Key clinical point: A higher proportion of patients with migraine treated with atogepant vs. placebo showed a significant reduction in the monthly migraine days (MMD) during the 12 weeks of treatment.

Major finding: At 12 weeks, ≥50% reduction in the mean MMD was achieved by a significantly higher proportion of patients receiving 10 mg (55.6%), 30 mg (58.7%), or 60 mg (60.8%) atogepantcompared with placebo (29.0%; all P < .001), with findings being similar for ≥25%, ≥75%, and 100% reduction in mean MMD. The incidence of treatment-emergent adverse events was similar among the treatment groups.

Study details: This was a secondary analysis of the ADVANCE trial including 873 patients with a ≥1-year history of migraine with or without aura who were randomly assigned to receive atogepant (10, 30, or 60 mg; n=659) or placebo (n=214).

Disclosures: This study was sponsored by Allergan. Some authors declared receiving speaking fees, consulting fees, personal fees, research grants, or royalties or owing stocks or stock options in various sources, including Allergan/AbbVie.

Source: Lipton RB et al.Rates of response to atogepant for migraine prophylaxis among adults:

A secondary analysis of a randomized clinical trial.JAMA Netw Open. 2022;5(6):e2215499 Jun 8). Doi: 10.1001/jamanetworkopen.2022.15499

Key clinical point: A higher proportion of patients with migraine treated with atogepant vs. placebo showed a significant reduction in the monthly migraine days (MMD) during the 12 weeks of treatment.

Major finding: At 12 weeks, ≥50% reduction in the mean MMD was achieved by a significantly higher proportion of patients receiving 10 mg (55.6%), 30 mg (58.7%), or 60 mg (60.8%) atogepantcompared with placebo (29.0%; all P < .001), with findings being similar for ≥25%, ≥75%, and 100% reduction in mean MMD. The incidence of treatment-emergent adverse events was similar among the treatment groups.

Study details: This was a secondary analysis of the ADVANCE trial including 873 patients with a ≥1-year history of migraine with or without aura who were randomly assigned to receive atogepant (10, 30, or 60 mg; n=659) or placebo (n=214).

Disclosures: This study was sponsored by Allergan. Some authors declared receiving speaking fees, consulting fees, personal fees, research grants, or royalties or owing stocks or stock options in various sources, including Allergan/AbbVie.

Source: Lipton RB et al.Rates of response to atogepant for migraine prophylaxis among adults:

A secondary analysis of a randomized clinical trial.JAMA Netw Open. 2022;5(6):e2215499 Jun 8). Doi: 10.1001/jamanetworkopen.2022.15499

Key clinical point: A higher proportion of patients with migraine treated with atogepant vs. placebo showed a significant reduction in the monthly migraine days (MMD) during the 12 weeks of treatment.

Major finding: At 12 weeks, ≥50% reduction in the mean MMD was achieved by a significantly higher proportion of patients receiving 10 mg (55.6%), 30 mg (58.7%), or 60 mg (60.8%) atogepantcompared with placebo (29.0%; all P < .001), with findings being similar for ≥25%, ≥75%, and 100% reduction in mean MMD. The incidence of treatment-emergent adverse events was similar among the treatment groups.

Study details: This was a secondary analysis of the ADVANCE trial including 873 patients with a ≥1-year history of migraine with or without aura who were randomly assigned to receive atogepant (10, 30, or 60 mg; n=659) or placebo (n=214).

Disclosures: This study was sponsored by Allergan. Some authors declared receiving speaking fees, consulting fees, personal fees, research grants, or royalties or owing stocks or stock options in various sources, including Allergan/AbbVie.

Source: Lipton RB et al.Rates of response to atogepant for migraine prophylaxis among adults:

A secondary analysis of a randomized clinical trial.JAMA Netw Open. 2022;5(6):e2215499 Jun 8). Doi: 10.1001/jamanetworkopen.2022.15499

Transmission of anxiety appears to be sex-specific – spreading from mothers to daughters and from fathers to sons, new research shows.

The new findings suggest that children learn anxious behavior from their parents, study investigator Barbara Pavlova, PhD, clinical psychologist with Nova Scotia Health Authority, told this news organization.

“This means that transmission of anxiety from parents to children may be preventable,” said Dr. Pavlova, assistant professor, department of psychiatry, Dalhousie University, Halifax, Canada.

Vlad Drobinin

Parental anxiety a disruptor

Anxiety disorders run in families. Both genes and environment are thought to be at play, but there are few data on sex-specific transmission from parent to child.

To investigate, the researchers conducted a cross-sectional study of 203 girls and 195 boys and their parents. The average age of the children was 11 years, and they had a familial risk for mood disorders.

Anxiety disorder in a same-sex parent was significantly associated with anxiety disorder in offspring (odds ratio, 2.85; 95% confidence interval, 1.52-5.34; P = .001) but not in an opposite-sex parent (OR, 1.51; 95% CI, 0.81-2.81; P = .20).

Living with a same-sex parent without anxiety was associated with lower rates of offspring anxiety (OR, 0.38; 95% CI, 0.22-0.67; P = .001).

Among all 398 children, 108 (27%) had been diagnosed with one or more anxiety disorders, including generalized anxiety disorder (7.8%), social anxiety disorder (6.3%), separation anxiety disorder (8.6%), specific phobia (8%), and anxiety disorder not otherwise specified (5%).

Rates of anxiety disorders in children increased with age, from 14% in those younger than 9 years to 52% in those older than 15 years. Anxiety disorders were similarly common among boys (24%) and girls (30%).

Rates of anxiety disorders were lowest (24%) in children of two parents without anxiety disorders and highest (41%) in cases in which both parents had anxiety disorders.

The findings point to the possible role of environmental factors, “such as modeling and vicarious learning,” in the transmission of anxiety from parents to their children, the researchers note.

“A child receives [a] similar amount of genetic information from each biological parent. A strong same-sex parent effect suggests children learn resilience by modeling the behavior of their same-sex parent. A parent’s anxiety disorder may disrupt this protective learning,” said Dr. Pavlova.
 

Early diagnosis, treatment essential

Reached for comment, Jill Emanuele, PhD, vice president of clinical training for the Child MIND Institute, New York, said that when it comes to anxiety, it’s important to assess and treat both the parent and the child.

“We know that both environment and genetics play a role in anxiety disorders. From a clinical perspective, if we see a parent with an anxiety disorder, we know that there is a chance that that is also going to affect the child – whether or not the child has an anxiety disorder,” Dr. Emanuele said in an interview.

“Anxiety disorders are the most common psychiatric disorders diagnosed. We also know that anxiety disorders emerge earlier than mood disorders and certainly can emerge in childhood. It’s important to address anxiety early because those same problems can continue into adulthood if left untreated,” Dr. Emanuele added.

The study was supported by the Canada Research Chairs Program, the Canadian Institutes of Health Research, the Brain & Behavior Research Foundation, the Nova Scotia Health Research Foundation, and the Dalhousie Medical Research Foundation. The authors have disclosed no relevant financial relationships. Dr. Emanuele is a board member with the Anxiety and Depression Association of America.

A version of this article first appeared on Medscape.com.

Transmission of anxiety appears to be sex-specific – spreading from mothers to daughters and from fathers to sons, new research shows.

The new findings suggest that children learn anxious behavior from their parents, study investigator Barbara Pavlova, PhD, clinical psychologist with Nova Scotia Health Authority, told this news organization.

“This means that transmission of anxiety from parents to children may be preventable,” said Dr. Pavlova, assistant professor, department of psychiatry, Dalhousie University, Halifax, Canada.

Vlad Drobinin

Parental anxiety a disruptor

Anxiety disorders run in families. Both genes and environment are thought to be at play, but there are few data on sex-specific transmission from parent to child.

To investigate, the researchers conducted a cross-sectional study of 203 girls and 195 boys and their parents. The average age of the children was 11 years, and they had a familial risk for mood disorders.

Anxiety disorder in a same-sex parent was significantly associated with anxiety disorder in offspring (odds ratio, 2.85; 95% confidence interval, 1.52-5.34; P = .001) but not in an opposite-sex parent (OR, 1.51; 95% CI, 0.81-2.81; P = .20).

Living with a same-sex parent without anxiety was associated with lower rates of offspring anxiety (OR, 0.38; 95% CI, 0.22-0.67; P = .001).

Among all 398 children, 108 (27%) had been diagnosed with one or more anxiety disorders, including generalized anxiety disorder (7.8%), social anxiety disorder (6.3%), separation anxiety disorder (8.6%), specific phobia (8%), and anxiety disorder not otherwise specified (5%).

Rates of anxiety disorders in children increased with age, from 14% in those younger than 9 years to 52% in those older than 15 years. Anxiety disorders were similarly common among boys (24%) and girls (30%).

Rates of anxiety disorders were lowest (24%) in children of two parents without anxiety disorders and highest (41%) in cases in which both parents had anxiety disorders.

The findings point to the possible role of environmental factors, “such as modeling and vicarious learning,” in the transmission of anxiety from parents to their children, the researchers note.

“A child receives [a] similar amount of genetic information from each biological parent. A strong same-sex parent effect suggests children learn resilience by modeling the behavior of their same-sex parent. A parent’s anxiety disorder may disrupt this protective learning,” said Dr. Pavlova.
 

Early diagnosis, treatment essential

Reached for comment, Jill Emanuele, PhD, vice president of clinical training for the Child MIND Institute, New York, said that when it comes to anxiety, it’s important to assess and treat both the parent and the child.

“We know that both environment and genetics play a role in anxiety disorders. From a clinical perspective, if we see a parent with an anxiety disorder, we know that there is a chance that that is also going to affect the child – whether or not the child has an anxiety disorder,” Dr. Emanuele said in an interview.

“Anxiety disorders are the most common psychiatric disorders diagnosed. We also know that anxiety disorders emerge earlier than mood disorders and certainly can emerge in childhood. It’s important to address anxiety early because those same problems can continue into adulthood if left untreated,” Dr. Emanuele added.

The study was supported by the Canada Research Chairs Program, the Canadian Institutes of Health Research, the Brain & Behavior Research Foundation, the Nova Scotia Health Research Foundation, and the Dalhousie Medical Research Foundation. The authors have disclosed no relevant financial relationships. Dr. Emanuele is a board member with the Anxiety and Depression Association of America.

A version of this article first appeared on Medscape.com.

Transmission of anxiety appears to be sex-specific – spreading from mothers to daughters and from fathers to sons, new research shows.

The new findings suggest that children learn anxious behavior from their parents, study investigator Barbara Pavlova, PhD, clinical psychologist with Nova Scotia Health Authority, told this news organization.

“This means that transmission of anxiety from parents to children may be preventable,” said Dr. Pavlova, assistant professor, department of psychiatry, Dalhousie University, Halifax, Canada.

Vlad Drobinin

Parental anxiety a disruptor

Anxiety disorders run in families. Both genes and environment are thought to be at play, but there are few data on sex-specific transmission from parent to child.

To investigate, the researchers conducted a cross-sectional study of 203 girls and 195 boys and their parents. The average age of the children was 11 years, and they had a familial risk for mood disorders.

Anxiety disorder in a same-sex parent was significantly associated with anxiety disorder in offspring (odds ratio, 2.85; 95% confidence interval, 1.52-5.34; P = .001) but not in an opposite-sex parent (OR, 1.51; 95% CI, 0.81-2.81; P = .20).

Living with a same-sex parent without anxiety was associated with lower rates of offspring anxiety (OR, 0.38; 95% CI, 0.22-0.67; P = .001).

Among all 398 children, 108 (27%) had been diagnosed with one or more anxiety disorders, including generalized anxiety disorder (7.8%), social anxiety disorder (6.3%), separation anxiety disorder (8.6%), specific phobia (8%), and anxiety disorder not otherwise specified (5%).

Rates of anxiety disorders in children increased with age, from 14% in those younger than 9 years to 52% in those older than 15 years. Anxiety disorders were similarly common among boys (24%) and girls (30%).

Rates of anxiety disorders were lowest (24%) in children of two parents without anxiety disorders and highest (41%) in cases in which both parents had anxiety disorders.

The findings point to the possible role of environmental factors, “such as modeling and vicarious learning,” in the transmission of anxiety from parents to their children, the researchers note.

“A child receives [a] similar amount of genetic information from each biological parent. A strong same-sex parent effect suggests children learn resilience by modeling the behavior of their same-sex parent. A parent’s anxiety disorder may disrupt this protective learning,” said Dr. Pavlova.
 

Early diagnosis, treatment essential

Reached for comment, Jill Emanuele, PhD, vice president of clinical training for the Child MIND Institute, New York, said that when it comes to anxiety, it’s important to assess and treat both the parent and the child.

“We know that both environment and genetics play a role in anxiety disorders. From a clinical perspective, if we see a parent with an anxiety disorder, we know that there is a chance that that is also going to affect the child – whether or not the child has an anxiety disorder,” Dr. Emanuele said in an interview.

“Anxiety disorders are the most common psychiatric disorders diagnosed. We also know that anxiety disorders emerge earlier than mood disorders and certainly can emerge in childhood. It’s important to address anxiety early because those same problems can continue into adulthood if left untreated,” Dr. Emanuele added.

The study was supported by the Canada Research Chairs Program, the Canadian Institutes of Health Research, the Brain & Behavior Research Foundation, the Nova Scotia Health Research Foundation, and the Dalhousie Medical Research Foundation. The authors have disclosed no relevant financial relationships. Dr. Emanuele is a board member with the Anxiety and Depression Association of America.

A version of this article first appeared on Medscape.com.

Key clinical point: Migraine was significantly associated with fetal-type posterior cerebral artery (PCA) status in patients with ischemic stroke.

Major finding: Fetal-type PCA status was independently associated with migraine (adjusted odds ratio [aOR] 2.06; P = .005). The other factors independently associated with migraine were hypertension (aOR 1.97; P = .011), female gender (aOR 2.03; P = .017) and National Institutes of Health Stroke Scale score at admission (aOR 1.08; P = .018).

Study details: This cross-sectional study included 750 patients aged ≥18 yearswith ischemic stroke, of which 11.3% had migraine history.

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

Source: Zhang Y et al. The association between migraine and fetal-type posterior cerebral artery in patients with ischemic stroke. Cerebrovasc Dis. 2022 (May 13). Doi:10.1159/000524616

Key clinical point: Migraine was significantly associated with fetal-type posterior cerebral artery (PCA) status in patients with ischemic stroke.

Major finding: Fetal-type PCA status was independently associated with migraine (adjusted odds ratio [aOR] 2.06; P = .005). The other factors independently associated with migraine were hypertension (aOR 1.97; P = .011), female gender (aOR 2.03; P = .017) and National Institutes of Health Stroke Scale score at admission (aOR 1.08; P = .018).

Study details: This cross-sectional study included 750 patients aged ≥18 yearswith ischemic stroke, of which 11.3% had migraine history.

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

Source: Zhang Y et al. The association between migraine and fetal-type posterior cerebral artery in patients with ischemic stroke. Cerebrovasc Dis. 2022 (May 13). Doi:10.1159/000524616

Key clinical point: Migraine was significantly associated with fetal-type posterior cerebral artery (PCA) status in patients with ischemic stroke.

Major finding: Fetal-type PCA status was independently associated with migraine (adjusted odds ratio [aOR] 2.06; P = .005). The other factors independently associated with migraine were hypertension (aOR 1.97; P = .011), female gender (aOR 2.03; P = .017) and National Institutes of Health Stroke Scale score at admission (aOR 1.08; P = .018).

Study details: This cross-sectional study included 750 patients aged ≥18 yearswith ischemic stroke, of which 11.3% had migraine history.

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

Source: Zhang Y et al. The association between migraine and fetal-type posterior cerebral artery in patients with ischemic stroke. Cerebrovasc Dis. 2022 (May 13). Doi:10.1159/000524616

Key clinical point: Erenumab is effective and welltolerated in patients with chronic migraine who did not respond to previous migraine treatments.

Major finding: Overall,71.4% of patients treated with erenumabachieved ≥30% reduction in monthly migraine days from baseline to 9-12 weeks and 34.0% of patients at all assessment periods through 52weeks. Constipation was the most common adverse event and 13.7% of patients discontinued treatment because of a lack of tolerability.

Study details: The data come from a 52-week, prospective, observational study including 300 patients with chronic migraine who received ≥1 dose of erenumab, of which 273 and 119 patients completed 12 and 52 weeks of treatment, respectively.

Disclosures: This study was funded by and conducted in collaboration with Novartis Pharma AG, Basel, Switzerland. Some authors reported being consultants, speakers, or scientific advisorsfor or receiving personal fees from various sources, including Novartis. Two authors declared being employees of and holding stocks in Novartis.

Source: Cullum CK et al.Real-world long-term efficacy and safety of erenumab in adults with chronic migraine: A 52-week, single-center, prospective, observational study. J Headache Pain. 2022;23(1):61 Jun 2). Doi:10.1186/s10194-022-01433-9

Key clinical point: Erenumab is effective and welltolerated in patients with chronic migraine who did not respond to previous migraine treatments.

Major finding: Overall,71.4% of patients treated with erenumabachieved ≥30% reduction in monthly migraine days from baseline to 9-12 weeks and 34.0% of patients at all assessment periods through 52weeks. Constipation was the most common adverse event and 13.7% of patients discontinued treatment because of a lack of tolerability.

Study details: The data come from a 52-week, prospective, observational study including 300 patients with chronic migraine who received ≥1 dose of erenumab, of which 273 and 119 patients completed 12 and 52 weeks of treatment, respectively.

Disclosures: This study was funded by and conducted in collaboration with Novartis Pharma AG, Basel, Switzerland. Some authors reported being consultants, speakers, or scientific advisorsfor or receiving personal fees from various sources, including Novartis. Two authors declared being employees of and holding stocks in Novartis.

Source: Cullum CK et al.Real-world long-term efficacy and safety of erenumab in adults with chronic migraine: A 52-week, single-center, prospective, observational study. J Headache Pain. 2022;23(1):61 Jun 2). Doi:10.1186/s10194-022-01433-9

Key clinical point: Erenumab is effective and welltolerated in patients with chronic migraine who did not respond to previous migraine treatments.

Major finding: Overall,71.4% of patients treated with erenumabachieved ≥30% reduction in monthly migraine days from baseline to 9-12 weeks and 34.0% of patients at all assessment periods through 52weeks. Constipation was the most common adverse event and 13.7% of patients discontinued treatment because of a lack of tolerability.

Study details: The data come from a 52-week, prospective, observational study including 300 patients with chronic migraine who received ≥1 dose of erenumab, of which 273 and 119 patients completed 12 and 52 weeks of treatment, respectively.

Disclosures: This study was funded by and conducted in collaboration with Novartis Pharma AG, Basel, Switzerland. Some authors reported being consultants, speakers, or scientific advisorsfor or receiving personal fees from various sources, including Novartis. Two authors declared being employees of and holding stocks in Novartis.

Source: Cullum CK et al.Real-world long-term efficacy and safety of erenumab in adults with chronic migraine: A 52-week, single-center, prospective, observational study. J Headache Pain. 2022;23(1):61 Jun 2). Doi:10.1186/s10194-022-01433-9

The potentially fatal parechovirus is now circulating in multiple states, causing fevers, seizures, and sepsis-like symptoms, including confusion and extreme pain, according to the CDC.

Human parechoviruses are common in children and most have been infected before they start kindergarten, the CDC said. Between 6 months and 5 years of age, symptoms include an upper respiratory tract infection, fever, and rash.

But infants younger than 3 months may have more serious, and possibly fatal, infections. They may get “sepsis-like illness, seizures, and meningitis or meningoencephalitis, particularly in infants younger than 1 month,” the CDC said. At least one newborn has reportedly died from the infection.

Parechovirus can spread like other common germs, from feces that are later ingested – likely due to poor handwashing – and through droplets sent airborne by coughing or sneezing. It can be transmitted by people both with and without symptoms of the infection.

The microbe can reproduce for 1-3 weeks in the upper respiratory tract and up to 6 months in the gastrointestinal tract, the CDC said.

Kristina Angel Bryant, MD, a pediatric infectious disease specialist at the University of Louisville Hospital, says parechoviruses often cause rashes on the hands and feet, which some experts refer to as “mittens and booties.”

The CDC is urging doctors to test for parechovirus if they recognize these symptoms in infants if there is no other explanation for what might be distressing them.

There is no specific treatment for parechovirus. And with no standard testing system in place, experts are unsure if the number of parechovirus cases is higher in 2022 than in previous years.

The message for parents, Dr. Bryant says, is: Don’t panic. “This is not a new virus.”

“One of the most common symptoms is fever, and in some kids, that is the only symptom,” she says. “Older infants and toddlers may have only cold symptoms, and some kids have no symptoms at all.”

Parents can take the usual steps to protect their child from the viral illness, including diligent handwashing and having less contact with people who are sick, Dr. Bryant says.

A version of this article first appeared on Medscape.com.

The potentially fatal parechovirus is now circulating in multiple states, causing fevers, seizures, and sepsis-like symptoms, including confusion and extreme pain, according to the CDC.

Human parechoviruses are common in children and most have been infected before they start kindergarten, the CDC said. Between 6 months and 5 years of age, symptoms include an upper respiratory tract infection, fever, and rash.

But infants younger than 3 months may have more serious, and possibly fatal, infections. They may get “sepsis-like illness, seizures, and meningitis or meningoencephalitis, particularly in infants younger than 1 month,” the CDC said. At least one newborn has reportedly died from the infection.

Parechovirus can spread like other common germs, from feces that are later ingested – likely due to poor handwashing – and through droplets sent airborne by coughing or sneezing. It can be transmitted by people both with and without symptoms of the infection.

The microbe can reproduce for 1-3 weeks in the upper respiratory tract and up to 6 months in the gastrointestinal tract, the CDC said.

Kristina Angel Bryant, MD, a pediatric infectious disease specialist at the University of Louisville Hospital, says parechoviruses often cause rashes on the hands and feet, which some experts refer to as “mittens and booties.”

The CDC is urging doctors to test for parechovirus if they recognize these symptoms in infants if there is no other explanation for what might be distressing them.

There is no specific treatment for parechovirus. And with no standard testing system in place, experts are unsure if the number of parechovirus cases is higher in 2022 than in previous years.

The message for parents, Dr. Bryant says, is: Don’t panic. “This is not a new virus.”

“One of the most common symptoms is fever, and in some kids, that is the only symptom,” she says. “Older infants and toddlers may have only cold symptoms, and some kids have no symptoms at all.”

Parents can take the usual steps to protect their child from the viral illness, including diligent handwashing and having less contact with people who are sick, Dr. Bryant says.

A version of this article first appeared on Medscape.com.

The potentially fatal parechovirus is now circulating in multiple states, causing fevers, seizures, and sepsis-like symptoms, including confusion and extreme pain, according to the CDC.

Human parechoviruses are common in children and most have been infected before they start kindergarten, the CDC said. Between 6 months and 5 years of age, symptoms include an upper respiratory tract infection, fever, and rash.

But infants younger than 3 months may have more serious, and possibly fatal, infections. They may get “sepsis-like illness, seizures, and meningitis or meningoencephalitis, particularly in infants younger than 1 month,” the CDC said. At least one newborn has reportedly died from the infection.

Parechovirus can spread like other common germs, from feces that are later ingested – likely due to poor handwashing – and through droplets sent airborne by coughing or sneezing. It can be transmitted by people both with and without symptoms of the infection.

The microbe can reproduce for 1-3 weeks in the upper respiratory tract and up to 6 months in the gastrointestinal tract, the CDC said.

Kristina Angel Bryant, MD, a pediatric infectious disease specialist at the University of Louisville Hospital, says parechoviruses often cause rashes on the hands and feet, which some experts refer to as “mittens and booties.”

The CDC is urging doctors to test for parechovirus if they recognize these symptoms in infants if there is no other explanation for what might be distressing them.

There is no specific treatment for parechovirus. And with no standard testing system in place, experts are unsure if the number of parechovirus cases is higher in 2022 than in previous years.

The message for parents, Dr. Bryant says, is: Don’t panic. “This is not a new virus.”

“One of the most common symptoms is fever, and in some kids, that is the only symptom,” she says. “Older infants and toddlers may have only cold symptoms, and some kids have no symptoms at all.”

Parents can take the usual steps to protect their child from the viral illness, including diligent handwashing and having less contact with people who are sick, Dr. Bryant says.

A version of this article first appeared on Medscape.com.

Key clinical point: Intravenous (IV) ketorolac plus metoclopramide failed to improve pain intensity in children presenting to the emergency department (ED) for the acute treatment of migraine compared with metoclopramide monotherapy.

Major finding: The mean change in pain intensity as assessed by a 100 mm Visual Analog Scale at 120 minutes was −44 mm (95% CI 32-57 mm) in the monotherapy group and −36 mm (95% CI 23-49 mm) in the ketorolac group, corresponding to a mean difference of 8 mm between the groups (P = .355),with no significant between-group difference in headache recurrence and adverse events.

Study details: Findings arefrom a double-blind, randomized placebo-controlled trialincluding 53children aged 6-17 years presenting to the ED for the acute treatment of migraine. They were randomly assigned to receive IV ketorolac plus metoclopramide (n=26) or IV metoclopramide plus placebo (n=27).

Disclosures: This study was funded by the Canadian Institutes of Health Research through a Drug Safety and Effectiveness Network grant. The authors declared no conflicts of interest.

Source: Richer LP et al.A randomized trial of ketorolac and metoclopramide for migraine in the emergency department.Headache. 2022; 62: 681-689(Jun 7). Doi:10.1111/head.14307

Key clinical point: Intravenous (IV) ketorolac plus metoclopramide failed to improve pain intensity in children presenting to the emergency department (ED) for the acute treatment of migraine compared with metoclopramide monotherapy.

Major finding: The mean change in pain intensity as assessed by a 100 mm Visual Analog Scale at 120 minutes was −44 mm (95% CI 32-57 mm) in the monotherapy group and −36 mm (95% CI 23-49 mm) in the ketorolac group, corresponding to a mean difference of 8 mm between the groups (P = .355),with no significant between-group difference in headache recurrence and adverse events.

Study details: Findings arefrom a double-blind, randomized placebo-controlled trialincluding 53children aged 6-17 years presenting to the ED for the acute treatment of migraine. They were randomly assigned to receive IV ketorolac plus metoclopramide (n=26) or IV metoclopramide plus placebo (n=27).

Disclosures: This study was funded by the Canadian Institutes of Health Research through a Drug Safety and Effectiveness Network grant. The authors declared no conflicts of interest.

Source: Richer LP et al.A randomized trial of ketorolac and metoclopramide for migraine in the emergency department.Headache. 2022; 62: 681-689(Jun 7). Doi:10.1111/head.14307

Key clinical point: Intravenous (IV) ketorolac plus metoclopramide failed to improve pain intensity in children presenting to the emergency department (ED) for the acute treatment of migraine compared with metoclopramide monotherapy.

Major finding: The mean change in pain intensity as assessed by a 100 mm Visual Analog Scale at 120 minutes was −44 mm (95% CI 32-57 mm) in the monotherapy group and −36 mm (95% CI 23-49 mm) in the ketorolac group, corresponding to a mean difference of 8 mm between the groups (P = .355),with no significant between-group difference in headache recurrence and adverse events.

Study details: Findings arefrom a double-blind, randomized placebo-controlled trialincluding 53children aged 6-17 years presenting to the ED for the acute treatment of migraine. They were randomly assigned to receive IV ketorolac plus metoclopramide (n=26) or IV metoclopramide plus placebo (n=27).

Disclosures: This study was funded by the Canadian Institutes of Health Research through a Drug Safety and Effectiveness Network grant. The authors declared no conflicts of interest.

Source: Richer LP et al.A randomized trial of ketorolac and metoclopramide for migraine in the emergency department.Headache. 2022; 62: 681-689(Jun 7). Doi:10.1111/head.14307

Key clinical point: Patients hospitalized with refractory chronic migraine treated with continuous multiday lidocaine infusions showed a significant improvement in pain immediately after the infusion, with some patients maintaining this improvement at 1 month.

Major finding: Medianpain ratings decreased from 7.0 on admission to 1.0 at discharge (P< .001), with 87.8% of admissions being cases of acute response. Among acute responders with data on average pain, 43.2% demonstrated sustained response at 1 month.

Study details: The data come from a retrospective cohort study of 609 hospital admissions involving 537 patients with refractory chronic migraine who received continuous multiday lidocaine infusions.

Disclosures: This study did not receive any specific funding. SD Silberstein declared serving as a consultant and advisory panel member for and receiving honoraria from various sources.

Source: Schwenk ES et al. Lidocaine infusions for refractory chronic migraine: A retrospective analysis. Reg Anesth Pain Med. 2022;47:408-413(May 23). Doi:10.1136/rapm-2021-103180

Key clinical point: Patients hospitalized with refractory chronic migraine treated with continuous multiday lidocaine infusions showed a significant improvement in pain immediately after the infusion, with some patients maintaining this improvement at 1 month.

Major finding: Medianpain ratings decreased from 7.0 on admission to 1.0 at discharge (P< .001), with 87.8% of admissions being cases of acute response. Among acute responders with data on average pain, 43.2% demonstrated sustained response at 1 month.

Study details: The data come from a retrospective cohort study of 609 hospital admissions involving 537 patients with refractory chronic migraine who received continuous multiday lidocaine infusions.

Disclosures: This study did not receive any specific funding. SD Silberstein declared serving as a consultant and advisory panel member for and receiving honoraria from various sources.

Source: Schwenk ES et al. Lidocaine infusions for refractory chronic migraine: A retrospective analysis. Reg Anesth Pain Med. 2022;47:408-413(May 23). Doi:10.1136/rapm-2021-103180

Key clinical point: Patients hospitalized with refractory chronic migraine treated with continuous multiday lidocaine infusions showed a significant improvement in pain immediately after the infusion, with some patients maintaining this improvement at 1 month.

Major finding: Medianpain ratings decreased from 7.0 on admission to 1.0 at discharge (P< .001), with 87.8% of admissions being cases of acute response. Among acute responders with data on average pain, 43.2% demonstrated sustained response at 1 month.

Study details: The data come from a retrospective cohort study of 609 hospital admissions involving 537 patients with refractory chronic migraine who received continuous multiday lidocaine infusions.

Disclosures: This study did not receive any specific funding. SD Silberstein declared serving as a consultant and advisory panel member for and receiving honoraria from various sources.

Source: Schwenk ES et al. Lidocaine infusions for refractory chronic migraine: A retrospective analysis. Reg Anesth Pain Med. 2022;47:408-413(May 23). Doi:10.1136/rapm-2021-103180

Key clinical point: Cold interventions, includingcold-gel headband, cold-gel cap, and intraoral cooling, provide instant relief from pain in patients with migraine; however, their long-term effects on pain are not significant.

Major finding: The cold intervention group vs. control group led to a significant reduction in pain on a visual analog scale score at 30 minutes (standard mean difference [SMD] −3.21; P = .02) but a nonsignificant reduction in the score at 24 hours (SMD −0.44; P = .07) after the intervention.

Study details: This was a meta-analysis of 6 studies (4 randomized controlled trials and 2 quasi-experimental studies) that included adult patients with migraine who underwent a cold intervention.

Disclosures: The study was partially sponsored by the Ministry of Science and Technology, Israel. The authors declared no conflicts of interest.

Source: Hsu Y-Y et al.Cold intervention for relieving migraine symptoms: A systematic review and meta-analysis. J Clin Nurs. 2022 (May 20). Doi:10.1111/jocn.16368

Key clinical point: Cold interventions, includingcold-gel headband, cold-gel cap, and intraoral cooling, provide instant relief from pain in patients with migraine; however, their long-term effects on pain are not significant.

Major finding: The cold intervention group vs. control group led to a significant reduction in pain on a visual analog scale score at 30 minutes (standard mean difference [SMD] −3.21; P = .02) but a nonsignificant reduction in the score at 24 hours (SMD −0.44; P = .07) after the intervention.

Study details: This was a meta-analysis of 6 studies (4 randomized controlled trials and 2 quasi-experimental studies) that included adult patients with migraine who underwent a cold intervention.

Disclosures: The study was partially sponsored by the Ministry of Science and Technology, Israel. The authors declared no conflicts of interest.

Source: Hsu Y-Y et al.Cold intervention for relieving migraine symptoms: A systematic review and meta-analysis. J Clin Nurs. 2022 (May 20). Doi:10.1111/jocn.16368

Key clinical point: Cold interventions, includingcold-gel headband, cold-gel cap, and intraoral cooling, provide instant relief from pain in patients with migraine; however, their long-term effects on pain are not significant.

Major finding: The cold intervention group vs. control group led to a significant reduction in pain on a visual analog scale score at 30 minutes (standard mean difference [SMD] −3.21; P = .02) but a nonsignificant reduction in the score at 24 hours (SMD −0.44; P = .07) after the intervention.

Study details: This was a meta-analysis of 6 studies (4 randomized controlled trials and 2 quasi-experimental studies) that included adult patients with migraine who underwent a cold intervention.

Disclosures: The study was partially sponsored by the Ministry of Science and Technology, Israel. The authors declared no conflicts of interest.

Source: Hsu Y-Y et al.Cold intervention for relieving migraine symptoms: A systematic review and meta-analysis. J Clin Nurs. 2022 (May 20). Doi:10.1111/jocn.16368

Key clinical point: As a migraine preventive agent, fremanezumab is effective across the full patient spectrum, including those with episodic migraine (EM), chronic migraine (CM), and difficult-to-treat (DTT) migraine (patients with medication overuse [MO], major depressive disorder [MDD], generalized anxiety disorder [GAD], or exposure to a different calcitonin gene-related peptide monoclonal antibody [CGRP mAb]).

Major finding: At month 6,the mean monthly migraine days reduced in patients with EM (−7.7 days), CM (−10.1 days), MO (−10.8 days), MDD (−9.9 days), GAD (−9.5 days), and prior CGRP mAb exposure (−9.0 days).

Study details: Findings are from aretrospective, online chart review study that collected data from 1003 patients with EM/CM aged ≥18 years at fremanezumab initiation, including those with DTT migraine, and 421 clinicians treating patients with EM/CM in a US-based practice.

Disclosures: This study was funded by Teva Pharmaceuticals. All authors declared being current or former employees of Teva Pharmaceuticals or Analysis Group, which performed these analyses funded by Teva.

Source: Driessen MT et al.Real-world effectiveness after initiating fremanezumab treatment in US patients with episodic and chronic migraine or difficult-to-treat migraine. J Headache Pain. 2022;23:56(May 16). Doi:10.1186/s10194-022-01415-x

Key clinical point: As a migraine preventive agent, fremanezumab is effective across the full patient spectrum, including those with episodic migraine (EM), chronic migraine (CM), and difficult-to-treat (DTT) migraine (patients with medication overuse [MO], major depressive disorder [MDD], generalized anxiety disorder [GAD], or exposure to a different calcitonin gene-related peptide monoclonal antibody [CGRP mAb]).

Major finding: At month 6,the mean monthly migraine days reduced in patients with EM (−7.7 days), CM (−10.1 days), MO (−10.8 days), MDD (−9.9 days), GAD (−9.5 days), and prior CGRP mAb exposure (−9.0 days).

Study details: Findings are from aretrospective, online chart review study that collected data from 1003 patients with EM/CM aged ≥18 years at fremanezumab initiation, including those with DTT migraine, and 421 clinicians treating patients with EM/CM in a US-based practice.

Disclosures: This study was funded by Teva Pharmaceuticals. All authors declared being current or former employees of Teva Pharmaceuticals or Analysis Group, which performed these analyses funded by Teva.

Source: Driessen MT et al.Real-world effectiveness after initiating fremanezumab treatment in US patients with episodic and chronic migraine or difficult-to-treat migraine. J Headache Pain. 2022;23:56(May 16). Doi:10.1186/s10194-022-01415-x

Key clinical point: As a migraine preventive agent, fremanezumab is effective across the full patient spectrum, including those with episodic migraine (EM), chronic migraine (CM), and difficult-to-treat (DTT) migraine (patients with medication overuse [MO], major depressive disorder [MDD], generalized anxiety disorder [GAD], or exposure to a different calcitonin gene-related peptide monoclonal antibody [CGRP mAb]).

Major finding: At month 6,the mean monthly migraine days reduced in patients with EM (−7.7 days), CM (−10.1 days), MO (−10.8 days), MDD (−9.9 days), GAD (−9.5 days), and prior CGRP mAb exposure (−9.0 days).

Study details: Findings are from aretrospective, online chart review study that collected data from 1003 patients with EM/CM aged ≥18 years at fremanezumab initiation, including those with DTT migraine, and 421 clinicians treating patients with EM/CM in a US-based practice.

Disclosures: This study was funded by Teva Pharmaceuticals. All authors declared being current or former employees of Teva Pharmaceuticals or Analysis Group, which performed these analyses funded by Teva.

Source: Driessen MT et al.Real-world effectiveness after initiating fremanezumab treatment in US patients with episodic and chronic migraine or difficult-to-treat migraine. J Headache Pain. 2022;23:56(May 16). Doi:10.1186/s10194-022-01415-x

Key clinical point: A dose of 120 mg galcanezumab subcutaneously safely and effectively reduces headache frequency, intensity, and duration in patients with episodic and chronic migraine and previous unsuccessful preventive treatments.

Major finding: The 6-month galcanezumab treatment led to a significant decrease in the headache attack frequency (−14.19 headache days/month; P< .001), headache attack pain intensity (numerical rating scale score −2.74; P< .001), and headache attack duration (−6.65 hours; P< .001).

Study details: The data come from an observational, prospective study including 43 patients with episodic high frequency and chronic migraine and unsuccessful treatment with≥3 preventive medication classes who received monthly 120 mg galcanezumab subcutaneously.

Disclosures: This study received no specific funding. Some authors declared receiving speaker honoraria and travel funding from various sources and serving as associate editors of neurology journals such as European Journal of Neurology.

Source: Silvestro M et al. Galcanezumab effect on “whole pain burden” and multidimensional outcomes in migraine patients with previous unsuccessful treatments: A real-world experience.J Headache Pain. 2022;23:69(Jun 13. Doi: 10.1186/s10194-022-01436-6

Key clinical point: A dose of 120 mg galcanezumab subcutaneously safely and effectively reduces headache frequency, intensity, and duration in patients with episodic and chronic migraine and previous unsuccessful preventive treatments.

Major finding: The 6-month galcanezumab treatment led to a significant decrease in the headache attack frequency (−14.19 headache days/month; P< .001), headache attack pain intensity (numerical rating scale score −2.74; P< .001), and headache attack duration (−6.65 hours; P< .001).

Study details: The data come from an observational, prospective study including 43 patients with episodic high frequency and chronic migraine and unsuccessful treatment with≥3 preventive medication classes who received monthly 120 mg galcanezumab subcutaneously.

Disclosures: This study received no specific funding. Some authors declared receiving speaker honoraria and travel funding from various sources and serving as associate editors of neurology journals such as European Journal of Neurology.

Source: Silvestro M et al. Galcanezumab effect on “whole pain burden” and multidimensional outcomes in migraine patients with previous unsuccessful treatments: A real-world experience.J Headache Pain. 2022;23:69(Jun 13. Doi: 10.1186/s10194-022-01436-6

Key clinical point: A dose of 120 mg galcanezumab subcutaneously safely and effectively reduces headache frequency, intensity, and duration in patients with episodic and chronic migraine and previous unsuccessful preventive treatments.

Major finding: The 6-month galcanezumab treatment led to a significant decrease in the headache attack frequency (−14.19 headache days/month; P< .001), headache attack pain intensity (numerical rating scale score −2.74; P< .001), and headache attack duration (−6.65 hours; P< .001).

Study details: The data come from an observational, prospective study including 43 patients with episodic high frequency and chronic migraine and unsuccessful treatment with≥3 preventive medication classes who received monthly 120 mg galcanezumab subcutaneously.

Disclosures: This study received no specific funding. Some authors declared receiving speaker honoraria and travel funding from various sources and serving as associate editors of neurology journals such as European Journal of Neurology.

Source: Silvestro M et al. Galcanezumab effect on “whole pain burden” and multidimensional outcomes in migraine patients with previous unsuccessful treatments: A real-world experience.J Headache Pain. 2022;23:69(Jun 13. Doi: 10.1186/s10194-022-01436-6