Anti-CGRP monoclonal antibodies (mAb) have been approved and successfully used in Russia since 2020.Objective: to investigate the efficacy and safety of fremanezumab (FRE) therapy (225 mg monthly or 675 mg quarterly) in real-life clinical practice in patients with migraine who referred to a specialized Russian headache center.Material and methods. This open-label, retrospective study involved 202 patients (mean age 39.4±12.2 years) with frequent episodic (EM) or chronic migraine (CM) who received at least three injections of FRE 225 mg or three injections with a total dose of 675 mg and regularly completed the Migrebot headache diary one month before starting therapy and throughout the course of treatment.Results. The mean number of migraine days per month decreased in the whole group from 20.1±8.2 (before treatment) to 8.5±7.9 after 12 weeks (p<0.0001), in the EM group from 10.9±4.1 to 3.6±3.7 (p<0.0001) and in the CM group - from 24.4±5.7 to 10.8±8.3 (p<0.0001). Adverse events were observed in 13 (6.4%) patients (most frequently local reactions: itching, rash, redness, induration at the injection site).Conclusion. The study showed a favourable efficacy and safety profile of FRE in the Russian population, where anti-CGRP mAbs are considered the first-line treatment for migraine.

Migraine is a chronic neurological disorder that is associated with considerable disadaptive effect on patients. Despite the development of pharmacotherapy strategies for migraine, only one third of patients are satisfied with their overall treatment. Many migraine patients turn to complementary and alternative medicine (CAM), which is not usually considered a part of conventional medicine and is not always evidence-based. In practise, however, they are often used to improve the effectiveness of standard therapy or to provide alternative treatment. In addition, in CAM methods, the patient is actively involved in the choice of treatment strategies, and they have good adherence. The basic principles and approaches of CAM are increasingly being introduced into clinical practise. This review discusses the principles of CAM in the treatment of migraine as a holistic approach using lifestyle strategies and selected non-pharmacological treatments that have been shown to be effective and rational.

Objective: to conduct a comparative analysis of factors associated with the development of medication overuse headache (MOH), considering demographic characteristics of patients and comorbid pathology.Material and methods. A prospective study was conducted at "Europe–Asia" International Medical Center. The main group comprised patients with primary headache (HA) aged 18 years and older with MOH, and the control group comprised patients with primary HA without MOH of comparable gender and age. A semi-structured interview was conducted with the patients and additional examinations were performed, including MRI of the brain if indicated. The study included 171 patients with MOH (mean age 43.3 years, 82% women) and 173 patients without MOH (mean age 41.4 years, 75% women).Results. Chronic migraine occurred more frequently in the MOH group (53 and 16%, respectively; p<0.001; OR 5.9; 95% CI 3.6–9.8). One third of patients in both groups suffered from chronic tension-type headache (CTH). Episodic migraine and episodic CTH occurred more frequently in patients without MOH (p<0.001). Patients in the MOH group were more frequently divorced (11.7 and 2.9%, respectively; p=0.002; OR 4.5; 95% CI 1.6–12.2). The majority of patients (76%) in both groups were employed, had a higher education (65% with MOH and 74% without MOH) and were married (63% with MOH and 72% without MOH).The analysis of more than 20 comorbid diseases revealed that three factors were most frequently associated with the development of MOH: chronic insomnia (60.2 and 47.4% respectively; p=0.02; OR 1.7; 95% CI 1.1–2.6), restless legs syndrome (37.4 and 22% respectively; p=0.002; OR 2.1; 95% CI 1.3–3.4) and subjective cognitive impairment (76 and 53.2% respectively; p<0.001; OR 2.8; 95% CI 1.8–4.8).Conclusion. Sleep disturbance, subjective cognitive impairment and marital status of patients are most frequently associated with MOH, indicating the great importance of these factors in the development of MOH and opening new opportunities for its prevention.

Currently, effective methods for the treatment of chronic migraine (CM) have been developed, but it remains unclear how they are used in real clinical practice and how often. The typical practice of treating patients with CM in our country has not been sufficiently investigated, which formed the basis for conducting this study.Objective: to evaluate the quality of treatment of patients with CM in real-life neurological practice.Material and methods. The study included 200 patients with CM (63 men and 137 women, mean age – 33.1±7.1 years) admitted to A.Ya. Kozhevnikov Clinic of Nervous Diseases (CND) of Sechenov University for frequent headaches, who were previously treated by neurologists in other medical institutions on an outpatient and/or inpatient basis. All patients were clinically interviewed to establish a diagnosis and analyze their previous treatment.Results. All patients had an experience of incorrect or inadequate treatment, including ineffective drug and non-drug methods. All patients were taking painkillers to relieve migraine, but less than half of them was satisfied with their effectiveness. Only 12 (8.5%) patients with medication overuse headache had previously received treatment for drug overuse. None of the patients who were admitted to CND had previously received cognitive-behavioral therapy and treatment with an interdisciplinary approach that included not only pharmacotherapy but also psychological and behavioral methods and kinesiotherapy.Conclusion. In real-life clinical practice, ineffective methods are often used to treat migraine, and an interdisciplinary approach that includes effective pharmacotherapy and non-pharmacological methods is lacking.

Chronic migraine (CM) is a neurological disorder whose diagnosis requires not only knowledge of its diagnostic criteria, but also the physician's ability to differentiate between various forms of primary and secondary headache (HA), as well as to recognize comorbid neurological disorders that aggravate the course of CM. Timely and correct diagnosis of CM and comorbid disorders allows to prescribe effective treatment to a patient and convert the migraine from a chronic to an episodic form. The diagnostics of CM and comorbid neurological disorders has not been sufficiently investigated in our country, which formed the basis for this study.Objective: to evaluate the quality of diagnostics of CM and comorbid neurological disorders in real-life neurological practice.Material and methods. The study included 200 patients with CM (63 men and 137 women, mean age 33.1±7.1 years) admitted to A.Ya. Kozhevnikov Clinic of Nervous Diseases (CND) of Sechenov University, complaining of frequent headaches. They had previously been examined and treated by neurologists in other medical institutions on an outpatient and/or inpatient basis. A clinical interview was conducted with all patients to establish a diagnosis and analyze their previous treatment, and a psychometric test was performed to assess symptoms of anxiety and depression.Results. Only 6% of patients had been previously diagnosed with CM, the remaining 94% were incorrectly diagnosed with secondary HA. All patients had previously been prescribed additional examinations, mainly neuroimaging of the brain and ultrasound of the cerebral vessels, although there were no "red flags". None of the patients had been previously assessed for their emotional state, while almost all patients had high situational anxiety (n=190; 95%) and high personal anxiety (n = 180; 90%), there were symptoms of depression (n=190; 95%) of varying severity. Comorbid neurological disorders (medication overuse HA), insomnia, musculoskeletal pain etc.) were diagnosed in 91.5% of patients in CND and in only in 8% of patients in other medical centers.Conclusion. In real-life clinical practice, CM and comorbid neurological disorders are inadequately diagnosed and excessive and unjustified additional examinations are prescribed.

Headache, which is often present in patients with epilepsy, can occur outside of epileptic seizures as well as have a temporary connection with them – occur immediately before, during or after an attack. Clinical types of headache in epilepsy are considered in the International Classification of Headache, but not in the classification of epileptic seizures and types of epilepsy. Meanwhile, the presence of concomitant headache and its clinical phenotype should be taken into account when choosing treatment tactics in patients with epilepsy. The article presents data on the prevalence of different types of headache in patients with epilepsy and a modern classification of cephalalgia depending on the temporal relationship with an epileptic attack. Diagnostic criteria for four clinical variants of cephalgia are given: interictal, preictal, ictal and postictal. The comorbid relationship between epilepsy and migraine is considered in more detail, including the pathophysiological mechanisms underlying the combination of these paroxysmal conditions.

Objective. To analyze diagnoses, clinical characteristics, incidence and specifics of comorbid mental and other disorders in Russian patients with a main complaint of headache before and after the novel coronavirus infection (COVID-19) pandemic and special military operation. Material and methods. We have retrospectively analyzed primary medical records of all patients over 16 years old with a main complaint of headache who appealed to the University Headache Clinic between April 1, 2019 and July 1, 2019 (before the COVID-19 pandemic), in 2021 (COVID-19 pandemic) and 2022 (after onset of special military operation). Results. There were more visits of patients diagnosed with migraine in April-June 2021 compared to the same period in 2019. In April-June 2022, the number of patients with migraine and aura significantly increased from 11.7 to 18.5% (p=0.03). Other migraine characteristics remained the same throughout 3 years. Indicators of emotional status changed significantly. In 2021, the number of patients with anxiety increased from 28.0 to 44.9% (p=0.001). In 2022, anxiety continued to be high. Prevalence of depression did not change significantly in 2021 compared to 2019, but its manifestations have changed. Anhedonia and an-ergy became more common. The number of patients with depression significantly increased among people with headache from 28.7 to 43.9% in 2022 (p=0.0001). The proportion of patients with a first-time depressive episode significantly increased (from 2.7% in 2021 to 21.3% in 2022, p=0.0001). The number of patients referred to a psychiatrist was 10.2% in 2022 that is significantly higher compared to 2021. Conclusion. Significant socio-economic events can be triggers for onset or relapse of comorbid anxiety-depressive disorders in patients with primary cephalalgia.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

This consensus reviewed the main current issues of clinical application and integration into everyday practice of a new targeted preventive therapy for migraine using monoclonal antibodies (mAbs) to the calcitonin gene related peptide (CGRP) ligand or receptor. These recommendations are based on current scientific and clinical studies and an analysis of the results of several years of clinical use. The main purpose of the consensus is to assist practitioners in prescribing effective prophylactic treatment of migraine using anti-CGRP mAbs and to improve care for patients with various forms of the disease.

The Russian experts’ guidelines on evaluation and treatment of medication-overuse headache are based on evidence-based medicine, the latest revision of the International Classification of Headache Disorders. Basic information about epidemiology, risk factors, pathophysiological mechanisms, evaluation, and the most effective pharmacological drug and non-pharmacological approaches to managing patients with medication-overuse headache are presented.

The article focuses on a rare form of primary headache – migraine with brainstem aura (previous term – basilar migraine). The place of this form in the International Classification of Headache Disorders is indicated, diagnostic criteria and clinical features are given. Clinical case of migraine with brainstem aura in a young man is presented. The effectiveness of the acute treatment and preventive therapy are discussed; features of the above case are analyzed.

The paper describes a clinical case of a female patient with chronic migraine (CM) and shows a modern approach to diagnosing CM and assessing chronicity factors. The patient received interdisciplinary treatment that involved standard therapy and cognitive behavioral therapy (CBT), a psychological treatment for pain and emotional disorders. The use of CBT in this clinical case was justified by the fact that the patient had pain catastrophizing, emotional disorder, abuse of painkillers and their discontinuation problems, and unsatisfactory tolerability of preventive pharmacotherapy for migraine. CBT could change the patient's ideas about the causes and prognosis of the disease, increase her intraday activity, teach effective skills to overcome pain, and cope with the symptoms of anxiety and depression. A long-term (12-month) follow-up of the female patient receiving behavioral interdisciplinary treatment showed a clinically significant improvement as transformation from chronic to episodic of migraine, as normalization of the emotional state, and as an increase in daily activity.

The paper deals with the actual problem of managing patients with drug-induced headache (DIH) in patients with primary headaches. It describes a clinical case of extremely severe DIH in a patient with chronic tension headache (TH). The paper analyzes the typical and atypical manifestations of DIH and discusses the role of prolonged stress in the development of TH. Special attention is paid to the problems with therapy and compliance during a long-term follow-up of the patient. Based on the clinical features of pain syndrome in the described patient, the authors suggest for the first time that the use of extremely high number of daily doses of combined narcotic analgesics for many years can result in recurrent DIH statuses. The paper discusses whether it is expedient to introduce the concept “DIH severity” and whether an additional clinical parameter “the number of doses of painkillers per month” can be of informative value, which has not been proposed yet in the literature. All the issues given in the paper are conjectural and are raised by the authors for further investigation of the DIH problem.

Objectives. To assess the value of using different treatment schemes in chronic migraine by comparing clinical results and the economic burdens of disease in real clinical practice. Materials and methods. The study included 66 patients attending the Academician Aleksandr Vein Headache and Autonomic Disorders Clinic: 60 women and six men aged 28–51 years with diagnoses of chronic migraine. The patients were divided into three groups: group 1 (n = 22) consisted of patients who received three months of oral prophylactic therapy with topiramate at doses of up to 100 mg/day; patients of group 2 (n = 20) received 12 sessions of acupuncture with three procedures per week; patients of group 3 (n = 24) received injections of botulinum toxin type A (Botox, BTA) at a dose of 155–195 U. The observation period was three months. Treatment efficacy was assessed using the following methods: clinical-neurological assessment, the Headache Impact Test HIT-6 questionnaire, and a subjective points questionnaire assessment for treatment satisfaction and tolerance. Results. BTA was the most effective of the three treatment methods studied in patients with chronic migraine. As compared with oral prophylactic therapy and acupuncture, BTA produced the fastest and strongest actions on the frequency of headache, promoting regression of chronic migraine and recovery of the episodic nature of headache (the numbers of headache days in group 1, 2, and 3 were 16.1 ± 0.1, 18.0 ± 0.02, and 13.9 ± 0.3, respectively, at one month). BTA also produced significantly faster and more effective recovery of quality of life and was better tolerated (good in 51%, 75%, and 85% in groups 1, 2, and 3, respectively; satisfactory in 35%, 25%, and 15% in groups 1, 2, and 3, respectively; poor in 14% in the oral prophylaxis group). Most patients in the BTA group achieved satisfactory treatment results more quickly. Despite the greater direct costs as compared with topiramate, the direct costs associated with the use of BTA (29931.51 and 32085.87 rubles, respectively, the predicted cost per non-headache day in the BTA group was the lowest, at 652.15 rubles (692.86 and 1017.60 rubles in the oral prophylaxis and acupuncture groups, respectively). Conclusions. The efficacy and cost data obtained here for the different methods of prophylaxis of chronic migraine may help specialists and patients select the most optimal therapeutic approaches.

The paper is devoted to the safe use of hormonal contraception in women with migraine, an urgent interdisciplinary problem daily faced by gynecologists, neurologists, and specialists in headache diagnosis and treatment. It gives information on the prevalence of migraine, the risk of ischemic stroke and other cardiovascular disorders in women with different types of migraine, including those receiving contraception and hormone replacement therapy. The paper presents the main provisions of the new interdisciplinary consensus «Hormonal contraceptives and the risk of ischemic stroke in women who have migraine», which are recommended to be taken into account by specialists of any profile when prescribing hormonal therapy to women with migraine in order to avoid cardiovascular events.

A number of epidemiological studies have shown the Association of migraine with peptic ulcer disease (JB), however, the processes underlying the pathogenesis and features of the course of these diseases have not been fully studied. Material and methods. A comprehensive examination of the gastrointestinal tract was performed in 114 patients with migraine. Focused on the major clinical and psychological characteristics of patients depending on the availability of gastroduodenopathies, especially pain therapy and serotonin levels in the blood serum. Results. In 18.4% of patients with migraine, regardless of its type, erosive and ulcerative lesions of the stomach and duodenum were detected. In patients with chronic migraine, gastric ULCER developed more often (PF =0.022), the clinical features of the combination of migraine and ULCER were more pronounced intensity of abdominal pain and heartburn. High (5 or more times a week) frequency of nonsteroidal anti-inflammatory drugs (NSAIDs) was an important ulcerogenic factor in patients with migraine. Serotoninergic hypofunction can be discussed as a mechanism that determines the comorbid relationship of migraine and JB. The combination of migraine with NSA contributed to the formation of a more severe course of migraine. In assessing the quality of life indicators of all scales in such patients were lower . Gastropathy can be considered as an additional factor of migraine chronization, requiring appropriate therapeutic interventions to improve the quality of life of patients.

Migraine is one of the most common types of headache, which can lead to a significant decrease in quality of life. Researchers identify migraine with aura, migraine without aura, and chronic migraine that substantially reduces the ability of patients to work and is frequently concurrent with mental disorders and drug-induced headache. The complications of migraine include status migrainosus, persistent aura without infarction, migrainous infarction (stroke), and a migraine aura-induced seizure. The diagnosis of migraine is based on complaints, past medical history, objective examination data, and the diagnostic criteria as laid down in the International Classification of Headache Disorders, 3 rd edition. Add-on trials are recommended only in the presence of red flags, such as the symptoms warning about the secondary nature of headache. Migraine treatment is aimed at reducing the frequency and intensity of attacks and the amount of analgesics taken. It includes three main approaches: behavioral therapy, seizure relief therapy, and preventive therapy. Behavioral therapy focuses on lifestyle modification. Nonsteroidal anti-inflammatory drugs, simple and combined analgesics, triptans, and antiemetic drugs for severe nausea or vomiting are recommended for seizure relief. Preventive therapy which includes antidepressants, anticonvulsants, beta-blockers, angiotensin II receptor antagonists, botulinum toxin type A-hemagglutinin complex and monoclonal antibodies to calcitonin gene-related peptide or its receptors, is indicated for frequent or severe migraine attacks and for chronic migraine. Pharmacotherapy is recommended to be combined with non-drug methods that involves cognitive behavioral therapy; progressive muscle relaxation; mindfulness; biofeedback; post-isometric relaxation; acupuncture; therapeutic exercises; greater occipital nerve block; non-invasive high-frequency repetitive transcranial magnetic stimulation; external stimulation of first trigeminal branch; and electrical stimulation of the occipital nerves (neurostimulation).