Article

At a glance, “health literacy” sounds like it has something specifically to do with the ability to read. Mary Laudon Thomas, MS, CNS, AOCN, a former president of Association of VA Hematology/Oncology, knows better.

“It’s not the same as reading level, and it’s not the same as educational level,” Thomas told Federal Practitioner. “Even educated people can think men can’t get breast cancer or misunderstand how to properly take their medications.”

Instead, health literacy is a broader topic: Do patients understand what’s going on when they get medical care? Can they use the information they get to make informed decisions about their health? Low health literacy is associated with lower use of preventative care of poorer adherence, poorer ability to navigate the health system and contributes to social inequities. In cancer care, low health literacy is associated with lower levels of screening, longer lag times in symptom identification, impairments in risk perception, fewer questions, lower perceived quality of life, and less follow-up.

Thomas and colleagues explored strategies to improve health literacy in cancer care during a half-day session on September 28th, kicking off the AVAHO 2023 annual meeting in Chicago. 

There are countless examples of patients who fail to understand aspects of their care, said Thomas, a retired clinical nurse specialist in hematology at California’s VA Palo Alto Health Care System who now serves as cochair of the AVAHO education committee. A patient may not realize that high blood pressure and hypertension are the same thing, for instance, or not understand that they need to go to the radiology department for a computed tomography.

“That’s our problem,” Thomas said. “We’re so fluent in our medical-speak that we forget we’re speaking a foreign language to other people.”

The goal of the AVAHO 2023 workshop is to “help people develop awareness of the scope of the problem and give them tools they can use to simplify how they speak to patients, teach patients and inform patients,” Thomas said.

In the first segment of the program, Angela Kumar, MPH, national program manager for Veterans Health Education and Information, discussed the VA organizational approach to health literacy. She noted that building a health-literate care organization aligns with the VA goal to be a high reliability organization. Veterans who have questions and concerns will need additional information throughout their cancer journey. The role for VA clinicians is to help answer veterans’ questions. “Rather than assume patients know what we are talking about, we have to make sure they understand,” Kumar explained. Institutional support will lead to better health outcomes and patient satisfaction throughout the system. VA is in the process of creating a patient centered learning program, Kumar noted. The program will be open to veterans, their families, caregivers, and provide training for VA health care professionals.

In the workshop’s 2 other sessions Janet Papadakos, PhD, MEd, a scientist at the University of Toronto’s Institute for Education Research, discussed the impact of health literacy on cancer treatment and outcomes and Fatemeh Youssefi, PhD, RN, OCN, director at large and committee member of the Oncology Nursing Society, discussed the roles of health literacy and patient education in empowering patients. Both speakers noted that patients with cancer are undergoing intense emotional stress, which can significantly impact their ability to understanding their treatment. Importantly, Papadakos explained, people can change and improve their health literacy, so clinicians have an opportunity to help influence and improve comprehension for their patient, by taking basic steps shown to improve health literacy.

“We know that in general, people with low health literacy report worse health, and they also have historically have poor outcomes,” Thomas said. Indeed, a 2021 systematic review of 66 papers found that “lower health literacy was associated with greater difficulties understanding and processing cancer related information, poorer quality of life and poorer experience of care.” Just 12% of US adults have proficient health literacy and one-third of adults have difficulty with common health tasks.

Papadakos and Youssefi provided some guidance for better communication with patients. Teach back, for example, is a tool to ensure patients understand topics when discussed. The key, Papadakos explained, is that it is not a test of the patient but rather a test of how well the information was communicated. Youssefi and Papadakos also emphasized the importance of using plain language. Clear and precise words that avoid technical terms avoid miscommunication and confusion. Finally, they urged clinicians to never assume health literacy and to approach all patients using clear language to ensure that they understand and can provide back the content covered.

Thomas said 3 more virtual sessions about health literacy will be offered over the coming year. Organizers will develop the specific topics after engaging in a discussion with attendees at the end of the AVAHO session. Meanwhile, advocates are developing a section of the AVAHO website that will be devoted to health literacy.

The workshop received support from Genentech.

At a glance, “health literacy” sounds like it has something specifically to do with the ability to read. Mary Laudon Thomas, MS, CNS, AOCN, a former president of Association of VA Hematology/Oncology, knows better.

“It’s not the same as reading level, and it’s not the same as educational level,” Thomas told Federal Practitioner. “Even educated people can think men can’t get breast cancer or misunderstand how to properly take their medications.”

Instead, health literacy is a broader topic: Do patients understand what’s going on when they get medical care? Can they use the information they get to make informed decisions about their health? Low health literacy is associated with lower use of preventative care of poorer adherence, poorer ability to navigate the health system and contributes to social inequities. In cancer care, low health literacy is associated with lower levels of screening, longer lag times in symptom identification, impairments in risk perception, fewer questions, lower perceived quality of life, and less follow-up.

Thomas and colleagues explored strategies to improve health literacy in cancer care during a half-day session on September 28th, kicking off the AVAHO 2023 annual meeting in Chicago. 

There are countless examples of patients who fail to understand aspects of their care, said Thomas, a retired clinical nurse specialist in hematology at California’s VA Palo Alto Health Care System who now serves as cochair of the AVAHO education committee. A patient may not realize that high blood pressure and hypertension are the same thing, for instance, or not understand that they need to go to the radiology department for a computed tomography.

“That’s our problem,” Thomas said. “We’re so fluent in our medical-speak that we forget we’re speaking a foreign language to other people.”

The goal of the AVAHO 2023 workshop is to “help people develop awareness of the scope of the problem and give them tools they can use to simplify how they speak to patients, teach patients and inform patients,” Thomas said.

In the first segment of the program, Angela Kumar, MPH, national program manager for Veterans Health Education and Information, discussed the VA organizational approach to health literacy. She noted that building a health-literate care organization aligns with the VA goal to be a high reliability organization. Veterans who have questions and concerns will need additional information throughout their cancer journey. The role for VA clinicians is to help answer veterans’ questions. “Rather than assume patients know what we are talking about, we have to make sure they understand,” Kumar explained. Institutional support will lead to better health outcomes and patient satisfaction throughout the system. VA is in the process of creating a patient centered learning program, Kumar noted. The program will be open to veterans, their families, caregivers, and provide training for VA health care professionals.

In the workshop’s 2 other sessions Janet Papadakos, PhD, MEd, a scientist at the University of Toronto’s Institute for Education Research, discussed the impact of health literacy on cancer treatment and outcomes and Fatemeh Youssefi, PhD, RN, OCN, director at large and committee member of the Oncology Nursing Society, discussed the roles of health literacy and patient education in empowering patients. Both speakers noted that patients with cancer are undergoing intense emotional stress, which can significantly impact their ability to understanding their treatment. Importantly, Papadakos explained, people can change and improve their health literacy, so clinicians have an opportunity to help influence and improve comprehension for their patient, by taking basic steps shown to improve health literacy.

“We know that in general, people with low health literacy report worse health, and they also have historically have poor outcomes,” Thomas said. Indeed, a 2021 systematic review of 66 papers found that “lower health literacy was associated with greater difficulties understanding and processing cancer related information, poorer quality of life and poorer experience of care.” Just 12% of US adults have proficient health literacy and one-third of adults have difficulty with common health tasks.

Papadakos and Youssefi provided some guidance for better communication with patients. Teach back, for example, is a tool to ensure patients understand topics when discussed. The key, Papadakos explained, is that it is not a test of the patient but rather a test of how well the information was communicated. Youssefi and Papadakos also emphasized the importance of using plain language. Clear and precise words that avoid technical terms avoid miscommunication and confusion. Finally, they urged clinicians to never assume health literacy and to approach all patients using clear language to ensure that they understand and can provide back the content covered.

Thomas said 3 more virtual sessions about health literacy will be offered over the coming year. Organizers will develop the specific topics after engaging in a discussion with attendees at the end of the AVAHO session. Meanwhile, advocates are developing a section of the AVAHO website that will be devoted to health literacy.

The workshop received support from Genentech.

At a glance, “health literacy” sounds like it has something specifically to do with the ability to read. Mary Laudon Thomas, MS, CNS, AOCN, a former president of Association of VA Hematology/Oncology, knows better.

“It’s not the same as reading level, and it’s not the same as educational level,” Thomas told Federal Practitioner. “Even educated people can think men can’t get breast cancer or misunderstand how to properly take their medications.”

Instead, health literacy is a broader topic: Do patients understand what’s going on when they get medical care? Can they use the information they get to make informed decisions about their health? Low health literacy is associated with lower use of preventative care of poorer adherence, poorer ability to navigate the health system and contributes to social inequities. In cancer care, low health literacy is associated with lower levels of screening, longer lag times in symptom identification, impairments in risk perception, fewer questions, lower perceived quality of life, and less follow-up.

Thomas and colleagues explored strategies to improve health literacy in cancer care during a half-day session on September 28th, kicking off the AVAHO 2023 annual meeting in Chicago. 

There are countless examples of patients who fail to understand aspects of their care, said Thomas, a retired clinical nurse specialist in hematology at California’s VA Palo Alto Health Care System who now serves as cochair of the AVAHO education committee. A patient may not realize that high blood pressure and hypertension are the same thing, for instance, or not understand that they need to go to the radiology department for a computed tomography.

“That’s our problem,” Thomas said. “We’re so fluent in our medical-speak that we forget we’re speaking a foreign language to other people.”

The goal of the AVAHO 2023 workshop is to “help people develop awareness of the scope of the problem and give them tools they can use to simplify how they speak to patients, teach patients and inform patients,” Thomas said.

In the first segment of the program, Angela Kumar, MPH, national program manager for Veterans Health Education and Information, discussed the VA organizational approach to health literacy. She noted that building a health-literate care organization aligns with the VA goal to be a high reliability organization. Veterans who have questions and concerns will need additional information throughout their cancer journey. The role for VA clinicians is to help answer veterans’ questions. “Rather than assume patients know what we are talking about, we have to make sure they understand,” Kumar explained. Institutional support will lead to better health outcomes and patient satisfaction throughout the system. VA is in the process of creating a patient centered learning program, Kumar noted. The program will be open to veterans, their families, caregivers, and provide training for VA health care professionals.

In the workshop’s 2 other sessions Janet Papadakos, PhD, MEd, a scientist at the University of Toronto’s Institute for Education Research, discussed the impact of health literacy on cancer treatment and outcomes and Fatemeh Youssefi, PhD, RN, OCN, director at large and committee member of the Oncology Nursing Society, discussed the roles of health literacy and patient education in empowering patients. Both speakers noted that patients with cancer are undergoing intense emotional stress, which can significantly impact their ability to understanding their treatment. Importantly, Papadakos explained, people can change and improve their health literacy, so clinicians have an opportunity to help influence and improve comprehension for their patient, by taking basic steps shown to improve health literacy.

“We know that in general, people with low health literacy report worse health, and they also have historically have poor outcomes,” Thomas said. Indeed, a 2021 systematic review of 66 papers found that “lower health literacy was associated with greater difficulties understanding and processing cancer related information, poorer quality of life and poorer experience of care.” Just 12% of US adults have proficient health literacy and one-third of adults have difficulty with common health tasks.

Papadakos and Youssefi provided some guidance for better communication with patients. Teach back, for example, is a tool to ensure patients understand topics when discussed. The key, Papadakos explained, is that it is not a test of the patient but rather a test of how well the information was communicated. Youssefi and Papadakos also emphasized the importance of using plain language. Clear and precise words that avoid technical terms avoid miscommunication and confusion. Finally, they urged clinicians to never assume health literacy and to approach all patients using clear language to ensure that they understand and can provide back the content covered.

Thomas said 3 more virtual sessions about health literacy will be offered over the coming year. Organizers will develop the specific topics after engaging in a discussion with attendees at the end of the AVAHO session. Meanwhile, advocates are developing a section of the AVAHO website that will be devoted to health literacy.

The workshop received support from Genentech.

Key clinical point: Fremanezumab was effective as a preventive treatment in patients with chronic migraine (CM) with or without medication overuse (MO) and showed potential benefits in reducing MO.

Major finding: During a 12-week follow-up period, the administration of monthly and quarterly fremanezumab vs placebo led to significantly reduced average number of monthly headache days of moderate or greater severity in patients with MO (monthly: mean change [∆] −2.0, P = .0012; and quarterly: ∆ −1.8, P = .0042) and without MO (monthly: ∆ −1.6, P = .0437; and quarterly: ∆ −1.5, P = .0441). A greater proportion of patients receiving fremanezumab vs placebo reverted to no MO (P ≤ .05).

Study details: This post hoc analysis of a phase 2b/3 trial included 479 Japanese patients with CM who were randomly assigned to receive monthly fremanezumab (n = 159), quarterly fremanezumab (n = 159), or placebo (n = 161), and of whom 320 patients reported MO.

Disclosures: This study was funded by Otsuka Pharmaceutical Co., Ltd. Several authors declared being full-time employees of Otsuka Pharmaceutical Co., Ltd., and N Imai declared ties with various other sources.

Source: Imai N et al. Effects of fremanezumab on medication overuse in Japanese chronic migraine patients: Post hoc analysis of a multicenter, randomized, double-blind, placebo-controlled trial. Neurol Ther. 2023 (Sep 11). doi: 10.1007/s40120-023-00531-3

Key clinical point: Fremanezumab was effective as a preventive treatment in patients with chronic migraine (CM) with or without medication overuse (MO) and showed potential benefits in reducing MO.

Major finding: During a 12-week follow-up period, the administration of monthly and quarterly fremanezumab vs placebo led to significantly reduced average number of monthly headache days of moderate or greater severity in patients with MO (monthly: mean change [∆] −2.0, P = .0012; and quarterly: ∆ −1.8, P = .0042) and without MO (monthly: ∆ −1.6, P = .0437; and quarterly: ∆ −1.5, P = .0441). A greater proportion of patients receiving fremanezumab vs placebo reverted to no MO (P ≤ .05).

Study details: This post hoc analysis of a phase 2b/3 trial included 479 Japanese patients with CM who were randomly assigned to receive monthly fremanezumab (n = 159), quarterly fremanezumab (n = 159), or placebo (n = 161), and of whom 320 patients reported MO.

Disclosures: This study was funded by Otsuka Pharmaceutical Co., Ltd. Several authors declared being full-time employees of Otsuka Pharmaceutical Co., Ltd., and N Imai declared ties with various other sources.

Source: Imai N et al. Effects of fremanezumab on medication overuse in Japanese chronic migraine patients: Post hoc analysis of a multicenter, randomized, double-blind, placebo-controlled trial. Neurol Ther. 2023 (Sep 11). doi: 10.1007/s40120-023-00531-3

Key clinical point: Fremanezumab was effective as a preventive treatment in patients with chronic migraine (CM) with or without medication overuse (MO) and showed potential benefits in reducing MO.

Major finding: During a 12-week follow-up period, the administration of monthly and quarterly fremanezumab vs placebo led to significantly reduced average number of monthly headache days of moderate or greater severity in patients with MO (monthly: mean change [∆] −2.0, P = .0012; and quarterly: ∆ −1.8, P = .0042) and without MO (monthly: ∆ −1.6, P = .0437; and quarterly: ∆ −1.5, P = .0441). A greater proportion of patients receiving fremanezumab vs placebo reverted to no MO (P ≤ .05).

Study details: This post hoc analysis of a phase 2b/3 trial included 479 Japanese patients with CM who were randomly assigned to receive monthly fremanezumab (n = 159), quarterly fremanezumab (n = 159), or placebo (n = 161), and of whom 320 patients reported MO.

Disclosures: This study was funded by Otsuka Pharmaceutical Co., Ltd. Several authors declared being full-time employees of Otsuka Pharmaceutical Co., Ltd., and N Imai declared ties with various other sources.

Source: Imai N et al. Effects of fremanezumab on medication overuse in Japanese chronic migraine patients: Post hoc analysis of a multicenter, randomized, double-blind, placebo-controlled trial. Neurol Ther. 2023 (Sep 11). doi: 10.1007/s40120-023-00531-3

Key clinical point: Patients with migraine who achieved ≥ 50% reduction in headache days at 6 months (responders) with anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) showed an even greater reduction in the number of days per month with photophobia, phonophobia, and aura ratios.

Major finding: Monthly headache days reduced significantly by 9.4 days/month (P < .001) and 2.2 days/month (P = .004) among responders and non-responders, respectively, with responders having additional significant reductions in photophobia (−19.5%; P < .001), phonophobia (−12.1%; P = .010), and aura (−25.1%; P = .008) ratios. Higher basal photophobia ratios were predictors of increased response rates between months 3 and 6 (incidence risk ratio 0.928; P = .040).

Study details: This prospective observational study included 158 patients with migraine treated with anti-CGRP mAb, of whom 43.7% were responders.

Disclosures: This study did not receive any funding. A Alpuente, E Caronna, M Torres-Ferrús, and P Pozo-Rosich declared receiving honoraria as consultants or speakers from various sources.

Source: Alpuente A et al. Impact of anti-CGRP monoclonal antibodies on migraine attack accompanying symptoms: A real-world evidence study. Cephalalgia. 2023;43(8):3331024231177636 (Aug 9). doi: 10.1177/03331024231177636

Key clinical point: Patients with migraine who achieved ≥ 50% reduction in headache days at 6 months (responders) with anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) showed an even greater reduction in the number of days per month with photophobia, phonophobia, and aura ratios.

Major finding: Monthly headache days reduced significantly by 9.4 days/month (P < .001) and 2.2 days/month (P = .004) among responders and non-responders, respectively, with responders having additional significant reductions in photophobia (−19.5%; P < .001), phonophobia (−12.1%; P = .010), and aura (−25.1%; P = .008) ratios. Higher basal photophobia ratios were predictors of increased response rates between months 3 and 6 (incidence risk ratio 0.928; P = .040).

Study details: This prospective observational study included 158 patients with migraine treated with anti-CGRP mAb, of whom 43.7% were responders.

Disclosures: This study did not receive any funding. A Alpuente, E Caronna, M Torres-Ferrús, and P Pozo-Rosich declared receiving honoraria as consultants or speakers from various sources.

Source: Alpuente A et al. Impact of anti-CGRP monoclonal antibodies on migraine attack accompanying symptoms: A real-world evidence study. Cephalalgia. 2023;43(8):3331024231177636 (Aug 9). doi: 10.1177/03331024231177636

Key clinical point: Patients with migraine who achieved ≥ 50% reduction in headache days at 6 months (responders) with anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) showed an even greater reduction in the number of days per month with photophobia, phonophobia, and aura ratios.

Major finding: Monthly headache days reduced significantly by 9.4 days/month (P < .001) and 2.2 days/month (P = .004) among responders and non-responders, respectively, with responders having additional significant reductions in photophobia (−19.5%; P < .001), phonophobia (−12.1%; P = .010), and aura (−25.1%; P = .008) ratios. Higher basal photophobia ratios were predictors of increased response rates between months 3 and 6 (incidence risk ratio 0.928; P = .040).

Study details: This prospective observational study included 158 patients with migraine treated with anti-CGRP mAb, of whom 43.7% were responders.

Disclosures: This study did not receive any funding. A Alpuente, E Caronna, M Torres-Ferrús, and P Pozo-Rosich declared receiving honoraria as consultants or speakers from various sources.

Source: Alpuente A et al. Impact of anti-CGRP monoclonal antibodies on migraine attack accompanying symptoms: A real-world evidence study. Cephalalgia. 2023;43(8):3331024231177636 (Aug 9). doi: 10.1177/03331024231177636

Key clinical point: No appreciable association was observed between a history of migraine or its subtypes and an increase in the risk for COVID-19, including hospitalization for COVID-19, in older women.

Major finding: No significant association was observed between a history of migraine and the risk of developing COVID-19 (odds ratio [OR] 1.08; 95% CI 0.95-1.22) or being hospitalized for COVID-19 (OR 1.20; 95% CI 0.86-1.68) among older women. Similarly, other migraine statuses, including migraine with aura, showed no association with the risk for COVID-19.

Study details: This prospective cohort study included 16,492 women (age ≥ 45 years) enrolled in the Women’s Health Study, of whom 28.9% had a history of migraine and 7.7% reported positive SARS-CoV-2 test results, a diagnosis of COVID-19, or hospitalization for COVID-19.

Disclosures: The Women’s Health Study was funded by grants from the US National Cancer Institute and the US National Heart, Lung, and Blood Institute. T Kurth declared receiving research grants and personal compensation from various sources. The other authors declared no conflicts of interest.

Source: Rist PM et al. History of migraine and risk of COVID-19: A cohort study. Am J Med. 2023 (Aug 18). doi: 10.1016/j.amjmed.2023.07.021

Key clinical point: No appreciable association was observed between a history of migraine or its subtypes and an increase in the risk for COVID-19, including hospitalization for COVID-19, in older women.

Major finding: No significant association was observed between a history of migraine and the risk of developing COVID-19 (odds ratio [OR] 1.08; 95% CI 0.95-1.22) or being hospitalized for COVID-19 (OR 1.20; 95% CI 0.86-1.68) among older women. Similarly, other migraine statuses, including migraine with aura, showed no association with the risk for COVID-19.

Study details: This prospective cohort study included 16,492 women (age ≥ 45 years) enrolled in the Women’s Health Study, of whom 28.9% had a history of migraine and 7.7% reported positive SARS-CoV-2 test results, a diagnosis of COVID-19, or hospitalization for COVID-19.

Disclosures: The Women’s Health Study was funded by grants from the US National Cancer Institute and the US National Heart, Lung, and Blood Institute. T Kurth declared receiving research grants and personal compensation from various sources. The other authors declared no conflicts of interest.

Source: Rist PM et al. History of migraine and risk of COVID-19: A cohort study. Am J Med. 2023 (Aug 18). doi: 10.1016/j.amjmed.2023.07.021

Key clinical point: No appreciable association was observed between a history of migraine or its subtypes and an increase in the risk for COVID-19, including hospitalization for COVID-19, in older women.

Major finding: No significant association was observed between a history of migraine and the risk of developing COVID-19 (odds ratio [OR] 1.08; 95% CI 0.95-1.22) or being hospitalized for COVID-19 (OR 1.20; 95% CI 0.86-1.68) among older women. Similarly, other migraine statuses, including migraine with aura, showed no association with the risk for COVID-19.

Study details: This prospective cohort study included 16,492 women (age ≥ 45 years) enrolled in the Women’s Health Study, of whom 28.9% had a history of migraine and 7.7% reported positive SARS-CoV-2 test results, a diagnosis of COVID-19, or hospitalization for COVID-19.

Disclosures: The Women’s Health Study was funded by grants from the US National Cancer Institute and the US National Heart, Lung, and Blood Institute. T Kurth declared receiving research grants and personal compensation from various sources. The other authors declared no conflicts of interest.

Source: Rist PM et al. History of migraine and risk of COVID-19: A cohort study. Am J Med. 2023 (Aug 18). doi: 10.1016/j.amjmed.2023.07.021

Key clinical point: Nearly 24% of patients with multiple sclerosis (MS) experience migraine, with the odds of migraine occurrence being approximately 2-fold higher in patients with MS compared with control individuals.

Major finding: The overall prevalence rate of migraine among patients with MS was 0.24 (95% CI 0.21-0.28). Moreover, patients with MS vs control participants without MS had a ~2-fold greater risk of experiencing migraine (odds ratio 1.96; 95% CI 1.20-3.20).

Study details: This meta-analysis of 35 studies included 279,620 patients with MS and 279,603 control participants without MS.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Mohammadi M et al. The association between multiple sclerosis and migraine: A meta-analysis. Mult Scler Relat Disord. 2023;79:104954 (Aug 30). doi: 10.1016/j.msard.2023.104954

Key clinical point: Nearly 24% of patients with multiple sclerosis (MS) experience migraine, with the odds of migraine occurrence being approximately 2-fold higher in patients with MS compared with control individuals.

Major finding: The overall prevalence rate of migraine among patients with MS was 0.24 (95% CI 0.21-0.28). Moreover, patients with MS vs control participants without MS had a ~2-fold greater risk of experiencing migraine (odds ratio 1.96; 95% CI 1.20-3.20).

Study details: This meta-analysis of 35 studies included 279,620 patients with MS and 279,603 control participants without MS.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Mohammadi M et al. The association between multiple sclerosis and migraine: A meta-analysis. Mult Scler Relat Disord. 2023;79:104954 (Aug 30). doi: 10.1016/j.msard.2023.104954

Key clinical point: Nearly 24% of patients with multiple sclerosis (MS) experience migraine, with the odds of migraine occurrence being approximately 2-fold higher in patients with MS compared with control individuals.

Major finding: The overall prevalence rate of migraine among patients with MS was 0.24 (95% CI 0.21-0.28). Moreover, patients with MS vs control participants without MS had a ~2-fold greater risk of experiencing migraine (odds ratio 1.96; 95% CI 1.20-3.20).

Study details: This meta-analysis of 35 studies included 279,620 patients with MS and 279,603 control participants without MS.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Mohammadi M et al. The association between multiple sclerosis and migraine: A meta-analysis. Mult Scler Relat Disord. 2023;79:104954 (Aug 30). doi: 10.1016/j.msard.2023.104954

Key clinical point: Absence of cutaneous allodynia was a predictor of treatment response following withdrawal therapy in patients with chronic migraine and medication overuse, with the predictive value being even more pronounced when compared with cephalic or extracephalic allodynia.

Major finding: The chances of reversion from chronic to episodic migraine were ~2.5 times higher in patients without vs with cutaneous allodynia (odds ratio [OR] 2.45; P = .042), with the predictive values of absence of allodynia being even more pronounced when compared with patients having cephalic (OR 4.16; P = .024) or extracephalic (OR 7.32; P = .003) allodynia.

Study details: This study, conducted as part of the Chronification And Reversibility of Migraine study, included 173 patients with chronic migraine and medication overuse, of whom 129 had cutaneous allodynia.

Disclosures: This study was supported by grants from the Netherlands Organization for Scientific Research and the Dutch Brain Foundation. I de Boer and GM Terwindt declared receiving independent support, consultancy support, or both from various sources.

Source: Pijpers JA et al. Cutaneous allodynia as predictor for treatment response in chronic migraine: A cohort study. J Headache Pain. 2023;24:118 (Aug 30). Doi: 10.1186/s10194-023-01651-9.

Key clinical point: Absence of cutaneous allodynia was a predictor of treatment response following withdrawal therapy in patients with chronic migraine and medication overuse, with the predictive value being even more pronounced when compared with cephalic or extracephalic allodynia.

Major finding: The chances of reversion from chronic to episodic migraine were ~2.5 times higher in patients without vs with cutaneous allodynia (odds ratio [OR] 2.45; P = .042), with the predictive values of absence of allodynia being even more pronounced when compared with patients having cephalic (OR 4.16; P = .024) or extracephalic (OR 7.32; P = .003) allodynia.

Study details: This study, conducted as part of the Chronification And Reversibility of Migraine study, included 173 patients with chronic migraine and medication overuse, of whom 129 had cutaneous allodynia.

Disclosures: This study was supported by grants from the Netherlands Organization for Scientific Research and the Dutch Brain Foundation. I de Boer and GM Terwindt declared receiving independent support, consultancy support, or both from various sources.

Source: Pijpers JA et al. Cutaneous allodynia as predictor for treatment response in chronic migraine: A cohort study. J Headache Pain. 2023;24:118 (Aug 30). Doi: 10.1186/s10194-023-01651-9.

Key clinical point: Absence of cutaneous allodynia was a predictor of treatment response following withdrawal therapy in patients with chronic migraine and medication overuse, with the predictive value being even more pronounced when compared with cephalic or extracephalic allodynia.

Major finding: The chances of reversion from chronic to episodic migraine were ~2.5 times higher in patients without vs with cutaneous allodynia (odds ratio [OR] 2.45; P = .042), with the predictive values of absence of allodynia being even more pronounced when compared with patients having cephalic (OR 4.16; P = .024) or extracephalic (OR 7.32; P = .003) allodynia.

Study details: This study, conducted as part of the Chronification And Reversibility of Migraine study, included 173 patients with chronic migraine and medication overuse, of whom 129 had cutaneous allodynia.

Disclosures: This study was supported by grants from the Netherlands Organization for Scientific Research and the Dutch Brain Foundation. I de Boer and GM Terwindt declared receiving independent support, consultancy support, or both from various sources.

Source: Pijpers JA et al. Cutaneous allodynia as predictor for treatment response in chronic migraine: A cohort study. J Headache Pain. 2023;24:118 (Aug 30). Doi: 10.1186/s10194-023-01651-9.

Key clinical point: A history of migraine was significantly associated with an increased risk for cervical artery dissection (CeAD), with the risk being predominantly driven by migraine without aura.

Major finding: The risk for CeAD was 1.74-fold higher in patients with vs without migraine (adjusted odds ratio [aOR] 1.74; 95% CI 1.38-2.19), with the risk being pronounced in migraine without aura (aOR 1.86; 95% CI 1.55-2.24) but not in migraine with aura (aOR 1.15; 95% CI 0.71-1.88).

Study details: This meta-analysis included 11 case-control studies with 2188 CeAD cases and 7669 control participants.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Sun Z et al. Migraine and the risk of cervical artery dissection: A systematic review and meta-analysis. Eur Stroke J. 2023 (Aug 9). doi: 10.1177/23969873231191860

Key clinical point: A history of migraine was significantly associated with an increased risk for cervical artery dissection (CeAD), with the risk being predominantly driven by migraine without aura.

Major finding: The risk for CeAD was 1.74-fold higher in patients with vs without migraine (adjusted odds ratio [aOR] 1.74; 95% CI 1.38-2.19), with the risk being pronounced in migraine without aura (aOR 1.86; 95% CI 1.55-2.24) but not in migraine with aura (aOR 1.15; 95% CI 0.71-1.88).

Study details: This meta-analysis included 11 case-control studies with 2188 CeAD cases and 7669 control participants.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Sun Z et al. Migraine and the risk of cervical artery dissection: A systematic review and meta-analysis. Eur Stroke J. 2023 (Aug 9). doi: 10.1177/23969873231191860

Key clinical point: A history of migraine was significantly associated with an increased risk for cervical artery dissection (CeAD), with the risk being predominantly driven by migraine without aura.

Major finding: The risk for CeAD was 1.74-fold higher in patients with vs without migraine (adjusted odds ratio [aOR] 1.74; 95% CI 1.38-2.19), with the risk being pronounced in migraine without aura (aOR 1.86; 95% CI 1.55-2.24) but not in migraine with aura (aOR 1.15; 95% CI 0.71-1.88).

Study details: This meta-analysis included 11 case-control studies with 2188 CeAD cases and 7669 control participants.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Sun Z et al. Migraine and the risk of cervical artery dissection: A systematic review and meta-analysis. Eur Stroke J. 2023 (Aug 9). doi: 10.1177/23969873231191860

Key clinical point: Early wearing-off effect (WOE) is common in patients with chronic migraine (CM) receiving onabotulinumtoxinA (OnabotA) and more frequent after the first cycle of OnabotA, with depression and anxiety disorders being clinical predictors of the WOE.

Major finding: Early WOE was reported more frequently after the first vs second treatment cycle of OnabotA (35.6% vs 23.8% of patients), with depression and anxiety disorders being significant clinical predictors of WOE (odds ratio 3.4; 95% CI 1.22-10.84; P = .028).

Study details: Findings are from a prospective real-life study including 59 patients with CM and insufficient response, absence of tolerability, or contraindications to previous migraine therapies who initiated prophylactic treatment with OnabotA, 40.6% of whom reported a WOE.

Disclosures: This study received no external funding. The authors declared no conflicts of interest.

Source: Rodríguez-Montolio J et al. Early wearing-off effect of OnabotulinumtoxinA in chronic migraine: A prospective real-life study. J Clin Med. 2023;12(16):5360 (Aug 17). doi: 10.3390/jcm12165360

Key clinical point: Early wearing-off effect (WOE) is common in patients with chronic migraine (CM) receiving onabotulinumtoxinA (OnabotA) and more frequent after the first cycle of OnabotA, with depression and anxiety disorders being clinical predictors of the WOE.

Major finding: Early WOE was reported more frequently after the first vs second treatment cycle of OnabotA (35.6% vs 23.8% of patients), with depression and anxiety disorders being significant clinical predictors of WOE (odds ratio 3.4; 95% CI 1.22-10.84; P = .028).

Study details: Findings are from a prospective real-life study including 59 patients with CM and insufficient response, absence of tolerability, or contraindications to previous migraine therapies who initiated prophylactic treatment with OnabotA, 40.6% of whom reported a WOE.

Disclosures: This study received no external funding. The authors declared no conflicts of interest.

Source: Rodríguez-Montolio J et al. Early wearing-off effect of OnabotulinumtoxinA in chronic migraine: A prospective real-life study. J Clin Med. 2023;12(16):5360 (Aug 17). doi: 10.3390/jcm12165360

Key clinical point: Early wearing-off effect (WOE) is common in patients with chronic migraine (CM) receiving onabotulinumtoxinA (OnabotA) and more frequent after the first cycle of OnabotA, with depression and anxiety disorders being clinical predictors of the WOE.

Major finding: Early WOE was reported more frequently after the first vs second treatment cycle of OnabotA (35.6% vs 23.8% of patients), with depression and anxiety disorders being significant clinical predictors of WOE (odds ratio 3.4; 95% CI 1.22-10.84; P = .028).

Study details: Findings are from a prospective real-life study including 59 patients with CM and insufficient response, absence of tolerability, or contraindications to previous migraine therapies who initiated prophylactic treatment with OnabotA, 40.6% of whom reported a WOE.

Disclosures: This study received no external funding. The authors declared no conflicts of interest.

Source: Rodríguez-Montolio J et al. Early wearing-off effect of OnabotulinumtoxinA in chronic migraine: A prospective real-life study. J Clin Med. 2023;12(16):5360 (Aug 17). doi: 10.3390/jcm12165360

Key clinical point: Ubrogepant shows similar efficacy and no new safety concerns for the treatment of perimenstrual migraine (pmM) and non-pmM attacks.

Major finding: At 2 hours post dose, pain freedom (P = .054) and pain relief (P = .683) were similar between pmM and non-pmM attacks treated with 50 mg ubrogepant. Absence of migraine-associated symptoms (photophobia and phonophobia) and functional disability was not significantly different between pmM and non-pmM attacks treated with 50 mg ubrogepant, with similar findings observed for 100 mg ubrogepant. Nausea and dizziness were reported in < 6% of participants overall in both the 50 mg and 100 mg ubrogepant groups.

Study details: This post hoc analysis of a long-term safety extension trial included 734 women with migraine, of whom 278 and 716 were treated with ubrogepant (50 mg or 100 mg) for ≥ 1 pmM and non-pmM attacks, respectively.

Disclosures: This study was funded by Allergan (prior to its acquisition by AbbVie). Four authors declared being employees of or holding stocks in AbbVie, and the other authors declared ties with various sources, including AbbVie.

Source: MacGregor EA et al. Safety and efficacy of ubrogepant for the acute treatment of perimenstrual migraine attacks: A post hoc analysis. Headache. 2023 (Sep 1). doi: 10.1111/head.14619

Key clinical point: Ubrogepant shows similar efficacy and no new safety concerns for the treatment of perimenstrual migraine (pmM) and non-pmM attacks.

Major finding: At 2 hours post dose, pain freedom (P = .054) and pain relief (P = .683) were similar between pmM and non-pmM attacks treated with 50 mg ubrogepant. Absence of migraine-associated symptoms (photophobia and phonophobia) and functional disability was not significantly different between pmM and non-pmM attacks treated with 50 mg ubrogepant, with similar findings observed for 100 mg ubrogepant. Nausea and dizziness were reported in < 6% of participants overall in both the 50 mg and 100 mg ubrogepant groups.

Study details: This post hoc analysis of a long-term safety extension trial included 734 women with migraine, of whom 278 and 716 were treated with ubrogepant (50 mg or 100 mg) for ≥ 1 pmM and non-pmM attacks, respectively.

Disclosures: This study was funded by Allergan (prior to its acquisition by AbbVie). Four authors declared being employees of or holding stocks in AbbVie, and the other authors declared ties with various sources, including AbbVie.

Source: MacGregor EA et al. Safety and efficacy of ubrogepant for the acute treatment of perimenstrual migraine attacks: A post hoc analysis. Headache. 2023 (Sep 1). doi: 10.1111/head.14619

Key clinical point: Ubrogepant shows similar efficacy and no new safety concerns for the treatment of perimenstrual migraine (pmM) and non-pmM attacks.

Major finding: At 2 hours post dose, pain freedom (P = .054) and pain relief (P = .683) were similar between pmM and non-pmM attacks treated with 50 mg ubrogepant. Absence of migraine-associated symptoms (photophobia and phonophobia) and functional disability was not significantly different between pmM and non-pmM attacks treated with 50 mg ubrogepant, with similar findings observed for 100 mg ubrogepant. Nausea and dizziness were reported in < 6% of participants overall in both the 50 mg and 100 mg ubrogepant groups.

Study details: This post hoc analysis of a long-term safety extension trial included 734 women with migraine, of whom 278 and 716 were treated with ubrogepant (50 mg or 100 mg) for ≥ 1 pmM and non-pmM attacks, respectively.

Disclosures: This study was funded by Allergan (prior to its acquisition by AbbVie). Four authors declared being employees of or holding stocks in AbbVie, and the other authors declared ties with various sources, including AbbVie.

Source: MacGregor EA et al. Safety and efficacy of ubrogepant for the acute treatment of perimenstrual migraine attacks: A post hoc analysis. Headache. 2023 (Sep 1). doi: 10.1111/head.14619

Key clinical point: In patients with migraine, COVID-19 vaccination worsened the overall migraine symptoms in the first month post-vaccination; however, COVID-19 infection solely increased the number of acute medication intake days in the first month following infection.

Major finding: COVID-19 vaccination led to a significant increase in the number of monthly migraine days (MMD), monthly headache days (MHD), and monthly acute medication days (MAMD) by 1.06, 1.52, and 0.72, respectively (all P < .001) in the first month post-vaccination. COVID-19 infection solely increased MAMD by 1.11 (P = .027) in the first month following infection, with no significant effects on MMD and MHD.

Study details: This longitudinal cohort study identified 547 patients with migraine, of whom 147 were included in the vaccine analysis and 59 in the infection analysis.

Disclosures: This study did not receive any funding. BWH van der Arend and GM Terwindt declared receiving independent support and consultancy or industry support from various sources. The other authors declared no conflicts of interest.

Source: van der Arend BWH et al. Effect of COVID vaccination on monthly migraine days: A longitudinal cohort study. Cephalalgia. 2023;43(9) (Sep 8). doi: 10.1177/03331024231198792

Key clinical point: In patients with migraine, COVID-19 vaccination worsened the overall migraine symptoms in the first month post-vaccination; however, COVID-19 infection solely increased the number of acute medication intake days in the first month following infection.

Major finding: COVID-19 vaccination led to a significant increase in the number of monthly migraine days (MMD), monthly headache days (MHD), and monthly acute medication days (MAMD) by 1.06, 1.52, and 0.72, respectively (all P < .001) in the first month post-vaccination. COVID-19 infection solely increased MAMD by 1.11 (P = .027) in the first month following infection, with no significant effects on MMD and MHD.

Study details: This longitudinal cohort study identified 547 patients with migraine, of whom 147 were included in the vaccine analysis and 59 in the infection analysis.

Disclosures: This study did not receive any funding. BWH van der Arend and GM Terwindt declared receiving independent support and consultancy or industry support from various sources. The other authors declared no conflicts of interest.

Source: van der Arend BWH et al. Effect of COVID vaccination on monthly migraine days: A longitudinal cohort study. Cephalalgia. 2023;43(9) (Sep 8). doi: 10.1177/03331024231198792

Key clinical point: In patients with migraine, COVID-19 vaccination worsened the overall migraine symptoms in the first month post-vaccination; however, COVID-19 infection solely increased the number of acute medication intake days in the first month following infection.

Major finding: COVID-19 vaccination led to a significant increase in the number of monthly migraine days (MMD), monthly headache days (MHD), and monthly acute medication days (MAMD) by 1.06, 1.52, and 0.72, respectively (all P < .001) in the first month post-vaccination. COVID-19 infection solely increased MAMD by 1.11 (P = .027) in the first month following infection, with no significant effects on MMD and MHD.

Study details: This longitudinal cohort study identified 547 patients with migraine, of whom 147 were included in the vaccine analysis and 59 in the infection analysis.

Disclosures: This study did not receive any funding. BWH van der Arend and GM Terwindt declared receiving independent support and consultancy or industry support from various sources. The other authors declared no conflicts of interest.

Source: van der Arend BWH et al. Effect of COVID vaccination on monthly migraine days: A longitudinal cohort study. Cephalalgia. 2023;43(9) (Sep 8). doi: 10.1177/03331024231198792