Leiden University Scholarly Publications

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Pijpers, J.A. (2022)

The clinical aspects and management of chronic migraine

Doctoral Thesis
Chronic migraine is a highly disabling and difficult to treat form of migraine. In this thesis, various clinical aspects and the management of chronic migraine are investigated, in order to enhance prevention and treatment of chronic migraine. 
Important risk factors for chronic migraine are depression, anxiety, cutaneous allodynia and especially overuse of acute anti-headache medication. The studies in this thesis conform that withdrawal of the overused medication results into a meaningful improvement in many patients. A double-blind randomised controlled trial did not show any additional benefit of treatment with Botulinum toxin A adjacent to acute withdrawal. Another double-blind randomised controlled trial did suggest effectiveness of a behavioural intervention during acute withdrawal on the reduction of medication intake during and shortly after withdrawal. 
Cutaneous allodynia (the perception of pain upon a non-painful stimuli) is a clinical marker of central...Show moreChronic migraine is a highly disabling and difficult to treat form of migraine. In this thesis, various clinical aspects and the management of chronic migraine are investigated, in order to enhance prevention and treatment of chronic migraine. 
Important risk factors for chronic migraine are depression, anxiety, cutaneous allodynia and especially overuse of acute anti-headache medication. The studies in this thesis conform that withdrawal of the overused medication results into a meaningful improvement in many patients. A double-blind randomised controlled trial did not show any additional benefit of treatment with Botulinum toxin A adjacent to acute withdrawal. Another double-blind randomised controlled trial did suggest effectiveness of a behavioural intervention during acute withdrawal on the reduction of medication intake during and shortly after withdrawal. 
Cutaneous allodynia (the perception of pain upon a non-painful stimuli) is a clinical marker of central sensitisation, an important mechanism in the pathophysiology of chronic migraine. The presence of cutaneous allodynia in general, and the extent of allodynia symptoms, appear to be a predictor for response to withdrawal therapy. 

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Migraine
Chronic migraine
Medication overuse
Medication overuse headache
Withdrawal therapy
Botulinum toxin A
Behavioural intervention
Headache nurse
Cutaneous allodynia
All authors
Pijpers, J.A.
Supervisor
Terwindt, G.M.; Ferrari, M.D.
Committee
Dahan, A.; Evers, A.W.M.; Jensen, R.H.; Verschuuren, J.J.G.M.
Qualification
Doctor (dr.)
Awarding Institution
Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
Date
2022-02-22
ISBN (print)
9789463328234

Funding

Sponsorship
Leiden University Medical Center (MD-PhD grant); Netherlands Organization for Scientific Research (NWO) (VIDI 917-11-319) ; Dutch Brain Foundation (2013(1)-247) ; European Community (EC) (FP7-EUROHEADPAIN-no.602633); Nederlandse Hoofdpijn Vereniging