are employees of Teva Pharmaceuticals

are employees of Teva Pharmaceuticals. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. How to cite this article: Rhyne C, Cohen JM, Seminerio MJ, Carr K, Krasenbaum LJ. peptide pathway have been developed as specific preventive treatments for migraine. Four of these monoclonal antibodies have been approved for the preventive treatment of migraine after demonstrating favorable safety and efficacy profiles. These treatments offer substantial benefits for migraine patients, including those with AMO or common psychiatric comorbidities, by reducing monthly headache days and migraine days, days of acute medication use, and disability measures, as NKP-1339 well as improving quality of life. Keywords: acute medication overuse, calcitonin gene-related peptide, comorbidity, depressive disorder, migraine, monoclonal antibody, prevention 1. Introduction 1.1. Epidemiology and burden of migraine Migraine, which is usually characterized by headache attacks associated with nausea, vomiting, and sensitivity to light or sound,[1,2] can be categorized by the frequency of attacks as episodic migraine (EM; headache on <15 d/mo) or chronic migraine (CM; headache on 15 d/mo for >3 months, with 8 d/mo meeting the migraine criteria as defined by the International Classification of Headache Disorders-3[3]). Migraine is one of the 3 most NKP-1339 burdensome neurological disorders in the United States, affecting approximately 68.5 million people and resulting in 2.4 million disability-adjusted life years.[4] Further, according to the 2019 Global Burden of Disease, Injuries, HNRNPA1L2 and Risk Factors study, migraine was ranked the second leading cause of disability worldwide, resulting in 4.9% of total years lived with disability.[5] By comparison, low back pain was the leading cause of disability globally, resulting in 7.6% of total years lived with disability. Similarly, average annual direct medical costs per patient for patients with migraine ($11,010) are higher compared with patients without migraine ($4436)[6] and are generally higher compared with those for patients with other common chronic conditions (e.g., diabetes, $3219C$4674; chronic obstructive pulmonary disease, $3968C$6491; asthma, $989C$3069).[7] Migraine is associated with a number of comorbidities, including depression and anxiety, which may be associated with an increase in the severity and burden of migraine.[8,9] Similarly, patients who are overusing acute migraine medications (acute medication overuse [AMO]) due to challenges with managing their migraine symptoms may experience greater migraine severity and burden.[10] Patients with migraine with AMO and psychiatric comorbidities may have greater costs and health care resource utilization.[10C12] 1.2. Pathophysiology of migraine Migraine has been shown to be associated with increased activity and sensitivity of the trigeminovascular system.[2] This hyperexcitability leads to the activation of nociceptors in the meningeal blood vessels, cerebral arteries, and sinuses, causing headaches and other migraine-related symptoms.[2] Calcitonin gene-related peptide (CGRP) plays a crucial role in migraine pathogenesis.[13] CGRP is usually expressed in the central and peripheral nervous system and may modulate the trigeminovascular system, leading to pain and other symptoms associated with migraine.[13,14] This review aims to describe the impairment and burden experienced by patients with migraine with AMO or psychiatric comorbidities, as well as barriers to diagnosis. The use of CGRP pathway-targeted monoclonal antibodies for the preventive treatment of migraine, particularly migraine with AMO or depressive disorder or stress, will also be discussed. 2. Burden of psychiatric comorbidities and AMO in migraine 2.1. Comorbidities of migraine Psychiatric diseases, including depressive disorder and anxiety, are common comorbidities associated with migraine.[15,16] Breslau and colleagues showed that patients with major depression are >3 occasions as likely to have migraine as those without depression, and patients with migraine are nearly 6 occasions as likely to have major depression as those without migraine.[17] Furthermore, the presence of comorbid anxiety and depression in patients NKP-1339 with migraine is usually associated with increased migraine-related disability, reduced quality of life, and greater work productivity and activity impairment.[18] Lipton and colleagues found that rates of moderate-to-severe migraine-related disability were higher among migraine patients with anxiety and/or depression (43C61%) compared to migraine patients without anxiety or depression (28%).[16] 2.2. Acute medication overuse Overuse of acute medications for migraine (AMO), defined by use of simple analgesics or combination medications on 15 d/mo or use of triptans, ergots, opioids, or combination analgesics on 10 d/mo,[19] is also associated with increased migraine severity, risk for progression from EM to CM, reduced quality of life, and an increase in pain symptoms.[20C25] Patients with CM and AMO may have higher headache-related disability and rates of depression and anxiety; thus, it is crucial to treat and reduce the burden of illness in patients with CM and AMO.[10] Excessive use of acute medications can also lead to the development of medication overuse headache (MOH).[26] 3. Screening Fewer than 50% of all migraine patients are properly.