Interventional Procedures in Episodic Migraine
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EPISODIC MIGRAINE (S NAHAS, SECTION EDITOR)
Interventional Procedures in Episodic Migraine Brian M. Plato 1
&
Mandy Whitt 1
Accepted: 28 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Migraine is a common disorder which in many cases can be adequately treated with medications. However, there are some patients who may either not respond to medications or have contraindications to their use. In this review, we will evaluate the available literature on the interventional procedures available to treat patients with episodic migraine. We will review the technical details of performing the procedures, the potential mechanisms of action, and available data on their effectiveness. Recent Findings Recent studies conducted on the subject of interventional procedures including peripheral nerve blocks and onabotulinumtoxinA indicate that some patients with episodic migraine may find benefit from such procedures. Summary In patients with episodic migraine whom traditional treatments have not been effective or are contraindicated, interventional procedures may offer an opportunity to provide additional treatment options. Keywords Episodic migraine . Procedures . Nerve blocks . OnabotulinumtoxinA
Introduction Migraine is a primary headache disorder with clearly defined diagnostic characteristics established within the International Classification of Headache Disorders, third edition [1]. The diagnostic criteria of migraine include attacks consisting of both headache features as well as non-headache features. Migraine is a common disorder, affecting 12% of the population in the USA [2] and is responsible for 5 to 9 million visits with primary care annually in the USA [3, 4]. According to ICHD-3 criteria, patients with migraine can then be further diagnosed with chronic migraine (CM) when having 15 or more headache days per month with at least 8 days meeting ICHD criteria for migraine with or without aura [1]. Patients can also be diagnosed with status migrainosus (SM) when having a migraine attack lasting more than 72 h causing disability [1]. While there are no specific diagnostic criteria for episodic migraine (EM) in ICHD-3, the term refers to those individuals with fewer than 15 headache days per month. This article is part of the Topical Collection on Episodic Migraine * Brian M. Plato [email protected] 1
Norton Neuroscience Institute, Louisville, KY, USA
Those individuals with CM may result in having migraines that can be a more severe and longer-lasting, more difficult treat and have greater functional impairment than those with EM [5]. To further differentiate patients, those with EM can be further subclassified as having either lowfrequency episodic migraine (LFEM) or high-frequency episodic migraine (HFEM). There is no clear standardization of the definition of LFEM versus HFEM, but generally ranges between 8 to 14 or 10 to 14 headache days per month are used to characterize HFEM [6, 7]. Despite the numerous recent advances in the pharmacological a
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