic LDM and followed up for 12 months. Headache exacerbations, pain intensity, use of rescue medications, and occurrence of adverse drug reactions (ADRs) were recorded. RESULTS: Thirty patients (24 females, median age 48 years) were enrolled. Nineteen (63%) patients dropped out, mainly because of early ADRs (n = 10), including nausea, vomiting, and constipation. At last available follow-up, LDM was associated with a significant decrease in the number of headache attacks/month (from a median of 45 (interquartile range 30–150) to 16 (5–30), p < 0.001), in pain intensity (from 8.5 (8–9) to 5 (3–6), p < 0.001), and in the number of rescue medications consumed per month (from 95 (34–240) to 15 (3–28), p < 0.001). No misuse or diversion cases were observed. CONCLUSION: LDM could represent a valuable and effective option in selected patients affected by RCM with continuous headache and MOH, although the frequency of early ADRs poses major safety concerns. Randomized controlled trials are needed to confirm the efficacy and safety of LDM prophylaxis. |
format | Online Article Text |
id | pubmed-7870632 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-78706322021-02-16 Low-dose methadone for refractory chronic migraine accompanied by medication-overuse headache: a prospective cohort study Benemei, Silvia Lupi, Chiara De Cesaris, Francesco Lombardi, Niccolò Bettiol, Alessandra Chiarugi, Alberto Geppetti, Pierangelo Galli, Valentina Pracucci, Chiara Occupati, Brunella Mannaioni, Guido Neurol Sci Original Article OBJECTIVES: A refractory chronic migraine (RCM) accompanied by medication-overuse headache (MOH) is an extremely disabling disease. Evidence suggests that in selected patients, chronic opioids may be a valuable therapeutic option for RCM. The aim of the present study was to evaluate the effectiveness and safety of prophylaxis with low-dose methadone (LDM) in patients affected by RCM with continuous headache and MOH. METHODS: A prospective cohort study was performed between May 2012 and November 2015 at the Headache Center and Toxicology Unit of the Careggi University Hospital. Eligible patients were treated with prophylactic LDM and followed up for 12 months. Headache exacerbations, pain intensity, use of rescue medications, and occurrence of adverse drug reactions (ADRs) were recorded. RESULTS: Thirty patients (24 females, median age 48 years) were enrolled. Nineteen (63%) patients dropped out, mainly because of early ADRs (n = 10), including nausea, vomiting, and constipation. At last available follow-up, LDM was associated with a significant decrease in the number of headache attacks/month (from a median of 45 (interquartile range 30–150) to 16 (5–30), p < 0.001), in pain intensity (from 8.5 (8–9) to 5 (3–6), p < 0.001), and in the number of rescue medications consumed per month (from 95 (34–240) to 15 (3–28), p < 0.001). No misuse or diversion cases were observed. CONCLUSION: LDM could represent a valuable and effective option in selected patients affected by RCM with continuous headache and MOH, although the frequency of early ADRs poses major safety concerns. Randomized controlled trials are needed to confirm the efficacy and safety of LDM prophylaxis. Springer International Publishing 2020-07-20 2021 /pmc/articles/PMC7870632/ /pubmed/32691178 http://dx.doi.org/10.1007/s10072-020-04602-3 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Article Benemei, Silvia Lupi, Chiara De Cesaris, Francesco Lombardi, Niccolò Bettiol, Alessandra Chiarugi, Alberto Geppetti, Pierangelo Galli, Valentina Pracucci, Chiara Occupati, Brunella Mannaioni, Guido Low-dose methadone for refractory chronic migraine accompanied by medication-overuse headache: a prospective cohort study |
title | Low-dose methadone for refractory chronic migraine accompanied by medication-overuse headache: a prospective cohort study |
title_full | Low-dose methadone for refractory chronic migraine accompanied by medication-overuse headache: a prospective cohort study |
title_fullStr | Low-dose methadone for refractory chronic migraine accompanied by medication-overuse headache: a prospective cohort study |
title_full_unstemmed | Low-dose methadone for refractory chronic migraine accompanied by medication-overuse headache: a prospective cohort study |
title_short | Low-dose methadone for refractory chronic migraine accompanied by medication-overuse headache: a prospective cohort study |
title_sort | low-dose methadone for refractory chronic migraine accompanied by medication-overuse headache: a prospective cohort study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870632/ https://www.ncbi.nlm.nih.gov/pubmed/32691178 http://dx.doi.org/10.1007/s10072-020-04602-3 |
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