Key clinical point: Habitual intake of caffeinated beverages may not increase headache frequency, duration, or intensity in patients with episodic migraine, contrary to popular belief.

Major finding: Compared with patients having episodic migraine who did not habitually consume caffeinated beverages, those who consumed 1-2 servings per day reported 0.3 (95% CI −2.0 to 2.5) more headache days per month, whereas those who consumed 3-4 servings per day reported 1.3 (95% CI −4.5 to 1.9) fewer headache days per month. Moreover, the headache duration and intensity did not differ across levels of caffeinated beverage intake.

Study details: This prospective cohort study evaluated the association between habitual caffeinated beverages intake and headache outcomes among 97 patients with episodic migraine (age ≥ 18 years).

Disclosures: This study was funded by US National Institute of Neurological Disorders and Stroke, the American Sleep Medicine Foundation, Harvard Catalyst—The Harvard Clinical and Translational Science Center. Suzanne M. Bertisch declared serving as a consultant for Idorsia and ResMed. The other authors declared no conflicts of interest.

Source: Mittleman MR, Mostofsky E, Vgontzas A, Bertisch SM. Habitual caffeinated beverage consumption and headaches among adults with episodic migraine: A prospective cohort study. Headache. 2024 (Feb 6). doi: 10.1111/head.14673 Source

Key clinical point: Habitual intake of caffeinated beverages may not increase headache frequency, duration, or intensity in patients with episodic migraine, contrary to popular belief.

Major finding: Compared with patients having episodic migraine who did not habitually consume caffeinated beverages, those who consumed 1-2 servings per day reported 0.3 (95% CI −2.0 to 2.5) more headache days per month, whereas those who consumed 3-4 servings per day reported 1.3 (95% CI −4.5 to 1.9) fewer headache days per month. Moreover, the headache duration and intensity did not differ across levels of caffeinated beverage intake.

Study details: This prospective cohort study evaluated the association between habitual caffeinated beverages intake and headache outcomes among 97 patients with episodic migraine (age ≥ 18 years).

Disclosures: This study was funded by US National Institute of Neurological Disorders and Stroke, the American Sleep Medicine Foundation, Harvard Catalyst—The Harvard Clinical and Translational Science Center. Suzanne M. Bertisch declared serving as a consultant for Idorsia and ResMed. The other authors declared no conflicts of interest.

Source: Mittleman MR, Mostofsky E, Vgontzas A, Bertisch SM. Habitual caffeinated beverage consumption and headaches among adults with episodic migraine: A prospective cohort study. Headache. 2024 (Feb 6). doi: 10.1111/head.14673 Source

Key clinical point: Habitual intake of caffeinated beverages may not increase headache frequency, duration, or intensity in patients with episodic migraine, contrary to popular belief.

Major finding: Compared with patients having episodic migraine who did not habitually consume caffeinated beverages, those who consumed 1-2 servings per day reported 0.3 (95% CI −2.0 to 2.5) more headache days per month, whereas those who consumed 3-4 servings per day reported 1.3 (95% CI −4.5 to 1.9) fewer headache days per month. Moreover, the headache duration and intensity did not differ across levels of caffeinated beverage intake.

Study details: This prospective cohort study evaluated the association between habitual caffeinated beverages intake and headache outcomes among 97 patients with episodic migraine (age ≥ 18 years).

Disclosures: This study was funded by US National Institute of Neurological Disorders and Stroke, the American Sleep Medicine Foundation, Harvard Catalyst—The Harvard Clinical and Translational Science Center. Suzanne M. Bertisch declared serving as a consultant for Idorsia and ResMed. The other authors declared no conflicts of interest.

Source: Mittleman MR, Mostofsky E, Vgontzas A, Bertisch SM. Habitual caffeinated beverage consumption and headaches among adults with episodic migraine: A prospective cohort study. Headache. 2024 (Feb 6). doi: 10.1111/head.14673 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were more effective than onabotulinumtoxinA (BoNT-A) in reducing monthly headache days (MHD) in patients with chronic migraine (CM), although the safety profile of both treatments was comparable.

Major finding: Anti-CGRP mAb vs BoNT-A led to a significantly greater reduction in MHD at 6 months (adjusted mean difference ‒7.1; P < .001) and 12 months(adjusted mean difference ‒6.2; P < .001). Both treatments had favorable and comparable safety profiles.

Study details: Findings are from an observational, retrospective, multicenter, cohort study including 183 patients with CM who had at least two oral preventive treatment failures and received anti-CGRP mAb (n = 86) and BoNT-A (n = 97).

Disclosures: This study was supported by Italian Ministry of Health. Four authors declared receiving consultancy and advisory fees, travel grants, honoraria, or personal fees for participating in advisory boards, speaker panels, or clinical investigation studies from various sources.

Source: Grazzi L, Giossi R, Montisano DA et al. Real-world effectiveness of anti-CGRP monoclonal antibodies compared to onabotulinumtoxinA (RAMO) in chronic migraine: A retrospective, observational, multicenter, cohort study. J Headache Pain. 2024;25:14. doi: 10.1186/s10194-024-01721-6 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were more effective than onabotulinumtoxinA (BoNT-A) in reducing monthly headache days (MHD) in patients with chronic migraine (CM), although the safety profile of both treatments was comparable.

Major finding: Anti-CGRP mAb vs BoNT-A led to a significantly greater reduction in MHD at 6 months (adjusted mean difference ‒7.1; P < .001) and 12 months(adjusted mean difference ‒6.2; P < .001). Both treatments had favorable and comparable safety profiles.

Study details: Findings are from an observational, retrospective, multicenter, cohort study including 183 patients with CM who had at least two oral preventive treatment failures and received anti-CGRP mAb (n = 86) and BoNT-A (n = 97).

Disclosures: This study was supported by Italian Ministry of Health. Four authors declared receiving consultancy and advisory fees, travel grants, honoraria, or personal fees for participating in advisory boards, speaker panels, or clinical investigation studies from various sources.

Source: Grazzi L, Giossi R, Montisano DA et al. Real-world effectiveness of anti-CGRP monoclonal antibodies compared to onabotulinumtoxinA (RAMO) in chronic migraine: A retrospective, observational, multicenter, cohort study. J Headache Pain. 2024;25:14. doi: 10.1186/s10194-024-01721-6 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were more effective than onabotulinumtoxinA (BoNT-A) in reducing monthly headache days (MHD) in patients with chronic migraine (CM), although the safety profile of both treatments was comparable.

Major finding: Anti-CGRP mAb vs BoNT-A led to a significantly greater reduction in MHD at 6 months (adjusted mean difference ‒7.1; P < .001) and 12 months(adjusted mean difference ‒6.2; P < .001). Both treatments had favorable and comparable safety profiles.

Study details: Findings are from an observational, retrospective, multicenter, cohort study including 183 patients with CM who had at least two oral preventive treatment failures and received anti-CGRP mAb (n = 86) and BoNT-A (n = 97).

Disclosures: This study was supported by Italian Ministry of Health. Four authors declared receiving consultancy and advisory fees, travel grants, honoraria, or personal fees for participating in advisory boards, speaker panels, or clinical investigation studies from various sources.

Source: Grazzi L, Giossi R, Montisano DA et al. Real-world effectiveness of anti-CGRP monoclonal antibodies compared to onabotulinumtoxinA (RAMO) in chronic migraine: A retrospective, observational, multicenter, cohort study. J Headache Pain. 2024;25:14. doi: 10.1186/s10194-024-01721-6 Source

and migraine or its subtypes, and vice versa.

Major finding: Genetic predispositions to AR were not casually associated with a higher risk for migraine (odds ratio [OR] 0.816; P = .394), both with aura (OR 0.690; P = .384) and without aura (OR 1.022; P = .954). Reciprocally, genetic predispositions to migraine or its subtypes showed no casual association with AR.

Study details: This two-sample Mendelian randomization analysis included 25,486 patients with AR and 87,907 control individuals without AR along with 3541 patients with migraine with aura, 3215 patients with migraine without aura, and 176,107 controls individuals without migraine.

Disclosures: This study was supported by grants from the National Natural Science Foundation of China and the Fundamental Research Funds for the Central Universities. The authors declared no conflicts of interest.

Source: Lv H, Liu K, Xie Y et al. No causal association between allergic rhinitis and migraine: A Mendelian randomization study. Eur J Med Res. 2024;29:78. doi: 10.1186/s40001-024-01682-1 Source

and migraine or its subtypes, and vice versa.

Major finding: Genetic predispositions to AR were not casually associated with a higher risk for migraine (odds ratio [OR] 0.816; P = .394), both with aura (OR 0.690; P = .384) and without aura (OR 1.022; P = .954). Reciprocally, genetic predispositions to migraine or its subtypes showed no casual association with AR.

Study details: This two-sample Mendelian randomization analysis included 25,486 patients with AR and 87,907 control individuals without AR along with 3541 patients with migraine with aura, 3215 patients with migraine without aura, and 176,107 controls individuals without migraine.

Disclosures: This study was supported by grants from the National Natural Science Foundation of China and the Fundamental Research Funds for the Central Universities. The authors declared no conflicts of interest.

Source: Lv H, Liu K, Xie Y et al. No causal association between allergic rhinitis and migraine: A Mendelian randomization study. Eur J Med Res. 2024;29:78. doi: 10.1186/s40001-024-01682-1 Source

and migraine or its subtypes, and vice versa.

Major finding: Genetic predispositions to AR were not casually associated with a higher risk for migraine (odds ratio [OR] 0.816; P = .394), both with aura (OR 0.690; P = .384) and without aura (OR 1.022; P = .954). Reciprocally, genetic predispositions to migraine or its subtypes showed no casual association with AR.

Study details: This two-sample Mendelian randomization analysis included 25,486 patients with AR and 87,907 control individuals without AR along with 3541 patients with migraine with aura, 3215 patients with migraine without aura, and 176,107 controls individuals without migraine.

Disclosures: This study was supported by grants from the National Natural Science Foundation of China and the Fundamental Research Funds for the Central Universities. The authors declared no conflicts of interest.

Source: Lv H, Liu K, Xie Y et al. No causal association between allergic rhinitis and migraine: A Mendelian randomization study. Eur J Med Res. 2024;29:78. doi: 10.1186/s40001-024-01682-1 Source

Key clinical point: Resuming anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) therapy was beneficial in patients with migraine who had responded to this treatment previously but relapsed upon discontinuation.

Major finding: The median monthly headache days (MHD) improved from 16 in the month before antibody reintroduction to 8 after 3 months of treatment re-introduction. The majority of patients achieved 30% reduction in MHD (75.3%) and monthly migraine days (80.8%) during the second treatment period with anti-CGRP mAb.

Study details: This observational prospective analytical multicentric study included 360 patients with migraine who had shown prior response to anti-CGRP mAb, with clinical worsening after withdrawal and were re-introduced anti-CGRP mAb therapy.

Disclosures: This study was funded by the Instituto de Salud Carlos III, European Union, and  Fondo Europeo de Desarrollo Regional (FEDER) funds. Several authors declared receiving speaker honoraria, payments or honoraria for lectures, or research support or grants from various sources.

Source: Romero Del Rincón C, Gonzalez-Martinez A, Quintas S et al. RE-START: Exploring the effectiveness of anti-calcitonin gene-related peptide resumption after discontinuation in migraine. Eur J Neurol. 2024 (Jan 25). doi: 10.1111/ene.16203 Source

Key clinical point: Resuming anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) therapy was beneficial in patients with migraine who had responded to this treatment previously but relapsed upon discontinuation.

Major finding: The median monthly headache days (MHD) improved from 16 in the month before antibody reintroduction to 8 after 3 months of treatment re-introduction. The majority of patients achieved 30% reduction in MHD (75.3%) and monthly migraine days (80.8%) during the second treatment period with anti-CGRP mAb.

Study details: This observational prospective analytical multicentric study included 360 patients with migraine who had shown prior response to anti-CGRP mAb, with clinical worsening after withdrawal and were re-introduced anti-CGRP mAb therapy.

Disclosures: This study was funded by the Instituto de Salud Carlos III, European Union, and  Fondo Europeo de Desarrollo Regional (FEDER) funds. Several authors declared receiving speaker honoraria, payments or honoraria for lectures, or research support or grants from various sources.

Source: Romero Del Rincón C, Gonzalez-Martinez A, Quintas S et al. RE-START: Exploring the effectiveness of anti-calcitonin gene-related peptide resumption after discontinuation in migraine. Eur J Neurol. 2024 (Jan 25). doi: 10.1111/ene.16203 Source

Key clinical point: Resuming anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) therapy was beneficial in patients with migraine who had responded to this treatment previously but relapsed upon discontinuation.

Major finding: The median monthly headache days (MHD) improved from 16 in the month before antibody reintroduction to 8 after 3 months of treatment re-introduction. The majority of patients achieved 30% reduction in MHD (75.3%) and monthly migraine days (80.8%) during the second treatment period with anti-CGRP mAb.

Study details: This observational prospective analytical multicentric study included 360 patients with migraine who had shown prior response to anti-CGRP mAb, with clinical worsening after withdrawal and were re-introduced anti-CGRP mAb therapy.

Disclosures: This study was funded by the Instituto de Salud Carlos III, European Union, and  Fondo Europeo de Desarrollo Regional (FEDER) funds. Several authors declared receiving speaker honoraria, payments or honoraria for lectures, or research support or grants from various sources.

Source: Romero Del Rincón C, Gonzalez-Martinez A, Quintas S et al. RE-START: Exploring the effectiveness of anti-calcitonin gene-related peptide resumption after discontinuation in migraine. Eur J Neurol. 2024 (Jan 25). doi: 10.1111/ene.16203 Source

Key clinical point: Body mass index (BMI) was positively correlated with an increased risk for severe headache or migraine, with the association being further increased in patients with diabetes and high BMI.

Major finding: BMI was positively associated with a higher risk for migraine (adjusted odds ratio [aOR] 1.02; P < .001), with participants in the highest (≥30.0 kg/m²) vs lowest (<25.0 kg/m²) BMI groups reporting an increased risk for migraine (aOR 1.30; P = .0022). The positive association between BMI and migraine was further strengthened in patients with diabetes, who had BMI ≥ 29.71 kg/m² (aOR 1.30; P = . 003).

Study details: This cross-sectional study included 10,074 participants, of whom 2004 had migraine and 1020 had diabetes.

Disclosures: This work was supported by the National Natural Science Foundation of China and Jiangxi Province, Jiangxi Provincial Department of Education Science and Technology Program Project, and Jiangxi Province Postgraduate Innovation Special Fund. The authors declared no competing interests.

Source: Tian S, Cheng Z, Zheng H et al. Interaction between diabetes and body mass index on severe headache or migraine in adults: A cross-sectional study. BMC Geriatr. 2024;24:76. doi: 10.1186/s12877-024-04657-3 Source

Key clinical point: Body mass index (BMI) was positively correlated with an increased risk for severe headache or migraine, with the association being further increased in patients with diabetes and high BMI.

Major finding: BMI was positively associated with a higher risk for migraine (adjusted odds ratio [aOR] 1.02; P < .001), with participants in the highest (≥30.0 kg/m²) vs lowest (<25.0 kg/m²) BMI groups reporting an increased risk for migraine (aOR 1.30; P = .0022). The positive association between BMI and migraine was further strengthened in patients with diabetes, who had BMI ≥ 29.71 kg/m² (aOR 1.30; P = . 003).

Study details: This cross-sectional study included 10,074 participants, of whom 2004 had migraine and 1020 had diabetes.

Disclosures: This work was supported by the National Natural Science Foundation of China and Jiangxi Province, Jiangxi Provincial Department of Education Science and Technology Program Project, and Jiangxi Province Postgraduate Innovation Special Fund. The authors declared no competing interests.

Source: Tian S, Cheng Z, Zheng H et al. Interaction between diabetes and body mass index on severe headache or migraine in adults: A cross-sectional study. BMC Geriatr. 2024;24:76. doi: 10.1186/s12877-024-04657-3 Source

Key clinical point: Body mass index (BMI) was positively correlated with an increased risk for severe headache or migraine, with the association being further increased in patients with diabetes and high BMI.

Major finding: BMI was positively associated with a higher risk for migraine (adjusted odds ratio [aOR] 1.02; P < .001), with participants in the highest (≥30.0 kg/m²) vs lowest (<25.0 kg/m²) BMI groups reporting an increased risk for migraine (aOR 1.30; P = .0022). The positive association between BMI and migraine was further strengthened in patients with diabetes, who had BMI ≥ 29.71 kg/m² (aOR 1.30; P = . 003).

Study details: This cross-sectional study included 10,074 participants, of whom 2004 had migraine and 1020 had diabetes.

Disclosures: This work was supported by the National Natural Science Foundation of China and Jiangxi Province, Jiangxi Provincial Department of Education Science and Technology Program Project, and Jiangxi Province Postgraduate Innovation Special Fund. The authors declared no competing interests.

Source: Tian S, Cheng Z, Zheng H et al. Interaction between diabetes and body mass index on severe headache or migraine in adults: A cross-sectional study. BMC Geriatr. 2024;24:76. doi: 10.1186/s12877-024-04657-3 Source

Key clinical point: Eptinezumab vs placebo led to a greater reduction in migraine frequency and an improvement in migraine response in patients with migraine, irrespective of the type of prior treatment failure.

Major finding: Across weeks 1-12, patients receiving eptinezumab vs placebo experienced greater reductions in monthly migraine days (MMD) from baseline in all subgroups, with even greater improvements at weeks 13-24 (all P < .0001). Migraine responder rates (≥50% reduction in MMD) were also higher with eptinezumab vs placebo and increased following a second infusion (all P < .0001).

Study details: Findings are from a post hoc analysis of the DELIVER trial that included 890 patients with migraine who were randomly assigned to receive either 100 mg or 300 mg eptinezumab or placebo.

Disclosures: The study was sponsored and funded by H. Lundbeck A/S. Several authors declared receiving personal fees, research support, or research funding from various sources. Four authors declared being full-time employees of or holding stocks in Lundbeck or one of its subsidiary companies.

Source: Pozo-Rosich P, Ashina M, Tepper SJ et al. Eptinezumab demonstrated efficacy regardless of prior preventive migraine treatment failure type: Post hoc analyses of the DELIVER study. Neurol Ther. 2024 (Jan 18). doi: 10.1007/s40120-023-00575-5  Source

Key clinical point: Eptinezumab vs placebo led to a greater reduction in migraine frequency and an improvement in migraine response in patients with migraine, irrespective of the type of prior treatment failure.

Major finding: Across weeks 1-12, patients receiving eptinezumab vs placebo experienced greater reductions in monthly migraine days (MMD) from baseline in all subgroups, with even greater improvements at weeks 13-24 (all P < .0001). Migraine responder rates (≥50% reduction in MMD) were also higher with eptinezumab vs placebo and increased following a second infusion (all P < .0001).

Study details: Findings are from a post hoc analysis of the DELIVER trial that included 890 patients with migraine who were randomly assigned to receive either 100 mg or 300 mg eptinezumab or placebo.

Disclosures: The study was sponsored and funded by H. Lundbeck A/S. Several authors declared receiving personal fees, research support, or research funding from various sources. Four authors declared being full-time employees of or holding stocks in Lundbeck or one of its subsidiary companies.

Source: Pozo-Rosich P, Ashina M, Tepper SJ et al. Eptinezumab demonstrated efficacy regardless of prior preventive migraine treatment failure type: Post hoc analyses of the DELIVER study. Neurol Ther. 2024 (Jan 18). doi: 10.1007/s40120-023-00575-5  Source

Key clinical point: Eptinezumab vs placebo led to a greater reduction in migraine frequency and an improvement in migraine response in patients with migraine, irrespective of the type of prior treatment failure.

Major finding: Across weeks 1-12, patients receiving eptinezumab vs placebo experienced greater reductions in monthly migraine days (MMD) from baseline in all subgroups, with even greater improvements at weeks 13-24 (all P < .0001). Migraine responder rates (≥50% reduction in MMD) were also higher with eptinezumab vs placebo and increased following a second infusion (all P < .0001).

Study details: Findings are from a post hoc analysis of the DELIVER trial that included 890 patients with migraine who were randomly assigned to receive either 100 mg or 300 mg eptinezumab or placebo.

Disclosures: The study was sponsored and funded by H. Lundbeck A/S. Several authors declared receiving personal fees, research support, or research funding from various sources. Four authors declared being full-time employees of or holding stocks in Lundbeck or one of its subsidiary companies.

Source: Pozo-Rosich P, Ashina M, Tepper SJ et al. Eptinezumab demonstrated efficacy regardless of prior preventive migraine treatment failure type: Post hoc analyses of the DELIVER study. Neurol Ther. 2024 (Jan 18). doi: 10.1007/s40120-023-00575-5  Source

Key clinical point: Patients diagnosed with migraine should be monitored for the potential onset of inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC); particularly, men with migraine may require increased monitoring for the development of UC.

Major finding: Patients with migraine had a higher risk for IBD (adjusted hazard ratio [aHR] 1.31; P < .0001), CD (aHR 1.58; P = .0002), and UC (aHR 1.26; P = .0004) than those without migraine. Presence of migraine increased the risk for UC more prominently in men (aHR 1.43; 95% CI 1.20-1.71) than in women (aHR 1.12; 95% CI 0.94-1.34; P_interaction = .042).

Study details: The data come from a nationwide population-based cohort study that included 10,131,193 individuals who had undergone a national health examination conducted by the Korean National Health Insurance Service in 2009, of which 281,144 patients had migraine.

Disclosures: This study did not disclose the funding source. The authors declared no competing interests.

Source: Lee CH, Han K, Lee HJ et al. Migraine is associated with the development of adult patients with inflammatory bowel disease: A nationwide, population-based study. Sci Rep. 2024;14:1157 (Jan 12).  doi: 10.1038/s41598-024-51455-3  Source.

Key clinical point: Patients diagnosed with migraine should be monitored for the potential onset of inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC); particularly, men with migraine may require increased monitoring for the development of UC.

Major finding: Patients with migraine had a higher risk for IBD (adjusted hazard ratio [aHR] 1.31; P < .0001), CD (aHR 1.58; P = .0002), and UC (aHR 1.26; P = .0004) than those without migraine. Presence of migraine increased the risk for UC more prominently in men (aHR 1.43; 95% CI 1.20-1.71) than in women (aHR 1.12; 95% CI 0.94-1.34; P_interaction = .042).

Study details: The data come from a nationwide population-based cohort study that included 10,131,193 individuals who had undergone a national health examination conducted by the Korean National Health Insurance Service in 2009, of which 281,144 patients had migraine.

Disclosures: This study did not disclose the funding source. The authors declared no competing interests.

Source: Lee CH, Han K, Lee HJ et al. Migraine is associated with the development of adult patients with inflammatory bowel disease: A nationwide, population-based study. Sci Rep. 2024;14:1157 (Jan 12).  doi: 10.1038/s41598-024-51455-3  Source.

Key clinical point: Patients diagnosed with migraine should be monitored for the potential onset of inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC); particularly, men with migraine may require increased monitoring for the development of UC.

Major finding: Patients with migraine had a higher risk for IBD (adjusted hazard ratio [aHR] 1.31; P < .0001), CD (aHR 1.58; P = .0002), and UC (aHR 1.26; P = .0004) than those without migraine. Presence of migraine increased the risk for UC more prominently in men (aHR 1.43; 95% CI 1.20-1.71) than in women (aHR 1.12; 95% CI 0.94-1.34; P_interaction = .042).

Study details: The data come from a nationwide population-based cohort study that included 10,131,193 individuals who had undergone a national health examination conducted by the Korean National Health Insurance Service in 2009, of which 281,144 patients had migraine.

Disclosures: This study did not disclose the funding source. The authors declared no competing interests.

Source: Lee CH, Han K, Lee HJ et al. Migraine is associated with the development of adult patients with inflammatory bowel disease: A nationwide, population-based study. Sci Rep. 2024;14:1157 (Jan 12).  doi: 10.1038/s41598-024-51455-3  Source.

Key clinical point: Patients with chronic migraine may be informed that they should not expect a consistent wearing-off effect when being treated with erenumab or fremanezumab as anxiety regarding attacks toward the end of the month may potentially trigger further migraine episodes.

Major finding: Overall, 62% of patients treated with erenumab and fremanezumab achieved a consistent ≥30% reduction in migraine days over 2 consecutive months (≥30% responders), with no consistent wearing-off effect (ie, an increase of ≥2 weekly migraine days from week 2 to 4 over 2 consecutive treatment months) in the erenumab (P = .194) and fremanezumab (P = .581) groups. Among ≥30% responders, there was no significant wearing-off effect from week 2 to 4 over 2 consecutive months (1.43 vs 1.52 days; P = .573).

Study details: This single-center, real-world, observational study included 100 patients with chronic migraine (age ≥ 18 years) who received either erenumab (n = 60) or fremanezumab (n = 40).

Disclosures: This study was supported by Lundbeck Foundation. Two authors declared receiving personal fees or honoraria from or serving on advisory boards for various sources.

Source: Florescu AM, Lannov LV, Younis S et al. No wearing-off effect of erenumab or fremanezumab for chronic migraine prevention: A single-center, real-world, observational study. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231222 Source.

Key clinical point: Patients with chronic migraine may be informed that they should not expect a consistent wearing-off effect when being treated with erenumab or fremanezumab as anxiety regarding attacks toward the end of the month may potentially trigger further migraine episodes.

Major finding: Overall, 62% of patients treated with erenumab and fremanezumab achieved a consistent ≥30% reduction in migraine days over 2 consecutive months (≥30% responders), with no consistent wearing-off effect (ie, an increase of ≥2 weekly migraine days from week 2 to 4 over 2 consecutive treatment months) in the erenumab (P = .194) and fremanezumab (P = .581) groups. Among ≥30% responders, there was no significant wearing-off effect from week 2 to 4 over 2 consecutive months (1.43 vs 1.52 days; P = .573).

Study details: This single-center, real-world, observational study included 100 patients with chronic migraine (age ≥ 18 years) who received either erenumab (n = 60) or fremanezumab (n = 40).

Disclosures: This study was supported by Lundbeck Foundation. Two authors declared receiving personal fees or honoraria from or serving on advisory boards for various sources.

Source: Florescu AM, Lannov LV, Younis S et al. No wearing-off effect of erenumab or fremanezumab for chronic migraine prevention: A single-center, real-world, observational study. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231222 Source.

Key clinical point: Patients with chronic migraine may be informed that they should not expect a consistent wearing-off effect when being treated with erenumab or fremanezumab as anxiety regarding attacks toward the end of the month may potentially trigger further migraine episodes.

Major finding: Overall, 62% of patients treated with erenumab and fremanezumab achieved a consistent ≥30% reduction in migraine days over 2 consecutive months (≥30% responders), with no consistent wearing-off effect (ie, an increase of ≥2 weekly migraine days from week 2 to 4 over 2 consecutive treatment months) in the erenumab (P = .194) and fremanezumab (P = .581) groups. Among ≥30% responders, there was no significant wearing-off effect from week 2 to 4 over 2 consecutive months (1.43 vs 1.52 days; P = .573).

Study details: This single-center, real-world, observational study included 100 patients with chronic migraine (age ≥ 18 years) who received either erenumab (n = 60) or fremanezumab (n = 40).

Disclosures: This study was supported by Lundbeck Foundation. Two authors declared receiving personal fees or honoraria from or serving on advisory boards for various sources.

Source: Florescu AM, Lannov LV, Younis S et al. No wearing-off effect of erenumab or fremanezumab for chronic migraine prevention: A single-center, real-world, observational study. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231222 Source.

Key clinical point: Women who had menarche at older age had a lower risk for migraine, whereas those who used oral contraceptives and those who had children had a higher risk for migraine.

Major finding: Older age at menarche decreased migraine risk (adjusted hazard ratio [aHR] 0.96; 95% CI 0.95-0.98), whereas oral contraceptive use (aHR 1.12; 95% CI 1.06-1.18) and having children (aHR 1.37; 95% CI 1.29-1.46) increased migraine risk.

Study details: This study evaluated the data of 62,959 women (age 30-70 years) from the Norwegian Women and Cancer Study, of whom 15,635 (24.8%) had migraine.

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

Source: Bugge NS, Grøtta Vetvik K, Alstadhaug KB, Braaten T et al. Cumulative exposure to estrogen may increase the risk of migraine in women. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231225 Source.

Key clinical point: Women who had menarche at older age had a lower risk for migraine, whereas those who used oral contraceptives and those who had children had a higher risk for migraine.

Major finding: Older age at menarche decreased migraine risk (adjusted hazard ratio [aHR] 0.96; 95% CI 0.95-0.98), whereas oral contraceptive use (aHR 1.12; 95% CI 1.06-1.18) and having children (aHR 1.37; 95% CI 1.29-1.46) increased migraine risk.

Study details: This study evaluated the data of 62,959 women (age 30-70 years) from the Norwegian Women and Cancer Study, of whom 15,635 (24.8%) had migraine.

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

Source: Bugge NS, Grøtta Vetvik K, Alstadhaug KB, Braaten T et al. Cumulative exposure to estrogen may increase the risk of migraine in women. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231225 Source.

Key clinical point: Women who had menarche at older age had a lower risk for migraine, whereas those who used oral contraceptives and those who had children had a higher risk for migraine.

Major finding: Older age at menarche decreased migraine risk (adjusted hazard ratio [aHR] 0.96; 95% CI 0.95-0.98), whereas oral contraceptive use (aHR 1.12; 95% CI 1.06-1.18) and having children (aHR 1.37; 95% CI 1.29-1.46) increased migraine risk.

Study details: This study evaluated the data of 62,959 women (age 30-70 years) from the Norwegian Women and Cancer Study, of whom 15,635 (24.8%) had migraine.

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

Source: Bugge NS, Grøtta Vetvik K, Alstadhaug KB, Braaten T et al. Cumulative exposure to estrogen may increase the risk of migraine in women. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231225 Source.

I can’t remember where I heard it. Maybe I made it up myself. But, one definition of a family is a group of folks with whom you share your genes and germs. In that same vein, one could define daycare as a group of germ-sharing children. Of course that’s news to almost no one. Parents who decide, or are forced, to send their children to daycare expect that those children will get more colds, “stomach flu,” and ear infections than the children who spend their days in isolation at home. Everyone from the pediatrician to the little old lady next door has warned parents of the inevitable reality of daycare. Of course there are upsides that parents can cling to, including increased socialization and the hope that getting sick young will build a more robust immunity in the long run.

However, there has been little research exploring the nuances of the germ sharing that we all know is happening in these and other social settings.

A team of evolutionary biologists at Harvard is working to better define the “social microbiome” and its “role in individuals’ susceptibility to, and resilience against, both communicable and noncommunicable diseases.” These researchers point out that while we harbor our own unique collection of microbes, we share those with the microbiomes of the people with whom we interact socially. They report that studies by other investigators have shown that residents of a household share a significant proportion of their gastrointestinal flora. There are other studies that have shown that villages can be identified by their own social biome. There are few social settings more intimately involved in microbe sharing than daycares. I have a friends who calls them “petri dishes.”

The biologists point out that antibiotic-resistant microbes can become part of an individual’s microbiome and can be shared with other individuals in their social group, who can then go on and share them in a different social environment. Imagine there is one popular physician in a community whose sense of antibiotic stewardship is, shall we say, somewhat lacking. By inappropriately prescribing antibiotics to a child or two in a daycare, he may be altering the social biome in that daycare, which could then jeopardize the health of all the children and eventually their own home-based social biomes, that may include an immune deficient individual.

The researchers also remind us that different cultures and countries may have different antibiotic usage patterns. Does this mean I am taking a risk by traveling in these “culture-dependent transmission landscapes”? Am I more likely to encounter an antibiotic-resistant microbe when I am visiting a country whose healthcare providers are less prudent prescribers?

However, as these evolutionary biologists point out, not all shared microbes are bad. There is some evidence in animals that individuals can share microbes that have been found to “increase resilience against colitis or improve their responsiveness to cancer therapy.” If a microbe can contribute to a disease that was once considered to be “noncommunicable,” we may need to redefine “communicable” in the light this more nuanced view of the social biome.

It became standard practice during the COVID pandemic to test dormitory and community sewage water to determine the level of infection. Can sewage water be used as a proxy for a social biome? If a parent is lucky enough to have a choice of daycares, would knowing each facility’s biome, as reflected in an analysis of its sewage effluent, help him or her decide? Should a daycare ask for a stool sample from each child before accepting him or her? Seems like this would raise some privacy issues, not to mention the logistical messiness of the process. As we learn more about social biomes, can we imagine a time when a daycare or country or region might proudly advertise itself as having the healthiest spectrum of microbes in its sewage system?

Communal living certainly has its benefits, not just for children but also adults as we realize how loneliness is eating its way into our society. However, living in close social contact means that, for better or worse, we will be reconfiguring our own personal biomes thanks to the inevitable gifts from our cohabitants.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].

I can’t remember where I heard it. Maybe I made it up myself. But, one definition of a family is a group of folks with whom you share your genes and germs. In that same vein, one could define daycare as a group of germ-sharing children. Of course that’s news to almost no one. Parents who decide, or are forced, to send their children to daycare expect that those children will get more colds, “stomach flu,” and ear infections than the children who spend their days in isolation at home. Everyone from the pediatrician to the little old lady next door has warned parents of the inevitable reality of daycare. Of course there are upsides that parents can cling to, including increased socialization and the hope that getting sick young will build a more robust immunity in the long run.

However, there has been little research exploring the nuances of the germ sharing that we all know is happening in these and other social settings.

A team of evolutionary biologists at Harvard is working to better define the “social microbiome” and its “role in individuals’ susceptibility to, and resilience against, both communicable and noncommunicable diseases.” These researchers point out that while we harbor our own unique collection of microbes, we share those with the microbiomes of the people with whom we interact socially. They report that studies by other investigators have shown that residents of a household share a significant proportion of their gastrointestinal flora. There are other studies that have shown that villages can be identified by their own social biome. There are few social settings more intimately involved in microbe sharing than daycares. I have a friends who calls them “petri dishes.”

The biologists point out that antibiotic-resistant microbes can become part of an individual’s microbiome and can be shared with other individuals in their social group, who can then go on and share them in a different social environment. Imagine there is one popular physician in a community whose sense of antibiotic stewardship is, shall we say, somewhat lacking. By inappropriately prescribing antibiotics to a child or two in a daycare, he may be altering the social biome in that daycare, which could then jeopardize the health of all the children and eventually their own home-based social biomes, that may include an immune deficient individual.

The researchers also remind us that different cultures and countries may have different antibiotic usage patterns. Does this mean I am taking a risk by traveling in these “culture-dependent transmission landscapes”? Am I more likely to encounter an antibiotic-resistant microbe when I am visiting a country whose healthcare providers are less prudent prescribers?

However, as these evolutionary biologists point out, not all shared microbes are bad. There is some evidence in animals that individuals can share microbes that have been found to “increase resilience against colitis or improve their responsiveness to cancer therapy.” If a microbe can contribute to a disease that was once considered to be “noncommunicable,” we may need to redefine “communicable” in the light this more nuanced view of the social biome.

It became standard practice during the COVID pandemic to test dormitory and community sewage water to determine the level of infection. Can sewage water be used as a proxy for a social biome? If a parent is lucky enough to have a choice of daycares, would knowing each facility’s biome, as reflected in an analysis of its sewage effluent, help him or her decide? Should a daycare ask for a stool sample from each child before accepting him or her? Seems like this would raise some privacy issues, not to mention the logistical messiness of the process. As we learn more about social biomes, can we imagine a time when a daycare or country or region might proudly advertise itself as having the healthiest spectrum of microbes in its sewage system?

Communal living certainly has its benefits, not just for children but also adults as we realize how loneliness is eating its way into our society. However, living in close social contact means that, for better or worse, we will be reconfiguring our own personal biomes thanks to the inevitable gifts from our cohabitants.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].

I can’t remember where I heard it. Maybe I made it up myself. But, one definition of a family is a group of folks with whom you share your genes and germs. In that same vein, one could define daycare as a group of germ-sharing children. Of course that’s news to almost no one. Parents who decide, or are forced, to send their children to daycare expect that those children will get more colds, “stomach flu,” and ear infections than the children who spend their days in isolation at home. Everyone from the pediatrician to the little old lady next door has warned parents of the inevitable reality of daycare. Of course there are upsides that parents can cling to, including increased socialization and the hope that getting sick young will build a more robust immunity in the long run.

However, there has been little research exploring the nuances of the germ sharing that we all know is happening in these and other social settings.

A team of evolutionary biologists at Harvard is working to better define the “social microbiome” and its “role in individuals’ susceptibility to, and resilience against, both communicable and noncommunicable diseases.” These researchers point out that while we harbor our own unique collection of microbes, we share those with the microbiomes of the people with whom we interact socially. They report that studies by other investigators have shown that residents of a household share a significant proportion of their gastrointestinal flora. There are other studies that have shown that villages can be identified by their own social biome. There are few social settings more intimately involved in microbe sharing than daycares. I have a friends who calls them “petri dishes.”

The biologists point out that antibiotic-resistant microbes can become part of an individual’s microbiome and can be shared with other individuals in their social group, who can then go on and share them in a different social environment. Imagine there is one popular physician in a community whose sense of antibiotic stewardship is, shall we say, somewhat lacking. By inappropriately prescribing antibiotics to a child or two in a daycare, he may be altering the social biome in that daycare, which could then jeopardize the health of all the children and eventually their own home-based social biomes, that may include an immune deficient individual.

The researchers also remind us that different cultures and countries may have different antibiotic usage patterns. Does this mean I am taking a risk by traveling in these “culture-dependent transmission landscapes”? Am I more likely to encounter an antibiotic-resistant microbe when I am visiting a country whose healthcare providers are less prudent prescribers?

However, as these evolutionary biologists point out, not all shared microbes are bad. There is some evidence in animals that individuals can share microbes that have been found to “increase resilience against colitis or improve their responsiveness to cancer therapy.” If a microbe can contribute to a disease that was once considered to be “noncommunicable,” we may need to redefine “communicable” in the light this more nuanced view of the social biome.

It became standard practice during the COVID pandemic to test dormitory and community sewage water to determine the level of infection. Can sewage water be used as a proxy for a social biome? If a parent is lucky enough to have a choice of daycares, would knowing each facility’s biome, as reflected in an analysis of its sewage effluent, help him or her decide? Should a daycare ask for a stool sample from each child before accepting him or her? Seems like this would raise some privacy issues, not to mention the logistical messiness of the process. As we learn more about social biomes, can we imagine a time when a daycare or country or region might proudly advertise itself as having the healthiest spectrum of microbes in its sewage system?

Communal living certainly has its benefits, not just for children but also adults as we realize how loneliness is eating its way into our society. However, living in close social contact means that, for better or worse, we will be reconfiguring our own personal biomes thanks to the inevitable gifts from our cohabitants.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].