PainRelief.com Interview with: Dr Ayşe Nur Özdag Acarli Ermenek State Hospital, Karaman, Turkey
PainRelief.com: What is the background for this study?
Response: Headache is the most common neurological problem in children and adolescents. Various factors can contribute to headache such as school, sleep, physical activity, electronic devices, mental health problems and socioeconomic conditions.
For young people, the COVID-19 pandemic has had a striking change on every aspect of life such as school closure, online education from home, fewer academic pressures, more self care at home. Early studies, examined shorter-term effects of the pandemic, reported a reduction on the prevalence of headache and chronic pain in adolescents during COVID-19, which was attributed to less school-related stress. However, in my personal clinical experience, young patients suffered more frequent and severe headaches during the pandemic, especially after the first year of the pandemic. However, literature has been lacking in the long term effects of the pandemic on headache in adolescents.
PainRelief.com Interview with: Don McGeary, PhD, ABPP Vice Chair for Research, Rehab Medicine Associate Professor, Rehab and Psychiatry UT Health San Antonio
Dr. McGeary
PainRelief.com: What is the background for this study? What are the main findings?
Response: This was a randomized clinical trial funded as part of the Consortium to Alleviate PTSD. The primary aim of the study was to test the efficacy of a novel non-pharmacological intervention (called CBT for headache; CBTH) for posttraumatic headache (PTH) attributable to mild traumatic brain injury (mTBI).
PTH is the most common and disabling consequence of mild traumatic brain injury and is a large concern for military service members and veterans in the post-9/11 deployment era because of the significant increase in head injury in this population over the last 20 years. Posttraumatic headache has been recognized under various labels (including “shell shock” and “hero’s headache”) for over a century, but there are no proven, frontline treatments for PTH. PTH is unique among headache diagnoses because it is classified as a secondary headache (i.e., develops as a consequence of another medical phenomenon, mTBI) and because it is diagnosed based on the injury that led to the headache with no criteria for specific clinical characteristics. Thus, the “phenotype” of posttraumatic headache is variable with the most frequent reports describing symptoms consistent with migraine AND tension type headaches.
Unfortunately, because the underlying mechanisms of PTH differ from the primary headaches they resemble, frontline medications (abortive and prophylactic) may not have the same efficacy for PTH as they do for the primary headaches for which they are usually prescribed. To complicate things further, PTH is often acquired in the context of a traumatic experience (blast, firearms overpressure, motor vehicle accident, other traumatic injury), so PTSD is highly comorbid with these headaches and there is an evolving body of research showing that PTSD can complicate, maintain and worsen pain.
Thus, our study sought to (1) Test a novel non-pharmacological intervention tailored to PTH rehabilitation and (2) Assess the relationship between PTSD and PTH to determine if preferred treatment pathways should include PTSD treatment as well.
This resulted in a three-arm trial comparing CBTH to a gold-standard non-pharmacological treatment for PTSD and usual care in a large VA polytrauma center.
PainRelief.com Interview with: Oved Daniel MD Headache and Facial Pain Clinic Ramat-Aviv Medical Center President of the Israeli Headache Association Tel-Aviv, Israel
PainRelief.com: What is the background for this study? What are the main findings?
Response: Migraine patients experience disabling symptoms, which often left untreated or exasperated by currently available therapies, therefore, a significant unmet medical need for treating migraine pain remains.
Current external nerve stimulation devices only target one nerve and this study assessed the safety and performance of a new external nerve stimulation device that stimulates the two major nerve branches associate with pain (occipital and trigeminal) .
The Relivion MG is a non-invasive device that the patient can wear at home to treat their migraine pain and associate symptoms.
PainRelief.com Interview with: Andrew F. Russo, Ph.D. Professor, Dept. Molecular Physiology and Biophysics University of Iowa Iowa City, IA 52242
Dr. Russo
PainRelief.com: What is the background for this study?
Response: The company Schedule 1 Therapeutics approached us with an interest in testing a combination of CBD:THC in migraine. We thought the topic had tremendous public interest so we teamed up with them and won grants from the Migraine Research Foundation and from the National Institute on Drug Abuse.
PainRelief.com Interview with: Eric C. Schwenk MD Anesthesiology Sidney Kimmel Medical College Thomas Jefferson University Philadelphia, Pennsylvania
Dr. Schwent
PainRelief.com: What is the background for this study? What are the main findings?
Response: Patients with refractory chronic migraine (rCM) have typically failed all available medications and many times have nearly constant headache pain and in many cases disability. Aggressive treatment is indicated to provide relief and help break the cycle of pain.
Lidocaine infusions have been used for decades in various acute and chronic pain conditions, including complex regional pain syndrome and pain after surgery. At the Jefferson Headache Center lidocaine has been a mainstay of treatment for such patients for several decades but evidence supporting its benefits is scarce.
The main findings were that patients with rCM experienced acute relief at the end of the infusion and that some relief was sustained at 1 month, although the degree of pain relief faded over time. It was also well tolerated with nausea and vomiting occurring in 16.6% of patients and other side effects occurring less frequently.
PainRelief.com Interview with: Allison Lee, MD, MS [she/her/hers] Associate Professor of Anesthesiology Division of Obstetric Anesthesia Officer of Diversity, Equity and Inclusion, Department of Anesthesiology Medical Director of the Margaret Wood Center for Simulation and Education Columbia University Medical Center New York, NY 10032
Dr. Lee
PainRelief.com: What is the background for this study?
Response: Racial and ethnic disparities in maternal health outcomes have been well documented but there has been limited research with respect to disparities specifically related to obstetric anesthesia care. We knew that among minority women, compared with non-Hispanic white women, there was evidence of:
Lower labor epidural rates, despite it being the most effective modality for pain relief.
Higher rates of general anesthesia for cesarean deliveries, which is associated with greater risks and complications (Anesthesiology. 2019 Jun;130(6):912-922.)
Worse management of pain after cesarean delivery
Given the importance of effective management of postdural puncture headache and in light of growing evidence of complications if untreated (Anesth Analg. 2019 Nov;129(5):1328-1336.), we hypothesized that similar patterns with respect to inferior management of postdural puncture headache among minority women would be observed.
PainRelief.com Interview with: Matthew S. Panizzon, Ph.D. Associate Professor Department of Psychiatry Center for Behavior Genetics of Aging University of California San Diego
Dr.Panizzon
PainRelief.com: What is the background for this study?
Response: Migraine is a severe neurological disease that affects over 12% of the population. Women are also much more likely to suffer from migraine then men. Despite how common it is, the factors that contribute to migraine are poorly understood.
PainRelief.com Interview with: Mark J. Burish, MD, PhD. Assistant Professor Vivian L. Smith Department of Neurosurgery Director, Will Erwin Headache Research Center McGovern Medical School at UTHealth Houston
Dr. Mark Burish – Neurosurgery Photo by Dwight C. Andrews/The University of Texas Medical School at Houston Office of Communications
PainRelief.com: What is the background for this study? Would you describe cluster headaches?
Response: Cluster headache is a disease associated with excruciating attacks of one-sided pain around the eye – patients regularly say it is more painful than childbirth, kidney stones, or gunshot wounds. The attacks last between 15 minutes and 3 hours and can occur up to 8 times per day. During an attack, patients will often have changes around the eye (such as a watery or bloodshot or droopy eye) changes in the nose (like congestion and a runny nose), and a restless feeling like they can’t sit still. It is called “cluster” headache because, for most patient, the headaches occur every day for several weeks then go away for the rest of the year, only to come back the following year. This is called “episodic” cluster headache, though there is another version called “chronic” cluster headache in which the headaches occur at least 9 months a year.
Cluster headache is found in about 1 in 1000 patients. Because it is uncommon, there have not been a lot of large international studies investigating basic questions like the age that these headaches start and the differences from patient to patient. There is a great need to understand more about this disorder at every level. So two researchers from the University of West Georgia (Larry Schor and Stuart Pearson) performed a large epidemiology study on cluster headache because very few have been done. They created an online questionnaire and advertised it internationally. They ended up obtaining the largest study in terms of participants and the most international study ever performed (at least to our knowledge). They then asked for help analyzing it from several physicians (including myself) and statisticians. I felt very fortunate that they reached out to me and I really enjoyed working on this project because I think it gives us a lot of insights into cluster headache.
PainRelief.com Interview with: David M. Dunaief, M.D. Principal Investigator MedicalCompassMD.com
PainRelief.com: What is the background for this study? What are the main findings?
Response: As an internist focusing on dietary intervention, I have been caring for patients with chronic diseases for the past 12 years. Many of my patients have had rapid, marked improvements when they adhere to my LIFE (Low Inflammatory Foods Everyday) diet. The diet, as well as objective evidence that it reduces systemic inflammation (lowers serum C-reactive protein levels), has been described in the peer-reviewed publications:
In addition to improving migraines, the diet has improved symptoms and blood chemistries in patients with high blood pressure, high cholesterol, diabetes, cancer, auto-immune diseases, inflammatory bowel disease, and others. In this case report, we describe a patient who suffered from debilitating migraines for 12.5 years, and who had minimal benefit from avoiding dietary triggers or medications. Within 3 months of adopting the LIFE diet, he was migraine free and remained that way for 7.5 years.
Dr. Debashish Chowdhury MBBS; DTCD; MD (Medicine); DM (Neurology); FIAN Commonwealth Fellow in Stroke Medicine (Edinburg, UK) Director – Professor and HOD Department of Neurology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
Dr. Chowdhury
PainRelief.com: What is the background for this study?
Response: Chronic migraine is a highly disabling headache disorder affecting about 2% of the global population. Oral preventive treatment options for chronic migraine are limited. Only topiramate has good evidence of efficacy. Although propranolol has class I evidence of efficacy for the prevention of episodic migraine, it has not been tested for chronic migraine with a robust clinical trial. Hence, we conducted an RCT, called the TOP-PRO study assessing the efficacy and tolerability of propranolol against topiramate for the prevention of chronic migraine using a non-inferiority design.
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