AHS Annual Meeting

WASHINGTON – Noncephalic pain is associated with higher likelihood of progression from episodic migraine to chronic migraine, and pain comorbidities at noncephalic locations are common with migraine regardless of headache frequency, according to findings from the CaMEO study.

The study was presented during the poster session of the American Headache Society’s annual meeting by Dr. Ann I. Scher, deputy director and professor at the Uniformed Services University of the Health Science, Bethesda, Md.

© Dirima/Thinkstock.com

The CaMEO (Chronic Migraine Epidemiology and Outcomes) study was initiated in the fall of 2012 as a prospective, web-based study that surveyed individuals with migraine and chronic migraine using “cross-sectional modules embedded in a longitudinal design.”

The investigators used the survey’s Comorbidity/Endophenotype module to study 12,810 individuals with migraine, of whom 8,908 were randomized and completed the second assessment snapshot module 3 months after baseline.

Overall, 8,139 (91.4%) had episodic migraine and 769 (8.6%) had chronic migraine. At baseline, subjects were asked to identify noncephalic pain sites by location (head, face, neck/shoulders, back, arms/hands, legs/feet, chest, abdomen/pelvis, or other), frequency of pain (0-4 scale ranging from “never” to “always” experiencing pain), and intensity of pain (0-10 scale of “no pain” to “worst pain imaginable”).

At 3 months, the investigators followed up with patients to determine if they still had either chronic or episode migraine, and performed multivariate binary regression analysis to determine if the noncephalic pain sites were an indicator of progression from episodic to chronic migraine, based on the aforementioned factors as well as sociodemographic ones.

Subjects with episodic migraine at baseline tended to stay that way, with 278 (3.4%) progressing to chronic after 3 months. However, 385 (50.1%) of those with chronic migraine at baseline were still classified as such after 3 months, meaning nearly half went from chronic to episodic. Regression models indicated that while noncephalic pain is common for both episodic and chronic migraine, after adjustment for pain site scores and sociodemographic factors, the odds of progressing from episodic to chronic migraine increases by about 30% for each noncephalic pain site (odds ratio, 1.30; 95% confidence interval, 1.21-1.40). For those already experiencing chronic migraine, the odds of remaining that way after 3 months increase by about 6% with each noncephalic pain site (OR, 1.06, 95% CI, 0.97-1.16).

In the CaMEO study, the mean age of subjects with episodic migraine was 40.6 years versus 41.0 years for those with chronic migraine. Both cohorts were mostly female, too: 73.8% for episodic and 81.1% for chronic. Both cohorts were mostly white – 83.3% and 87.5%, respectively – while 45.9% of those with episodic and 34.9% of those with chronic migraine had at least a bachelor’s degree–level education. Sixty-six percent of those with episodic and 56.4% of those with chronic migraine held full-time employment at baseline.

The CaMEO study was sponsored by Allergan. Lead author Dr. Scher has received honoraria from Allergan and grant support from Congressionally Directed Medical Research Programs and the Center for Neuroscience and Regenerative Medicine, and is on the editorial boards of Cephalagia and Pain Medicine.

[email protected]

WASHINGTON – Noncephalic pain is associated with higher likelihood of progression from episodic migraine to chronic migraine, and pain comorbidities at noncephalic locations are common with migraine regardless of headache frequency, according to findings from the CaMEO study.

The study was presented during the poster session of the American Headache Society’s annual meeting by Dr. Ann I. Scher, deputy director and professor at the Uniformed Services University of the Health Science, Bethesda, Md.

© Dirima/Thinkstock.com

The CaMEO (Chronic Migraine Epidemiology and Outcomes) study was initiated in the fall of 2012 as a prospective, web-based study that surveyed individuals with migraine and chronic migraine using “cross-sectional modules embedded in a longitudinal design.”

The investigators used the survey’s Comorbidity/Endophenotype module to study 12,810 individuals with migraine, of whom 8,908 were randomized and completed the second assessment snapshot module 3 months after baseline.

Overall, 8,139 (91.4%) had episodic migraine and 769 (8.6%) had chronic migraine. At baseline, subjects were asked to identify noncephalic pain sites by location (head, face, neck/shoulders, back, arms/hands, legs/feet, chest, abdomen/pelvis, or other), frequency of pain (0-4 scale ranging from “never” to “always” experiencing pain), and intensity of pain (0-10 scale of “no pain” to “worst pain imaginable”).

At 3 months, the investigators followed up with patients to determine if they still had either chronic or episode migraine, and performed multivariate binary regression analysis to determine if the noncephalic pain sites were an indicator of progression from episodic to chronic migraine, based on the aforementioned factors as well as sociodemographic ones.

Subjects with episodic migraine at baseline tended to stay that way, with 278 (3.4%) progressing to chronic after 3 months. However, 385 (50.1%) of those with chronic migraine at baseline were still classified as such after 3 months, meaning nearly half went from chronic to episodic. Regression models indicated that while noncephalic pain is common for both episodic and chronic migraine, after adjustment for pain site scores and sociodemographic factors, the odds of progressing from episodic to chronic migraine increases by about 30% for each noncephalic pain site (odds ratio, 1.30; 95% confidence interval, 1.21-1.40). For those already experiencing chronic migraine, the odds of remaining that way after 3 months increase by about 6% with each noncephalic pain site (OR, 1.06, 95% CI, 0.97-1.16).

In the CaMEO study, the mean age of subjects with episodic migraine was 40.6 years versus 41.0 years for those with chronic migraine. Both cohorts were mostly female, too: 73.8% for episodic and 81.1% for chronic. Both cohorts were mostly white – 83.3% and 87.5%, respectively – while 45.9% of those with episodic and 34.9% of those with chronic migraine had at least a bachelor’s degree–level education. Sixty-six percent of those with episodic and 56.4% of those with chronic migraine held full-time employment at baseline.

The CaMEO study was sponsored by Allergan. Lead author Dr. Scher has received honoraria from Allergan and grant support from Congressionally Directed Medical Research Programs and the Center for Neuroscience and Regenerative Medicine, and is on the editorial boards of Cephalagia and Pain Medicine.

[email protected]

WASHINGTON – Noncephalic pain is associated with higher likelihood of progression from episodic migraine to chronic migraine, and pain comorbidities at noncephalic locations are common with migraine regardless of headache frequency, according to findings from the CaMEO study.

The study was presented during the poster session of the American Headache Society’s annual meeting by Dr. Ann I. Scher, deputy director and professor at the Uniformed Services University of the Health Science, Bethesda, Md.

© Dirima/Thinkstock.com

The CaMEO (Chronic Migraine Epidemiology and Outcomes) study was initiated in the fall of 2012 as a prospective, web-based study that surveyed individuals with migraine and chronic migraine using “cross-sectional modules embedded in a longitudinal design.”

The investigators used the survey’s Comorbidity/Endophenotype module to study 12,810 individuals with migraine, of whom 8,908 were randomized and completed the second assessment snapshot module 3 months after baseline.

Overall, 8,139 (91.4%) had episodic migraine and 769 (8.6%) had chronic migraine. At baseline, subjects were asked to identify noncephalic pain sites by location (head, face, neck/shoulders, back, arms/hands, legs/feet, chest, abdomen/pelvis, or other), frequency of pain (0-4 scale ranging from “never” to “always” experiencing pain), and intensity of pain (0-10 scale of “no pain” to “worst pain imaginable”).

At 3 months, the investigators followed up with patients to determine if they still had either chronic or episode migraine, and performed multivariate binary regression analysis to determine if the noncephalic pain sites were an indicator of progression from episodic to chronic migraine, based on the aforementioned factors as well as sociodemographic ones.

Subjects with episodic migraine at baseline tended to stay that way, with 278 (3.4%) progressing to chronic after 3 months. However, 385 (50.1%) of those with chronic migraine at baseline were still classified as such after 3 months, meaning nearly half went from chronic to episodic. Regression models indicated that while noncephalic pain is common for both episodic and chronic migraine, after adjustment for pain site scores and sociodemographic factors, the odds of progressing from episodic to chronic migraine increases by about 30% for each noncephalic pain site (odds ratio, 1.30; 95% confidence interval, 1.21-1.40). For those already experiencing chronic migraine, the odds of remaining that way after 3 months increase by about 6% with each noncephalic pain site (OR, 1.06, 95% CI, 0.97-1.16).

In the CaMEO study, the mean age of subjects with episodic migraine was 40.6 years versus 41.0 years for those with chronic migraine. Both cohorts were mostly female, too: 73.8% for episodic and 81.1% for chronic. Both cohorts were mostly white – 83.3% and 87.5%, respectively – while 45.9% of those with episodic and 34.9% of those with chronic migraine had at least a bachelor’s degree–level education. Sixty-six percent of those with episodic and 56.4% of those with chronic migraine held full-time employment at baseline.

The CaMEO study was sponsored by Allergan. Lead author Dr. Scher has received honoraria from Allergan and grant support from Congressionally Directed Medical Research Programs and the Center for Neuroscience and Regenerative Medicine, and is on the editorial boards of Cephalagia and Pain Medicine.

[email protected]

WASHINGTON – Lithium is the best treatment option for patients with hypnic headaches, according to a retrospective, cross-sectional study presented by Dr. Nauman Tariq of the Cleveland Clinic at the annual meeting of the American Headache Society.

The study, which looked at a series of 40 patients, is the largest to date from a single institution and examined treatment of hypnic headache, defined as a primary headache disorder characterized by onset during sleep that causes waking.

Seven patients were excluded for having active chronic migraine, and one who was taking lithium was excluded after developing renal side effects. Dr. Tariq and his associates studied the efficacy of 13 different treatments on the 32 remaining patients, between October 2008 and September 2014 using ICD-9 codes and the International Classification of Headache Disorders II and III–beta criteria for diagnosis.

Lithium had the highest positive response rate of all treatments, with 70% of study subjects experiencing complete response and 20% experiencing moderate response, defined as more than a 50% improvement in the frequency and intensity of hypnic headache episodes.

The researchers reported that the second-best treatment option was caffeine taken before bedtime, which induced complete response in 29% of subjects and moderate response in 33% of subjects. Dr. Tariq also stated that consuming caffeine upon awakening can also help alleviate symptoms. One patient on the lithium regimen was removed from the study after experiencing renal side effects.

Of the 32 patients included in the study, 86% were women, with a mean headache onset age of 62 years and a range of 44 to 83 years of age. More than half (59%) of subjects had a previous history of migraine prior to the study, and 90% experienced hypnic headaches between 1:00 a.m. and 5:00 a.m. Mean duration of these episodes was 193 minutes – with a range of 45-720 minutes. The mean number of days per month subjects were awakened due to hypnic headache was 21 days, with 20% of subjects experiencing headaches lasting longer than 4 hours.

Dr. Tariq did not report any relevant financial disclosures.

[email protected]

WASHINGTON – Lithium is the best treatment option for patients with hypnic headaches, according to a retrospective, cross-sectional study presented by Dr. Nauman Tariq of the Cleveland Clinic at the annual meeting of the American Headache Society.

The study, which looked at a series of 40 patients, is the largest to date from a single institution and examined treatment of hypnic headache, defined as a primary headache disorder characterized by onset during sleep that causes waking.

Seven patients were excluded for having active chronic migraine, and one who was taking lithium was excluded after developing renal side effects. Dr. Tariq and his associates studied the efficacy of 13 different treatments on the 32 remaining patients, between October 2008 and September 2014 using ICD-9 codes and the International Classification of Headache Disorders II and III–beta criteria for diagnosis.

Lithium had the highest positive response rate of all treatments, with 70% of study subjects experiencing complete response and 20% experiencing moderate response, defined as more than a 50% improvement in the frequency and intensity of hypnic headache episodes.

The researchers reported that the second-best treatment option was caffeine taken before bedtime, which induced complete response in 29% of subjects and moderate response in 33% of subjects. Dr. Tariq also stated that consuming caffeine upon awakening can also help alleviate symptoms. One patient on the lithium regimen was removed from the study after experiencing renal side effects.

Of the 32 patients included in the study, 86% were women, with a mean headache onset age of 62 years and a range of 44 to 83 years of age. More than half (59%) of subjects had a previous history of migraine prior to the study, and 90% experienced hypnic headaches between 1:00 a.m. and 5:00 a.m. Mean duration of these episodes was 193 minutes – with a range of 45-720 minutes. The mean number of days per month subjects were awakened due to hypnic headache was 21 days, with 20% of subjects experiencing headaches lasting longer than 4 hours.

Dr. Tariq did not report any relevant financial disclosures.

[email protected]

WASHINGTON – Lithium is the best treatment option for patients with hypnic headaches, according to a retrospective, cross-sectional study presented by Dr. Nauman Tariq of the Cleveland Clinic at the annual meeting of the American Headache Society.

The study, which looked at a series of 40 patients, is the largest to date from a single institution and examined treatment of hypnic headache, defined as a primary headache disorder characterized by onset during sleep that causes waking.

Seven patients were excluded for having active chronic migraine, and one who was taking lithium was excluded after developing renal side effects. Dr. Tariq and his associates studied the efficacy of 13 different treatments on the 32 remaining patients, between October 2008 and September 2014 using ICD-9 codes and the International Classification of Headache Disorders II and III–beta criteria for diagnosis.

Lithium had the highest positive response rate of all treatments, with 70% of study subjects experiencing complete response and 20% experiencing moderate response, defined as more than a 50% improvement in the frequency and intensity of hypnic headache episodes.

The researchers reported that the second-best treatment option was caffeine taken before bedtime, which induced complete response in 29% of subjects and moderate response in 33% of subjects. Dr. Tariq also stated that consuming caffeine upon awakening can also help alleviate symptoms. One patient on the lithium regimen was removed from the study after experiencing renal side effects.

Of the 32 patients included in the study, 86% were women, with a mean headache onset age of 62 years and a range of 44 to 83 years of age. More than half (59%) of subjects had a previous history of migraine prior to the study, and 90% experienced hypnic headaches between 1:00 a.m. and 5:00 a.m. Mean duration of these episodes was 193 minutes – with a range of 45-720 minutes. The mean number of days per month subjects were awakened due to hypnic headache was 21 days, with 20% of subjects experiencing headaches lasting longer than 4 hours.

Dr. Tariq did not report any relevant financial disclosures.

[email protected]

WASHINGTON – AMG 334, a fully human monoclonal antibody that blocks the calcitonin gene-related peptide (CGRP) receptor, is an effective treatment for episodic migraine when administered in 70-mg doses, Dr. Robert Lenz of Amgen said at the annual meeting of the American Headache Society.

The researchers randomized 483 patients with episodic migraine – characterized as experiencing at least 4 and no more than 14 migraines per month – into cohorts receiving a 70-mg dose (107 subjects), a 21-mg dose (108 patients), a 7-mg dose (108 patients), or a placebo (160 subjects). The primary endpoint measure was a reduction in the number of migraine episodes from baseline to 12 weeks. Secondary endpoints were overall reduction in migraine episodes per month, the number of patients who experienced an episode reduction of at least 50%, and safety/tolerability factors. Women comprised 81% of the study population, and mean age was 41 years.

Christopher Robbins/ThinkStock

Patients on the 70-mg dosage of AMG 334 had a mean reduction of 3.40 migraine days per month, versus the 2.28 mean migraine-days reduction observed in the placebo cohort (P = .021). In secondary outcomes, 46.5% of patients taking 70 mg of AMG 334 experienced an episode reduction per month of at least 50%, compared with only 29.9% in the placebo cohort (P = .011); reductions were also seen in monthly headache days (3.54 in 70-mg cohort vs. 2.39 in placebo cohort, P = .022) and monthly migraine specific–medication use days (1.64 in 70-mg cohort vs. 0.69 in placebo cohort, P = .004).

There were no significant differences in the safety and tolerability data between the AMG 334 70-mg patients and those taking the placebo. Subjects in the cohorts receiving 7-mg and 21-mg doses of AMG 334 did not experience a statistically significant reduction in mean migraine days.

Dr. Lenz is employed by Amgen and receives a salary, stock options, and ownership interests.

[email protected]

WASHINGTON – AMG 334, a fully human monoclonal antibody that blocks the calcitonin gene-related peptide (CGRP) receptor, is an effective treatment for episodic migraine when administered in 70-mg doses, Dr. Robert Lenz of Amgen said at the annual meeting of the American Headache Society.

The researchers randomized 483 patients with episodic migraine – characterized as experiencing at least 4 and no more than 14 migraines per month – into cohorts receiving a 70-mg dose (107 subjects), a 21-mg dose (108 patients), a 7-mg dose (108 patients), or a placebo (160 subjects). The primary endpoint measure was a reduction in the number of migraine episodes from baseline to 12 weeks. Secondary endpoints were overall reduction in migraine episodes per month, the number of patients who experienced an episode reduction of at least 50%, and safety/tolerability factors. Women comprised 81% of the study population, and mean age was 41 years.

Christopher Robbins/ThinkStock

Patients on the 70-mg dosage of AMG 334 had a mean reduction of 3.40 migraine days per month, versus the 2.28 mean migraine-days reduction observed in the placebo cohort (P = .021). In secondary outcomes, 46.5% of patients taking 70 mg of AMG 334 experienced an episode reduction per month of at least 50%, compared with only 29.9% in the placebo cohort (P = .011); reductions were also seen in monthly headache days (3.54 in 70-mg cohort vs. 2.39 in placebo cohort, P = .022) and monthly migraine specific–medication use days (1.64 in 70-mg cohort vs. 0.69 in placebo cohort, P = .004).

There were no significant differences in the safety and tolerability data between the AMG 334 70-mg patients and those taking the placebo. Subjects in the cohorts receiving 7-mg and 21-mg doses of AMG 334 did not experience a statistically significant reduction in mean migraine days.

Dr. Lenz is employed by Amgen and receives a salary, stock options, and ownership interests.

[email protected]

WASHINGTON – AMG 334, a fully human monoclonal antibody that blocks the calcitonin gene-related peptide (CGRP) receptor, is an effective treatment for episodic migraine when administered in 70-mg doses, Dr. Robert Lenz of Amgen said at the annual meeting of the American Headache Society.

The researchers randomized 483 patients with episodic migraine – characterized as experiencing at least 4 and no more than 14 migraines per month – into cohorts receiving a 70-mg dose (107 subjects), a 21-mg dose (108 patients), a 7-mg dose (108 patients), or a placebo (160 subjects). The primary endpoint measure was a reduction in the number of migraine episodes from baseline to 12 weeks. Secondary endpoints were overall reduction in migraine episodes per month, the number of patients who experienced an episode reduction of at least 50%, and safety/tolerability factors. Women comprised 81% of the study population, and mean age was 41 years.

Christopher Robbins/ThinkStock

Patients on the 70-mg dosage of AMG 334 had a mean reduction of 3.40 migraine days per month, versus the 2.28 mean migraine-days reduction observed in the placebo cohort (P = .021). In secondary outcomes, 46.5% of patients taking 70 mg of AMG 334 experienced an episode reduction per month of at least 50%, compared with only 29.9% in the placebo cohort (P = .011); reductions were also seen in monthly headache days (3.54 in 70-mg cohort vs. 2.39 in placebo cohort, P = .022) and monthly migraine specific–medication use days (1.64 in 70-mg cohort vs. 0.69 in placebo cohort, P = .004).

There were no significant differences in the safety and tolerability data between the AMG 334 70-mg patients and those taking the placebo. Subjects in the cohorts receiving 7-mg and 21-mg doses of AMG 334 did not experience a statistically significant reduction in mean migraine days.

Dr. Lenz is employed by Amgen and receives a salary, stock options, and ownership interests.

[email protected]

WASHINGTON – Intravenous diphenhydramine is not an effective adjuvant therapy for the treatment of acute migraine, according to a study presented by Dr. Ben Friedman at the annual meeting of the American Headache Society.

Dr. Friedman of the department of emergency medicine at Albert Einstein College of Medicine in New York explained that no high-quality evidence exists to support or refute the role of antihistamines in the treatment of acute migraine. Therefore, the purpose of Dr. Friedman’s investigation was to confirm that acute migraine, of either moderate or severe intensity, can be effectively treated by a combination of diphenhydramine 50 mg IV plus metoclopramide 10 mg IV, rather than a placebo and metoclopramide 10 mg IV.

©DKart/iStockphoto

All subjects were no older than 65 years and presented to an emergency department with acute or severe migraine, or had probable migraine without aura – International Classification of Headache Disorders, 2nd edition, diagnoses 1.1 and 1.6.1, respectively – in the previous year. Patients were excluded if they had a history of allergy, a contraindication, intolerance of medications in the trial, or suspicion of secondary headache.

In total, 420 patients were deemed eligible for inclusion and 208 ultimately consented; they were randomized into either the placebo or diphenhydramine arm, and followed for 21 months starting in April 2013. The primary outcome was defined as achieving a mild headache, or no headache at all, within 2 hours of receiving medication and maintaining that level for at least 48 hours. The secondary outcome was an average improvement in the 0-10 numerical migraine rating scale within 1 hour of taking medication.

The results between the two cohorts, however, were not significantly different, and the study was halted for futility by a data safety monitoring committee at a planned interim analysis because of the lack of effect of diphenhydramine. Of patients randomized to diphenhydramine, 40% reported sustained relief, compared with 37% of patients randomized to placebo. One hour after medication administration, those randomized to diphenhydramine improved by a mean of 5.1 on a 0-10 scale, versus 4.8 for those randomized to placebo. Overall, 85% of the patients in the diphenhydramine arm reported they would want the same medication combination during a subsequent ED visit, as did 76% of those who received placebo. The length of stay in emergency departments – 122 minutes for patients who took diphenhydramine versus 131 minutes for those who took placebo – and the rates of side effects were also not significantly different between the two cohorts.

Eighty-five percent of the diphenhydramine group (88/104) were females, while 89% (92/104) were female in the placebo group. The average age was 34 years versus 36 years, while 64% (66 of 104) and 65% (67 of 104) were taking some form of medication before coming to the emergency department, respectively. Both cohorts reported a mean of 3 headache days per subject at baseline.

Although the study was conducted at just a single center (Montefiore Medical Center) within an underserved population, the results of the study clearly show that “there is no reason to administer [intravenous] diphenhydramine routinely for patients who present with acute or severe migraine,” Dr. Friedman said.

He did not report any relevant financial disclosures. 

[email protected]

WASHINGTON – Intravenous diphenhydramine is not an effective adjuvant therapy for the treatment of acute migraine, according to a study presented by Dr. Ben Friedman at the annual meeting of the American Headache Society.

Dr. Friedman of the department of emergency medicine at Albert Einstein College of Medicine in New York explained that no high-quality evidence exists to support or refute the role of antihistamines in the treatment of acute migraine. Therefore, the purpose of Dr. Friedman’s investigation was to confirm that acute migraine, of either moderate or severe intensity, can be effectively treated by a combination of diphenhydramine 50 mg IV plus metoclopramide 10 mg IV, rather than a placebo and metoclopramide 10 mg IV.

©DKart/iStockphoto

All subjects were no older than 65 years and presented to an emergency department with acute or severe migraine, or had probable migraine without aura – International Classification of Headache Disorders, 2nd edition, diagnoses 1.1 and 1.6.1, respectively – in the previous year. Patients were excluded if they had a history of allergy, a contraindication, intolerance of medications in the trial, or suspicion of secondary headache.

In total, 420 patients were deemed eligible for inclusion and 208 ultimately consented; they were randomized into either the placebo or diphenhydramine arm, and followed for 21 months starting in April 2013. The primary outcome was defined as achieving a mild headache, or no headache at all, within 2 hours of receiving medication and maintaining that level for at least 48 hours. The secondary outcome was an average improvement in the 0-10 numerical migraine rating scale within 1 hour of taking medication.

The results between the two cohorts, however, were not significantly different, and the study was halted for futility by a data safety monitoring committee at a planned interim analysis because of the lack of effect of diphenhydramine. Of patients randomized to diphenhydramine, 40% reported sustained relief, compared with 37% of patients randomized to placebo. One hour after medication administration, those randomized to diphenhydramine improved by a mean of 5.1 on a 0-10 scale, versus 4.8 for those randomized to placebo. Overall, 85% of the patients in the diphenhydramine arm reported they would want the same medication combination during a subsequent ED visit, as did 76% of those who received placebo. The length of stay in emergency departments – 122 minutes for patients who took diphenhydramine versus 131 minutes for those who took placebo – and the rates of side effects were also not significantly different between the two cohorts.

Eighty-five percent of the diphenhydramine group (88/104) were females, while 89% (92/104) were female in the placebo group. The average age was 34 years versus 36 years, while 64% (66 of 104) and 65% (67 of 104) were taking some form of medication before coming to the emergency department, respectively. Both cohorts reported a mean of 3 headache days per subject at baseline.

Although the study was conducted at just a single center (Montefiore Medical Center) within an underserved population, the results of the study clearly show that “there is no reason to administer [intravenous] diphenhydramine routinely for patients who present with acute or severe migraine,” Dr. Friedman said.

He did not report any relevant financial disclosures. 

[email protected]

WASHINGTON – Intravenous diphenhydramine is not an effective adjuvant therapy for the treatment of acute migraine, according to a study presented by Dr. Ben Friedman at the annual meeting of the American Headache Society.

Dr. Friedman of the department of emergency medicine at Albert Einstein College of Medicine in New York explained that no high-quality evidence exists to support or refute the role of antihistamines in the treatment of acute migraine. Therefore, the purpose of Dr. Friedman’s investigation was to confirm that acute migraine, of either moderate or severe intensity, can be effectively treated by a combination of diphenhydramine 50 mg IV plus metoclopramide 10 mg IV, rather than a placebo and metoclopramide 10 mg IV.

©DKart/iStockphoto

All subjects were no older than 65 years and presented to an emergency department with acute or severe migraine, or had probable migraine without aura – International Classification of Headache Disorders, 2nd edition, diagnoses 1.1 and 1.6.1, respectively – in the previous year. Patients were excluded if they had a history of allergy, a contraindication, intolerance of medications in the trial, or suspicion of secondary headache.

In total, 420 patients were deemed eligible for inclusion and 208 ultimately consented; they were randomized into either the placebo or diphenhydramine arm, and followed for 21 months starting in April 2013. The primary outcome was defined as achieving a mild headache, or no headache at all, within 2 hours of receiving medication and maintaining that level for at least 48 hours. The secondary outcome was an average improvement in the 0-10 numerical migraine rating scale within 1 hour of taking medication.

The results between the two cohorts, however, were not significantly different, and the study was halted for futility by a data safety monitoring committee at a planned interim analysis because of the lack of effect of diphenhydramine. Of patients randomized to diphenhydramine, 40% reported sustained relief, compared with 37% of patients randomized to placebo. One hour after medication administration, those randomized to diphenhydramine improved by a mean of 5.1 on a 0-10 scale, versus 4.8 for those randomized to placebo. Overall, 85% of the patients in the diphenhydramine arm reported they would want the same medication combination during a subsequent ED visit, as did 76% of those who received placebo. The length of stay in emergency departments – 122 minutes for patients who took diphenhydramine versus 131 minutes for those who took placebo – and the rates of side effects were also not significantly different between the two cohorts.

Eighty-five percent of the diphenhydramine group (88/104) were females, while 89% (92/104) were female in the placebo group. The average age was 34 years versus 36 years, while 64% (66 of 104) and 65% (67 of 104) were taking some form of medication before coming to the emergency department, respectively. Both cohorts reported a mean of 3 headache days per subject at baseline.

Although the study was conducted at just a single center (Montefiore Medical Center) within an underserved population, the results of the study clearly show that “there is no reason to administer [intravenous] diphenhydramine routinely for patients who present with acute or severe migraine,” Dr. Friedman said.

He did not report any relevant financial disclosures. 

[email protected]

WASHINGTON – Treatment of acute migraine in pediatric patients needs substantial improvement, particularly from providers in metropolitan areas, according to a retrospective observational study presented at the annual meeting of the American Headache Society.

“We know that there are practice parameters outlined by the [American Academy of Neurology] and other organizations, that there are expert recommendations, and [Food and Drug Administration]-approved medications,” said Robert A. Nicholson, Ph.D., director of behavioral medicine at Mercy Clinic Headache Center, St. Louis. “So there is definitely useful and effective treatment information available for dealing with pediatric migraine patients.”

©Jupiterimages/Thinkstockphotos.com

Dr. Nicholson and his coinvestigators collected electronic health records data on 94,444 cases in children aged 6-17 years, including 32,926 children in the study. All subjects presented with primary migraine and headache to 1 of 1,617 metropolitan and nonmetropolitan primary care, specialty care, or emergency departments between January 2009 and June 2014. Children were included based on a multi-input inclusion algorithm, which “determined presence of primary migraine, headache, or undiagnosed primary migraine,” and were excluded for post-traumatic presentation, neoplasms, pregnancy, and “infectious conditions for which headache was secondary.”

Just 16.1% of children received evidence-based medications for their acute migraine, while 37.9% received other medication and 46% did not receive any medication at all. Furthermore, 45.7% of subjects did not receive any diagnosis when they presented; only 17.7% were diagnosed with a migraine, while 36.6% received a headache diagnosis. Evidence-based medications most commonly prescribed were NSAIDs, triptans, and acetaminophen.

The percentage of children who received medication improved as they got older, with those aged 15-17 years receiving diagnoses and medications more consistently. Children who received the correct diagnosis at a younger age were better off in terms of getting medication more consistently as they aged.

“We see here that migraine does go up over time, but even in the best-case scenario, only about one out of four kids who are 15-17 [years] get evidence-based medication,” said Dr. Nicholson. “So although we find that there is a decrease in migraines as kids get older, it’s not as if we suddenly find some magical point at which they receive optimal treatment, it’s just that treatment gets less woeful than it was when kids are younger.”

Nearly 57% of subjects were female, and over 78% were white. Providers were predominantly located in metropolitan areas (78.2% vs. 21.8% nonmetropolitan) and 64.6% of centers were primary centers, 26.5% were emergency or urgent care departments, and 9% were specialty.

“We also found that providers in metropolitan areas were less likely to prescribe evidence-based medicine,” he said. “We don’t yet know much about that, [but] we’re going to do more work on that, as it’s something we found that we thought would be the exact opposite.”

Dr. Nicholson acknowledged the Migraine Research Foundation and the Mercy Research/MTS for their support of this study. He did not report any other relevant disclosures.

[email protected]

WASHINGTON – Treatment of acute migraine in pediatric patients needs substantial improvement, particularly from providers in metropolitan areas, according to a retrospective observational study presented at the annual meeting of the American Headache Society.

“We know that there are practice parameters outlined by the [American Academy of Neurology] and other organizations, that there are expert recommendations, and [Food and Drug Administration]-approved medications,” said Robert A. Nicholson, Ph.D., director of behavioral medicine at Mercy Clinic Headache Center, St. Louis. “So there is definitely useful and effective treatment information available for dealing with pediatric migraine patients.”

©Jupiterimages/Thinkstockphotos.com

Dr. Nicholson and his coinvestigators collected electronic health records data on 94,444 cases in children aged 6-17 years, including 32,926 children in the study. All subjects presented with primary migraine and headache to 1 of 1,617 metropolitan and nonmetropolitan primary care, specialty care, or emergency departments between January 2009 and June 2014. Children were included based on a multi-input inclusion algorithm, which “determined presence of primary migraine, headache, or undiagnosed primary migraine,” and were excluded for post-traumatic presentation, neoplasms, pregnancy, and “infectious conditions for which headache was secondary.”

Just 16.1% of children received evidence-based medications for their acute migraine, while 37.9% received other medication and 46% did not receive any medication at all. Furthermore, 45.7% of subjects did not receive any diagnosis when they presented; only 17.7% were diagnosed with a migraine, while 36.6% received a headache diagnosis. Evidence-based medications most commonly prescribed were NSAIDs, triptans, and acetaminophen.

The percentage of children who received medication improved as they got older, with those aged 15-17 years receiving diagnoses and medications more consistently. Children who received the correct diagnosis at a younger age were better off in terms of getting medication more consistently as they aged.

“We see here that migraine does go up over time, but even in the best-case scenario, only about one out of four kids who are 15-17 [years] get evidence-based medication,” said Dr. Nicholson. “So although we find that there is a decrease in migraines as kids get older, it’s not as if we suddenly find some magical point at which they receive optimal treatment, it’s just that treatment gets less woeful than it was when kids are younger.”

Nearly 57% of subjects were female, and over 78% were white. Providers were predominantly located in metropolitan areas (78.2% vs. 21.8% nonmetropolitan) and 64.6% of centers were primary centers, 26.5% were emergency or urgent care departments, and 9% were specialty.

“We also found that providers in metropolitan areas were less likely to prescribe evidence-based medicine,” he said. “We don’t yet know much about that, [but] we’re going to do more work on that, as it’s something we found that we thought would be the exact opposite.”

Dr. Nicholson acknowledged the Migraine Research Foundation and the Mercy Research/MTS for their support of this study. He did not report any other relevant disclosures.

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WASHINGTON – Treatment of acute migraine in pediatric patients needs substantial improvement, particularly from providers in metropolitan areas, according to a retrospective observational study presented at the annual meeting of the American Headache Society.

“We know that there are practice parameters outlined by the [American Academy of Neurology] and other organizations, that there are expert recommendations, and [Food and Drug Administration]-approved medications,” said Robert A. Nicholson, Ph.D., director of behavioral medicine at Mercy Clinic Headache Center, St. Louis. “So there is definitely useful and effective treatment information available for dealing with pediatric migraine patients.”

©Jupiterimages/Thinkstockphotos.com

Dr. Nicholson and his coinvestigators collected electronic health records data on 94,444 cases in children aged 6-17 years, including 32,926 children in the study. All subjects presented with primary migraine and headache to 1 of 1,617 metropolitan and nonmetropolitan primary care, specialty care, or emergency departments between January 2009 and June 2014. Children were included based on a multi-input inclusion algorithm, which “determined presence of primary migraine, headache, or undiagnosed primary migraine,” and were excluded for post-traumatic presentation, neoplasms, pregnancy, and “infectious conditions for which headache was secondary.”

Just 16.1% of children received evidence-based medications for their acute migraine, while 37.9% received other medication and 46% did not receive any medication at all. Furthermore, 45.7% of subjects did not receive any diagnosis when they presented; only 17.7% were diagnosed with a migraine, while 36.6% received a headache diagnosis. Evidence-based medications most commonly prescribed were NSAIDs, triptans, and acetaminophen.

The percentage of children who received medication improved as they got older, with those aged 15-17 years receiving diagnoses and medications more consistently. Children who received the correct diagnosis at a younger age were better off in terms of getting medication more consistently as they aged.

“We see here that migraine does go up over time, but even in the best-case scenario, only about one out of four kids who are 15-17 [years] get evidence-based medication,” said Dr. Nicholson. “So although we find that there is a decrease in migraines as kids get older, it’s not as if we suddenly find some magical point at which they receive optimal treatment, it’s just that treatment gets less woeful than it was when kids are younger.”

Nearly 57% of subjects were female, and over 78% were white. Providers were predominantly located in metropolitan areas (78.2% vs. 21.8% nonmetropolitan) and 64.6% of centers were primary centers, 26.5% were emergency or urgent care departments, and 9% were specialty.

“We also found that providers in metropolitan areas were less likely to prescribe evidence-based medicine,” he said. “We don’t yet know much about that, [but] we’re going to do more work on that, as it’s something we found that we thought would be the exact opposite.”

Dr. Nicholson acknowledged the Migraine Research Foundation and the Mercy Research/MTS for their support of this study. He did not report any other relevant disclosures.

[email protected]

WASHINGTON – Chronic migraine can have a noticeable impact on child-rearing and affect the overall quality of care provided to children by an afflicted parent or domestic partner, according to findings from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study presented at the annual meeting of the American Headache Society.

“Limited data exists on the burden of migraine on family members, [but] no one has actually studied the burden to family members of chronic migraine,” explained Dawn C. Buse, Ph.D., of the Albert Einstein College of Medicine in New York.

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The CaMEO study was initiated in the fall of 2012 as a prospective, web-based study that surveyed individuals with migraine and chronic migraine, with “cross-sectional modules embedded in a longitudinal design.” This module, called by investigators the Family Burden module, surveyed 13,064 individuals with migraine, of whom 994 met the criteria for chronic migraine – that is, subjects experienced at least 15 headache days per month for the last 3 months.

To assess the burden of chronic migraine on children and other family members, subjects and their partners/spouses responded to questions designed for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The questions covered reduced participation in, or enjoyment of, family activities; missed or canceled family events; effects of migraine on family members’ activities and emotions; and effect of migraine on migraineur’s interaction with children. Each question was answered with a number of 1-4, with 1 being complete disagreement and 4 being complete agreement.

“We also collected data directly from children who were age 13 and older,” said Dr. Buse. “That data, however, will be coming out next year.”

Unsurprisingly, 75.1% of migraine sufferers said that the noise of their child’s activities can cause or aggravate their headaches, but 66% said they get more easily angry or annoyed with their children when they have a headache, and 71.7% of parents said that they would be a better parent if they did not have chromic migraines.

For questions pertaining to participation and enjoyment of family events, 44.4% of migraineurs and 19.6% of partners “somewhat or completely” agreed that their migraines reduced their ability to properly parent their children. Forty-nine percent of migraneurs responded that chronic migraines reduced their enjoyment of children’s activities, 56.5% said that chronic migraines reduced their enjoyment of a significant event in the past year, and 65.3% said that migraines reduced their enjoyment of family activities.

Nearly 39% of subjects experiencing chronic migraines said that the affliction caused them to miss a holiday in the last year, 39% canceled an important holiday celebration in their own home over the last year, 33% said their children missed a scheduled activity in the last 30 days due to their parent’s migraine, and 33.9% said their children either missed a day of school or was dropped off/picked up late because the parent had a migraine.

Almost 32% of partners said that migraineurs were more demanding of their children because of their migraine, while 30.3% of subjects with migraines said that it has caused conflict between them and their children. Thirty percent of migraineurs said that the condition causes stress with their children, regardless of whether they’ve actually experienced a headache that day.

“Probands with chronic migraine and their spouses perceive a higher rate of burden on children,” Dr. Buse concluded. “Generally, the probands are harder on themselves than their spouses are; probands feel guiltier, sadder, angrier, more frustrated, or that their kids are more affected than their spouses perceive, and going forward, we’ll be analyzing what the kids say themselves.”

The CaMEO study was sponsored by Allergan. Dr. Buse disclosed that she has received grant support and honoraria from Allergan, the American Headache Society, and the National Headache Foundation; that she is an employee of Montefiore Medical Center, which has received research support funded by Allergan, CoLucid, Endo Pharmaceuticals, GlaxoSmithKline, MAP Pharmaceuticals, Merck, NuPathe, Novartis, Ortho-McNeil, and Zogenix, both directly and via grants from the National Headache Foundation.

[email protected]

WASHINGTON – Chronic migraine can have a noticeable impact on child-rearing and affect the overall quality of care provided to children by an afflicted parent or domestic partner, according to findings from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study presented at the annual meeting of the American Headache Society.

“Limited data exists on the burden of migraine on family members, [but] no one has actually studied the burden to family members of chronic migraine,” explained Dawn C. Buse, Ph.D., of the Albert Einstein College of Medicine in New York.

©Getty Images

The CaMEO study was initiated in the fall of 2012 as a prospective, web-based study that surveyed individuals with migraine and chronic migraine, with “cross-sectional modules embedded in a longitudinal design.” This module, called by investigators the Family Burden module, surveyed 13,064 individuals with migraine, of whom 994 met the criteria for chronic migraine – that is, subjects experienced at least 15 headache days per month for the last 3 months.

To assess the burden of chronic migraine on children and other family members, subjects and their partners/spouses responded to questions designed for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The questions covered reduced participation in, or enjoyment of, family activities; missed or canceled family events; effects of migraine on family members’ activities and emotions; and effect of migraine on migraineur’s interaction with children. Each question was answered with a number of 1-4, with 1 being complete disagreement and 4 being complete agreement.

“We also collected data directly from children who were age 13 and older,” said Dr. Buse. “That data, however, will be coming out next year.”

Unsurprisingly, 75.1% of migraine sufferers said that the noise of their child’s activities can cause or aggravate their headaches, but 66% said they get more easily angry or annoyed with their children when they have a headache, and 71.7% of parents said that they would be a better parent if they did not have chromic migraines.

For questions pertaining to participation and enjoyment of family events, 44.4% of migraineurs and 19.6% of partners “somewhat or completely” agreed that their migraines reduced their ability to properly parent their children. Forty-nine percent of migraneurs responded that chronic migraines reduced their enjoyment of children’s activities, 56.5% said that chronic migraines reduced their enjoyment of a significant event in the past year, and 65.3% said that migraines reduced their enjoyment of family activities.

Nearly 39% of subjects experiencing chronic migraines said that the affliction caused them to miss a holiday in the last year, 39% canceled an important holiday celebration in their own home over the last year, 33% said their children missed a scheduled activity in the last 30 days due to their parent’s migraine, and 33.9% said their children either missed a day of school or was dropped off/picked up late because the parent had a migraine.

Almost 32% of partners said that migraineurs were more demanding of their children because of their migraine, while 30.3% of subjects with migraines said that it has caused conflict between them and their children. Thirty percent of migraineurs said that the condition causes stress with their children, regardless of whether they’ve actually experienced a headache that day.

“Probands with chronic migraine and their spouses perceive a higher rate of burden on children,” Dr. Buse concluded. “Generally, the probands are harder on themselves than their spouses are; probands feel guiltier, sadder, angrier, more frustrated, or that their kids are more affected than their spouses perceive, and going forward, we’ll be analyzing what the kids say themselves.”

The CaMEO study was sponsored by Allergan. Dr. Buse disclosed that she has received grant support and honoraria from Allergan, the American Headache Society, and the National Headache Foundation; that she is an employee of Montefiore Medical Center, which has received research support funded by Allergan, CoLucid, Endo Pharmaceuticals, GlaxoSmithKline, MAP Pharmaceuticals, Merck, NuPathe, Novartis, Ortho-McNeil, and Zogenix, both directly and via grants from the National Headache Foundation.

[email protected]

WASHINGTON – Chronic migraine can have a noticeable impact on child-rearing and affect the overall quality of care provided to children by an afflicted parent or domestic partner, according to findings from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study presented at the annual meeting of the American Headache Society.

“Limited data exists on the burden of migraine on family members, [but] no one has actually studied the burden to family members of chronic migraine,” explained Dawn C. Buse, Ph.D., of the Albert Einstein College of Medicine in New York.

©Getty Images

The CaMEO study was initiated in the fall of 2012 as a prospective, web-based study that surveyed individuals with migraine and chronic migraine, with “cross-sectional modules embedded in a longitudinal design.” This module, called by investigators the Family Burden module, surveyed 13,064 individuals with migraine, of whom 994 met the criteria for chronic migraine – that is, subjects experienced at least 15 headache days per month for the last 3 months.

To assess the burden of chronic migraine on children and other family members, subjects and their partners/spouses responded to questions designed for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The questions covered reduced participation in, or enjoyment of, family activities; missed or canceled family events; effects of migraine on family members’ activities and emotions; and effect of migraine on migraineur’s interaction with children. Each question was answered with a number of 1-4, with 1 being complete disagreement and 4 being complete agreement.

“We also collected data directly from children who were age 13 and older,” said Dr. Buse. “That data, however, will be coming out next year.”

Unsurprisingly, 75.1% of migraine sufferers said that the noise of their child’s activities can cause or aggravate their headaches, but 66% said they get more easily angry or annoyed with their children when they have a headache, and 71.7% of parents said that they would be a better parent if they did not have chromic migraines.

For questions pertaining to participation and enjoyment of family events, 44.4% of migraineurs and 19.6% of partners “somewhat or completely” agreed that their migraines reduced their ability to properly parent their children. Forty-nine percent of migraneurs responded that chronic migraines reduced their enjoyment of children’s activities, 56.5% said that chronic migraines reduced their enjoyment of a significant event in the past year, and 65.3% said that migraines reduced their enjoyment of family activities.

Nearly 39% of subjects experiencing chronic migraines said that the affliction caused them to miss a holiday in the last year, 39% canceled an important holiday celebration in their own home over the last year, 33% said their children missed a scheduled activity in the last 30 days due to their parent’s migraine, and 33.9% said their children either missed a day of school or was dropped off/picked up late because the parent had a migraine.

Almost 32% of partners said that migraineurs were more demanding of their children because of their migraine, while 30.3% of subjects with migraines said that it has caused conflict between them and their children. Thirty percent of migraineurs said that the condition causes stress with their children, regardless of whether they’ve actually experienced a headache that day.

“Probands with chronic migraine and their spouses perceive a higher rate of burden on children,” Dr. Buse concluded. “Generally, the probands are harder on themselves than their spouses are; probands feel guiltier, sadder, angrier, more frustrated, or that their kids are more affected than their spouses perceive, and going forward, we’ll be analyzing what the kids say themselves.”

The CaMEO study was sponsored by Allergan. Dr. Buse disclosed that she has received grant support and honoraria from Allergan, the American Headache Society, and the National Headache Foundation; that she is an employee of Montefiore Medical Center, which has received research support funded by Allergan, CoLucid, Endo Pharmaceuticals, GlaxoSmithKline, MAP Pharmaceuticals, Merck, NuPathe, Novartis, Ortho-McNeil, and Zogenix, both directly and via grants from the National Headache Foundation.

[email protected]