Key clinical point: In patients with migraine, an increase in monthly headache days (MHD) adversely impacts health-related quality of life (HRQoL) measured by the Migraine-Specific Quality-of-Life Questionnaire (MSQ), with the impact being partially mediated by depression, allodynia, and anxiety.

Major finding: For every 1-day increase in the MHD, the scores for MSQ’s Role Function-Restrictive, Role Function-Preventive, and Emotional Function parameters worsened by 0.92, 0.60, and 1.23 points, respectively (all P < .001). Depression, allodynia, and anxiety mediated 15.2%-24.3%, 9.6%-16.1%, and 2.3%-6.0%, respectively, of the total observed effects of MHD on the HRQoL.

Study details: Findings are from a post hoc analysis of the CaMEO study including 12,715 patients with migraine who completed the Core and Comorbidities/Endophenotypes modules.

Disclosures: This study was funded by Allergan (prior to its acquisition by AbbVie). B Dabruzzo declared being an employee of AbbVie and may own its stocks. The other authors declared ties with various sources, including AbbVie.

Source: Lipton RB et al. Impact of monthly headache days on migraine-related quality of life: Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Headache. 2023 (Oct 5). doi: 10.1111/head.14629

Key clinical point: In patients with migraine, an increase in monthly headache days (MHD) adversely impacts health-related quality of life (HRQoL) measured by the Migraine-Specific Quality-of-Life Questionnaire (MSQ), with the impact being partially mediated by depression, allodynia, and anxiety.

Major finding: For every 1-day increase in the MHD, the scores for MSQ’s Role Function-Restrictive, Role Function-Preventive, and Emotional Function parameters worsened by 0.92, 0.60, and 1.23 points, respectively (all P < .001). Depression, allodynia, and anxiety mediated 15.2%-24.3%, 9.6%-16.1%, and 2.3%-6.0%, respectively, of the total observed effects of MHD on the HRQoL.

Study details: Findings are from a post hoc analysis of the CaMEO study including 12,715 patients with migraine who completed the Core and Comorbidities/Endophenotypes modules.

Disclosures: This study was funded by Allergan (prior to its acquisition by AbbVie). B Dabruzzo declared being an employee of AbbVie and may own its stocks. The other authors declared ties with various sources, including AbbVie.

Source: Lipton RB et al. Impact of monthly headache days on migraine-related quality of life: Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Headache. 2023 (Oct 5). doi: 10.1111/head.14629

Key clinical point: In patients with migraine, an increase in monthly headache days (MHD) adversely impacts health-related quality of life (HRQoL) measured by the Migraine-Specific Quality-of-Life Questionnaire (MSQ), with the impact being partially mediated by depression, allodynia, and anxiety.

Major finding: For every 1-day increase in the MHD, the scores for MSQ’s Role Function-Restrictive, Role Function-Preventive, and Emotional Function parameters worsened by 0.92, 0.60, and 1.23 points, respectively (all P < .001). Depression, allodynia, and anxiety mediated 15.2%-24.3%, 9.6%-16.1%, and 2.3%-6.0%, respectively, of the total observed effects of MHD on the HRQoL.

Study details: Findings are from a post hoc analysis of the CaMEO study including 12,715 patients with migraine who completed the Core and Comorbidities/Endophenotypes modules.

Disclosures: This study was funded by Allergan (prior to its acquisition by AbbVie). B Dabruzzo declared being an employee of AbbVie and may own its stocks. The other authors declared ties with various sources, including AbbVie.

Source: Lipton RB et al. Impact of monthly headache days on migraine-related quality of life: Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Headache. 2023 (Oct 5). doi: 10.1111/head.14629

Key clinical point: Valproic acid, propranolol, and venlafaxine significantly improved vestibular migraine frequency but had no significant differences in terms of vestibular migraine severity, dropout rates, and safety profiles compared with placebo.

Major finding: Compared with placebo, valproic acid (standardized mean difference [SMD] −1.61; 95% CI −2.69 to −0.54), propranolol (SMD −1.36; 95% CI −2.55 to −0.17), and venlafaxine (SMD −1.25; 95% CI −2.32 to −0.18) led to better improvement in vestibular migraine frequency. However, vestibular migraine severity, dropout rates, and safety profiles did not differ significantly between the treatment groups.

Study details: This network meta-analysis of seven randomized controlled trials included 828 patients with vestibular migraine.

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

Source: Chen J-J et al. Network meta-analysis of different treatments for vestibular migraine. CNS Drugs. 2023;37(9):837-847 (Sep 7). doi: 10.1007/s40263-023-01037-0

Key clinical point: Valproic acid, propranolol, and venlafaxine significantly improved vestibular migraine frequency but had no significant differences in terms of vestibular migraine severity, dropout rates, and safety profiles compared with placebo.

Major finding: Compared with placebo, valproic acid (standardized mean difference [SMD] −1.61; 95% CI −2.69 to −0.54), propranolol (SMD −1.36; 95% CI −2.55 to −0.17), and venlafaxine (SMD −1.25; 95% CI −2.32 to −0.18) led to better improvement in vestibular migraine frequency. However, vestibular migraine severity, dropout rates, and safety profiles did not differ significantly between the treatment groups.

Study details: This network meta-analysis of seven randomized controlled trials included 828 patients with vestibular migraine.

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

Source: Chen J-J et al. Network meta-analysis of different treatments for vestibular migraine. CNS Drugs. 2023;37(9):837-847 (Sep 7). doi: 10.1007/s40263-023-01037-0

Key clinical point: Valproic acid, propranolol, and venlafaxine significantly improved vestibular migraine frequency but had no significant differences in terms of vestibular migraine severity, dropout rates, and safety profiles compared with placebo.

Major finding: Compared with placebo, valproic acid (standardized mean difference [SMD] −1.61; 95% CI −2.69 to −0.54), propranolol (SMD −1.36; 95% CI −2.55 to −0.17), and venlafaxine (SMD −1.25; 95% CI −2.32 to −0.18) led to better improvement in vestibular migraine frequency. However, vestibular migraine severity, dropout rates, and safety profiles did not differ significantly between the treatment groups.

Study details: This network meta-analysis of seven randomized controlled trials included 828 patients with vestibular migraine.

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

Source: Chen J-J et al. Network meta-analysis of different treatments for vestibular migraine. CNS Drugs. 2023;37(9):837-847 (Sep 7). doi: 10.1007/s40263-023-01037-0

Key clinical point: High dietary potassium intake is associated with a decreased risk for migraine, with an L-shaped correlation between dietary potassium intake and migraine highlighting an inflection at ~1,439.3 mg/day.

Major finding: Participants in the second quartile (potassium intake 1771-2476 mg/day) vs first quartile (potassium intake ≤ 1771 mg/day) showed a lower risk for migraine (adjusted odds ratio 0.84; P = .021), which suggested an L-shaped (non-linear) association between dietary potassium intake and migraine (P = .016), with an inflection at ~1439.3 mg/day.

Study details: This cross-sectional study included 10,254 participants age ≥ 20 years, of whom 2065 (20.1%) had migraine.

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

Source: Xu L et al. Association between dietary potassium intake and severe headache or migraine in US adults: A population-based analysis. Front Nutr. 2023;10:1255468 (Sep 15). doi:  10.3389/fnut.2023.1255468

Key clinical point: High dietary potassium intake is associated with a decreased risk for migraine, with an L-shaped correlation between dietary potassium intake and migraine highlighting an inflection at ~1,439.3 mg/day.

Major finding: Participants in the second quartile (potassium intake 1771-2476 mg/day) vs first quartile (potassium intake ≤ 1771 mg/day) showed a lower risk for migraine (adjusted odds ratio 0.84; P = .021), which suggested an L-shaped (non-linear) association between dietary potassium intake and migraine (P = .016), with an inflection at ~1439.3 mg/day.

Study details: This cross-sectional study included 10,254 participants age ≥ 20 years, of whom 2065 (20.1%) had migraine.

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

Source: Xu L et al. Association between dietary potassium intake and severe headache or migraine in US adults: A population-based analysis. Front Nutr. 2023;10:1255468 (Sep 15). doi:  10.3389/fnut.2023.1255468

Key clinical point: High dietary potassium intake is associated with a decreased risk for migraine, with an L-shaped correlation between dietary potassium intake and migraine highlighting an inflection at ~1,439.3 mg/day.

Major finding: Participants in the second quartile (potassium intake 1771-2476 mg/day) vs first quartile (potassium intake ≤ 1771 mg/day) showed a lower risk for migraine (adjusted odds ratio 0.84; P = .021), which suggested an L-shaped (non-linear) association between dietary potassium intake and migraine (P = .016), with an inflection at ~1439.3 mg/day.

Study details: This cross-sectional study included 10,254 participants age ≥ 20 years, of whom 2065 (20.1%) had migraine.

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

Source: Xu L et al. Association between dietary potassium intake and severe headache or migraine in US adults: A population-based analysis. Front Nutr. 2023;10:1255468 (Sep 15). doi:  10.3389/fnut.2023.1255468

TOPLINE: 

A new study shows that piperacillin-tazobactam and cefepime are equally safe for acute kidney injury (AKI) in acute infection, with cefepime linked to more neurological issues.

METHODOLOGY:

The coadministration of piperacillin-tazobactam and vancomycin may raise the risk for AKI, according to a warning from the Food and Drug Administration.

The ACORN trial included 2,511 adults presenting to emergency department or intensive care unit with suspected infection.

Within 12 hours of presentation, these individuals were prescribed either cefepime (n = 1,214) or piperacillin-tazobactam (n = 1,297).

The primary outcome was the risk for the highest stage of AKI or death within 14 days of randomization.
 

TAKEAWAY:

The highest stage of AKI or death within 14 days did not differ significantly between the cefepime and piperacillin-tazobactam groups (odds ratio, 0.95; P = .56).

The incidence of major adverse kidney events by day 14 was not significantly different between the two groups (absolute risk difference, 1.4%; 95% confidence interval, −1.0% to 3.8%).

Patients in the cefepime versus piperacillin-tazobactam group had fewer days alive and free of delirium and coma within 14 days (OR, 0.79; 95% CI, 0.65-0.95).
 

IN PRACTICE:

In an accompanying editorial, Steven Y. C. Tong, department of infectious diseases, University of Melbourne, and colleagues wrote: “Because institutions must make decisions about which antibiotics to position on medical wards for rapid administration in patients meeting sepsis criteria, these data should offer solace that if the choice is made to use piperacillin-tazobactam, there is not an increased risk of AKI.”

SOURCE:

The study was led by Edward T. Qian, MD, of Vanderbilt University Medical Center, Nashville, Tenn. It was published online in JAMA with an accompanying editorial.

LIMITATIONS:

The study was conducted at a single academic center, which may limit the generalizability of findings.

Both patients and clinicians were not blinded to group assignment, which may have influenced clinical assessments like Richmond Agitation-Sedation Scale and CAM-ICU or the frequency of laboratory measurements like creatinine.
 

DISCLOSURES:

The project was supported by the Vanderbilt Institute for Clinical and Translational Research and several other sources, including grants from the National Center for Advancing Translational Sciences. Some authors declared receiving travel grant, personal fees, honoraria, and unrelated research support from various sources.

A version of this article appeared on Medscape.com.

TOPLINE: 

A new study shows that piperacillin-tazobactam and cefepime are equally safe for acute kidney injury (AKI) in acute infection, with cefepime linked to more neurological issues.

METHODOLOGY:

The coadministration of piperacillin-tazobactam and vancomycin may raise the risk for AKI, according to a warning from the Food and Drug Administration.

The ACORN trial included 2,511 adults presenting to emergency department or intensive care unit with suspected infection.

Within 12 hours of presentation, these individuals were prescribed either cefepime (n = 1,214) or piperacillin-tazobactam (n = 1,297).

The primary outcome was the risk for the highest stage of AKI or death within 14 days of randomization.
 

TAKEAWAY:

The highest stage of AKI or death within 14 days did not differ significantly between the cefepime and piperacillin-tazobactam groups (odds ratio, 0.95; P = .56).

The incidence of major adverse kidney events by day 14 was not significantly different between the two groups (absolute risk difference, 1.4%; 95% confidence interval, −1.0% to 3.8%).

Patients in the cefepime versus piperacillin-tazobactam group had fewer days alive and free of delirium and coma within 14 days (OR, 0.79; 95% CI, 0.65-0.95).
 

IN PRACTICE:

In an accompanying editorial, Steven Y. C. Tong, department of infectious diseases, University of Melbourne, and colleagues wrote: “Because institutions must make decisions about which antibiotics to position on medical wards for rapid administration in patients meeting sepsis criteria, these data should offer solace that if the choice is made to use piperacillin-tazobactam, there is not an increased risk of AKI.”

SOURCE:

The study was led by Edward T. Qian, MD, of Vanderbilt University Medical Center, Nashville, Tenn. It was published online in JAMA with an accompanying editorial.

LIMITATIONS:

The study was conducted at a single academic center, which may limit the generalizability of findings.

Both patients and clinicians were not blinded to group assignment, which may have influenced clinical assessments like Richmond Agitation-Sedation Scale and CAM-ICU or the frequency of laboratory measurements like creatinine.
 

DISCLOSURES:

The project was supported by the Vanderbilt Institute for Clinical and Translational Research and several other sources, including grants from the National Center for Advancing Translational Sciences. Some authors declared receiving travel grant, personal fees, honoraria, and unrelated research support from various sources.

A version of this article appeared on Medscape.com.

TOPLINE: 

A new study shows that piperacillin-tazobactam and cefepime are equally safe for acute kidney injury (AKI) in acute infection, with cefepime linked to more neurological issues.

METHODOLOGY:

The coadministration of piperacillin-tazobactam and vancomycin may raise the risk for AKI, according to a warning from the Food and Drug Administration.

The ACORN trial included 2,511 adults presenting to emergency department or intensive care unit with suspected infection.

Within 12 hours of presentation, these individuals were prescribed either cefepime (n = 1,214) or piperacillin-tazobactam (n = 1,297).

The primary outcome was the risk for the highest stage of AKI or death within 14 days of randomization.
 

TAKEAWAY:

The highest stage of AKI or death within 14 days did not differ significantly between the cefepime and piperacillin-tazobactam groups (odds ratio, 0.95; P = .56).

The incidence of major adverse kidney events by day 14 was not significantly different between the two groups (absolute risk difference, 1.4%; 95% confidence interval, −1.0% to 3.8%).

Patients in the cefepime versus piperacillin-tazobactam group had fewer days alive and free of delirium and coma within 14 days (OR, 0.79; 95% CI, 0.65-0.95).
 

IN PRACTICE:

In an accompanying editorial, Steven Y. C. Tong, department of infectious diseases, University of Melbourne, and colleagues wrote: “Because institutions must make decisions about which antibiotics to position on medical wards for rapid administration in patients meeting sepsis criteria, these data should offer solace that if the choice is made to use piperacillin-tazobactam, there is not an increased risk of AKI.”

SOURCE:

The study was led by Edward T. Qian, MD, of Vanderbilt University Medical Center, Nashville, Tenn. It was published online in JAMA with an accompanying editorial.

LIMITATIONS:

The study was conducted at a single academic center, which may limit the generalizability of findings.

Both patients and clinicians were not blinded to group assignment, which may have influenced clinical assessments like Richmond Agitation-Sedation Scale and CAM-ICU or the frequency of laboratory measurements like creatinine.
 

DISCLOSURES:

The project was supported by the Vanderbilt Institute for Clinical and Translational Research and several other sources, including grants from the National Center for Advancing Translational Sciences. Some authors declared receiving travel grant, personal fees, honoraria, and unrelated research support from various sources.

A version of this article appeared on Medscape.com.

Key clinical point: Poor sleep could be a significant risk factor for an ensuing migraine attack, and an intensely painful migraine attack may lead to a subsequent increase in sleep duration, thus highlighting that sleep hygiene is an inherent part of migraine management.

Major finding: The odds of having a migraine attack increased by 6.1% and 17.4% with every deviation from mean sleep and every sleep interruption, respectively, during the previous day, whereas the overall sleep duration had no effect on attack occurrences. An intensely painful attack (M = 0.13; 95% high density interval 0.06-0.20) positively predicted increased sleep duration during the same evening.

Study details: This retrospective cross-sectional study included 724 patients (ages, 18-81 years) with a mean monthly migraine attack frequency of 9.94.

Disclosures: This study was supported by a UK Medical Research Council PhD studentship. Two authors declared being employees of Healint Pte. Ltd, and some authors declared ties with various sources.

Source: Stanyer EC et al. Investigating the relationship between sleep and migraine in a global sample: A Bayesian cross-sectional approach. J Headache Pain. 2023;24:123 (Sep 8). doi: 10.1186/s10194-023-01638-6

Key clinical point: Poor sleep could be a significant risk factor for an ensuing migraine attack, and an intensely painful migraine attack may lead to a subsequent increase in sleep duration, thus highlighting that sleep hygiene is an inherent part of migraine management.

Major finding: The odds of having a migraine attack increased by 6.1% and 17.4% with every deviation from mean sleep and every sleep interruption, respectively, during the previous day, whereas the overall sleep duration had no effect on attack occurrences. An intensely painful attack (M = 0.13; 95% high density interval 0.06-0.20) positively predicted increased sleep duration during the same evening.

Study details: This retrospective cross-sectional study included 724 patients (ages, 18-81 years) with a mean monthly migraine attack frequency of 9.94.

Disclosures: This study was supported by a UK Medical Research Council PhD studentship. Two authors declared being employees of Healint Pte. Ltd, and some authors declared ties with various sources.

Source: Stanyer EC et al. Investigating the relationship between sleep and migraine in a global sample: A Bayesian cross-sectional approach. J Headache Pain. 2023;24:123 (Sep 8). doi: 10.1186/s10194-023-01638-6

Key clinical point: Poor sleep could be a significant risk factor for an ensuing migraine attack, and an intensely painful migraine attack may lead to a subsequent increase in sleep duration, thus highlighting that sleep hygiene is an inherent part of migraine management.

Major finding: The odds of having a migraine attack increased by 6.1% and 17.4% with every deviation from mean sleep and every sleep interruption, respectively, during the previous day, whereas the overall sleep duration had no effect on attack occurrences. An intensely painful attack (M = 0.13; 95% high density interval 0.06-0.20) positively predicted increased sleep duration during the same evening.

Study details: This retrospective cross-sectional study included 724 patients (ages, 18-81 years) with a mean monthly migraine attack frequency of 9.94.

Disclosures: This study was supported by a UK Medical Research Council PhD studentship. Two authors declared being employees of Healint Pte. Ltd, and some authors declared ties with various sources.

Source: Stanyer EC et al. Investigating the relationship between sleep and migraine in a global sample: A Bayesian cross-sectional approach. J Headache Pain. 2023;24:123 (Sep 8). doi: 10.1186/s10194-023-01638-6

Key clinical point: In this real-world study of patients with migraine, galcanezumab showed higher response rates than those reported in clinical trials, with chronic migraine (CM) and multiple failures to previous preventive medication being significant predictors of a poor response to galcanezumab.

Major finding: At 3 months of galcanezumab treatment, 55.7% of patients showed a 50% response to galcanezumab. CM (odds ratio [OR] 0.09; P = .047) and the number of previous nonresponse to preventive medication classes (OR 0.55; P = .022) were significantly associated with a poor response to galcanezumab.

Study details: This real-world study involved a prospective follow-up of 104 patients with migraine who received monthly galcanezumab.

Disclosures: This study was supported by the New Faculty Startup Fund from Seoul National University and a National Research Foundation of Korea grant. The authors declared no conflicts of interest.

Source: Kim SA et al. Predictors of galcanezumab response in a real-world study of Korean patients with migraine. Sci Rep. 2023;13:14825 (Sep 8). doi: 10.1038/s41598-023-42110-4

Key clinical point: In this real-world study of patients with migraine, galcanezumab showed higher response rates than those reported in clinical trials, with chronic migraine (CM) and multiple failures to previous preventive medication being significant predictors of a poor response to galcanezumab.

Major finding: At 3 months of galcanezumab treatment, 55.7% of patients showed a 50% response to galcanezumab. CM (odds ratio [OR] 0.09; P = .047) and the number of previous nonresponse to preventive medication classes (OR 0.55; P = .022) were significantly associated with a poor response to galcanezumab.

Study details: This real-world study involved a prospective follow-up of 104 patients with migraine who received monthly galcanezumab.

Disclosures: This study was supported by the New Faculty Startup Fund from Seoul National University and a National Research Foundation of Korea grant. The authors declared no conflicts of interest.

Source: Kim SA et al. Predictors of galcanezumab response in a real-world study of Korean patients with migraine. Sci Rep. 2023;13:14825 (Sep 8). doi: 10.1038/s41598-023-42110-4

Key clinical point: In this real-world study of patients with migraine, galcanezumab showed higher response rates than those reported in clinical trials, with chronic migraine (CM) and multiple failures to previous preventive medication being significant predictors of a poor response to galcanezumab.

Major finding: At 3 months of galcanezumab treatment, 55.7% of patients showed a 50% response to galcanezumab. CM (odds ratio [OR] 0.09; P = .047) and the number of previous nonresponse to preventive medication classes (OR 0.55; P = .022) were significantly associated with a poor response to galcanezumab.

Study details: This real-world study involved a prospective follow-up of 104 patients with migraine who received monthly galcanezumab.

Disclosures: This study was supported by the New Faculty Startup Fund from Seoul National University and a National Research Foundation of Korea grant. The authors declared no conflicts of interest.

Source: Kim SA et al. Predictors of galcanezumab response in a real-world study of Korean patients with migraine. Sci Rep. 2023;13:14825 (Sep 8). doi: 10.1038/s41598-023-42110-4

Key clinical point: A significant proportion of patients with migraine do not respond to ≥1 triptans, and this lack of response is associated with increased migraine severity and disability.

Major finding: Overall, 42.5%, 13.1%, 3.9%, and 0.6% of patients did not respond to ≥1, ≥2 triptans, ≥3 triptans, and ≥3 triptans including a subcutaneous formulation, respectively, with triptan non-responders vs responders having a significantly higher migraine frequency (P < .001), intensity (P < .05), and disability (P < .001).

Study details: This study evaluated 2284 patients with migraine using cross-sectional data from the German Migraine and Headache Society Headache Registry.

Disclosures: This study was supported by Projekt DEAL. Several authors declared serving as advisory boards members or consultants for or receiving travel or research grants or honoraria for consulting, lectures, advisory boards, adboards, and educational talks from various sources.

Source: Ruscheweyh R et al. Triptan non-response in specialized headache care: Cross-sectional data from the DMKG Headache Registry. J Headache Pain. 2023;24:135 (Oct 10). doi: 10.1186/s10194-023-01676-0

Key clinical point: A significant proportion of patients with migraine do not respond to ≥1 triptans, and this lack of response is associated with increased migraine severity and disability.

Major finding: Overall, 42.5%, 13.1%, 3.9%, and 0.6% of patients did not respond to ≥1, ≥2 triptans, ≥3 triptans, and ≥3 triptans including a subcutaneous formulation, respectively, with triptan non-responders vs responders having a significantly higher migraine frequency (P < .001), intensity (P < .05), and disability (P < .001).

Study details: This study evaluated 2284 patients with migraine using cross-sectional data from the German Migraine and Headache Society Headache Registry.

Disclosures: This study was supported by Projekt DEAL. Several authors declared serving as advisory boards members or consultants for or receiving travel or research grants or honoraria for consulting, lectures, advisory boards, adboards, and educational talks from various sources.

Source: Ruscheweyh R et al. Triptan non-response in specialized headache care: Cross-sectional data from the DMKG Headache Registry. J Headache Pain. 2023;24:135 (Oct 10). doi: 10.1186/s10194-023-01676-0

Key clinical point: A significant proportion of patients with migraine do not respond to ≥1 triptans, and this lack of response is associated with increased migraine severity and disability.

Major finding: Overall, 42.5%, 13.1%, 3.9%, and 0.6% of patients did not respond to ≥1, ≥2 triptans, ≥3 triptans, and ≥3 triptans including a subcutaneous formulation, respectively, with triptan non-responders vs responders having a significantly higher migraine frequency (P < .001), intensity (P < .05), and disability (P < .001).

Study details: This study evaluated 2284 patients with migraine using cross-sectional data from the German Migraine and Headache Society Headache Registry.

Disclosures: This study was supported by Projekt DEAL. Several authors declared serving as advisory boards members or consultants for or receiving travel or research grants or honoraria for consulting, lectures, advisory boards, adboards, and educational talks from various sources.

Source: Ruscheweyh R et al. Triptan non-response in specialized headache care: Cross-sectional data from the DMKG Headache Registry. J Headache Pain. 2023;24:135 (Oct 10). doi: 10.1186/s10194-023-01676-0

Key clinical point: Cutaneous allodynia and aura contribute significantly to the risk for calcitonin gene-related peptide (CGRP)-induced migraine attacks in patients having migraine with or without aura.

Major finding: Overall, 79% of patients had CGRP-induced migraine attacks during a 12-hour observation period following CGRP infusion. The presence of cutaneous allodynia and aura, respectively, led to significant increase (odds ratio [OR] 3.26; P = .013) and decrease (OR 0.32; P = .02) in the risk for CGRP-induced migraine attacks.

Study details: The data come from a non-randomized, open-label trial including 139 patients having migraine with or without aura who received a continuous 20-min intravenous infusion of CGRP (dosage, 1.5 mg/minute).

Disclosures: This study was funded by a professor grant from the Lundbeck Foundation, Denmark. Five authors declared receiving personal fees and institutional grants from various sources. M Ashina declared serving as an associate editor of Cephalalgia, The Journal of Headache and Pain, and Brain.

Source: Al-Khazali HM et al. An exploratory analysis of clinical and sociodemographic factors in CGRP-induced migraine attacks: A REFORM study. Cephalalgia. 2023 (Oct 10). doi: 10.1177/03331024231206375

Key clinical point: Cutaneous allodynia and aura contribute significantly to the risk for calcitonin gene-related peptide (CGRP)-induced migraine attacks in patients having migraine with or without aura.

Major finding: Overall, 79% of patients had CGRP-induced migraine attacks during a 12-hour observation period following CGRP infusion. The presence of cutaneous allodynia and aura, respectively, led to significant increase (odds ratio [OR] 3.26; P = .013) and decrease (OR 0.32; P = .02) in the risk for CGRP-induced migraine attacks.

Study details: The data come from a non-randomized, open-label trial including 139 patients having migraine with or without aura who received a continuous 20-min intravenous infusion of CGRP (dosage, 1.5 mg/minute).

Disclosures: This study was funded by a professor grant from the Lundbeck Foundation, Denmark. Five authors declared receiving personal fees and institutional grants from various sources. M Ashina declared serving as an associate editor of Cephalalgia, The Journal of Headache and Pain, and Brain.

Source: Al-Khazali HM et al. An exploratory analysis of clinical and sociodemographic factors in CGRP-induced migraine attacks: A REFORM study. Cephalalgia. 2023 (Oct 10). doi: 10.1177/03331024231206375

Key clinical point: Cutaneous allodynia and aura contribute significantly to the risk for calcitonin gene-related peptide (CGRP)-induced migraine attacks in patients having migraine with or without aura.

Major finding: Overall, 79% of patients had CGRP-induced migraine attacks during a 12-hour observation period following CGRP infusion. The presence of cutaneous allodynia and aura, respectively, led to significant increase (odds ratio [OR] 3.26; P = .013) and decrease (OR 0.32; P = .02) in the risk for CGRP-induced migraine attacks.

Study details: The data come from a non-randomized, open-label trial including 139 patients having migraine with or without aura who received a continuous 20-min intravenous infusion of CGRP (dosage, 1.5 mg/minute).

Disclosures: This study was funded by a professor grant from the Lundbeck Foundation, Denmark. Five authors declared receiving personal fees and institutional grants from various sources. M Ashina declared serving as an associate editor of Cephalalgia, The Journal of Headache and Pain, and Brain.

Source: Al-Khazali HM et al. An exploratory analysis of clinical and sociodemographic factors in CGRP-induced migraine attacks: A REFORM study. Cephalalgia. 2023 (Oct 10). doi: 10.1177/03331024231206375

Key clinical point: Add-on therapy with a low fixed dose of levothyroxine significantly reduced the headache frequency and severity in patients with episodic migraine and subclinical hypothyroidism.

Major finding: At a 3-month follow-up, patients receiving levothyroxine supplementation vs placebo showed a significant reduction in the mean headache frequency (1.67 vs 3.28) and severity (2.05 vs 3.20; both P = .001), mean Migraine Disability Assessment Score (MIDAS; 6.30 vs 8.45; P = .026), and mean MIDAS grade (1.49 vs 1.84; P = .029).

Study details: The data come from a prospective, quasi-randomized interventional study including 87 patients with episodic migraine and subclinical hypothyroidism who were quasi-randomized to the levothyroxine supplementation (n = 43) or placebo (n = 44) arm.

Disclosures: This study was supported by an Institution of Eminence, India, grant. The authors declared no conflicts of interest.

Source: Dev P et al. The effect of low dose thyroid replacement therapy in patients with episodic migraine and subclinical hypothyroidism: A randomised placebo-controlled trial. Cephalalgia. 2023 (Oct 6). doi: 10.1177/03331024231182684

Key clinical point: Add-on therapy with a low fixed dose of levothyroxine significantly reduced the headache frequency and severity in patients with episodic migraine and subclinical hypothyroidism.

Major finding: At a 3-month follow-up, patients receiving levothyroxine supplementation vs placebo showed a significant reduction in the mean headache frequency (1.67 vs 3.28) and severity (2.05 vs 3.20; both P = .001), mean Migraine Disability Assessment Score (MIDAS; 6.30 vs 8.45; P = .026), and mean MIDAS grade (1.49 vs 1.84; P = .029).

Study details: The data come from a prospective, quasi-randomized interventional study including 87 patients with episodic migraine and subclinical hypothyroidism who were quasi-randomized to the levothyroxine supplementation (n = 43) or placebo (n = 44) arm.

Disclosures: This study was supported by an Institution of Eminence, India, grant. The authors declared no conflicts of interest.

Source: Dev P et al. The effect of low dose thyroid replacement therapy in patients with episodic migraine and subclinical hypothyroidism: A randomised placebo-controlled trial. Cephalalgia. 2023 (Oct 6). doi: 10.1177/03331024231182684

Key clinical point: Add-on therapy with a low fixed dose of levothyroxine significantly reduced the headache frequency and severity in patients with episodic migraine and subclinical hypothyroidism.

Major finding: At a 3-month follow-up, patients receiving levothyroxine supplementation vs placebo showed a significant reduction in the mean headache frequency (1.67 vs 3.28) and severity (2.05 vs 3.20; both P = .001), mean Migraine Disability Assessment Score (MIDAS; 6.30 vs 8.45; P = .026), and mean MIDAS grade (1.49 vs 1.84; P = .029).

Study details: The data come from a prospective, quasi-randomized interventional study including 87 patients with episodic migraine and subclinical hypothyroidism who were quasi-randomized to the levothyroxine supplementation (n = 43) or placebo (n = 44) arm.

Disclosures: This study was supported by an Institution of Eminence, India, grant. The authors declared no conflicts of interest.

Source: Dev P et al. The effect of low dose thyroid replacement therapy in patients with episodic migraine and subclinical hypothyroidism: A randomised placebo-controlled trial. Cephalalgia. 2023 (Oct 6). doi: 10.1177/03331024231182684

Key clinical point: Repetitive intravenous dihydroergotamine (DHE) administration using an inpatient protocol seemed effective and tolerable in patients with refractory chronic migraine (rCM), even in those at an elevated risk for atherosclerotic cardiovascular disease (ASCVD).

Major finding: The elevated-ASCVD vs low-ASCVD risk group had fewer patients receiving the maximum dose of DHE (42.2% vs 64.4%; P = .002) and lower median doses of DHE on discharge (0.75 vs 1.00 mg; P < .001). Both groups experienced significant pain reduction, but it was more pronounced in the low-ASCVD risk group (P = .037). No significant cardiovascular adverse events or electrocardiogram abnormalities were reported in either group.

Study details: This single-center retrospective cohort study included 347 patients with rCM who received inpatient intravenous DHE, of whom 64 and 163 patients had elevated and low ASCVD risk, respectively.

Disclosures: This study was partially funded by Impel Pharmaceuticals, Inc. Two authors declared being full-time employees and stockowners of Impel Pharmaceuticals. Some authors declared ties with various sources, including Impel Pharmaceuticals.

Source: Wang VS et al. Safety, tolerability, and effectiveness of repetitive intravenous dihydroergotamine for refractory chronic migraine with cardiovascular risk factors: A retrospective study. Headache. 2023;63(9):1251-1258 (Sep 23). doi: 10.1111/head.14636

Key clinical point: Repetitive intravenous dihydroergotamine (DHE) administration using an inpatient protocol seemed effective and tolerable in patients with refractory chronic migraine (rCM), even in those at an elevated risk for atherosclerotic cardiovascular disease (ASCVD).

Major finding: The elevated-ASCVD vs low-ASCVD risk group had fewer patients receiving the maximum dose of DHE (42.2% vs 64.4%; P = .002) and lower median doses of DHE on discharge (0.75 vs 1.00 mg; P < .001). Both groups experienced significant pain reduction, but it was more pronounced in the low-ASCVD risk group (P = .037). No significant cardiovascular adverse events or electrocardiogram abnormalities were reported in either group.

Study details: This single-center retrospective cohort study included 347 patients with rCM who received inpatient intravenous DHE, of whom 64 and 163 patients had elevated and low ASCVD risk, respectively.

Disclosures: This study was partially funded by Impel Pharmaceuticals, Inc. Two authors declared being full-time employees and stockowners of Impel Pharmaceuticals. Some authors declared ties with various sources, including Impel Pharmaceuticals.

Source: Wang VS et al. Safety, tolerability, and effectiveness of repetitive intravenous dihydroergotamine for refractory chronic migraine with cardiovascular risk factors: A retrospective study. Headache. 2023;63(9):1251-1258 (Sep 23). doi: 10.1111/head.14636

Key clinical point: Repetitive intravenous dihydroergotamine (DHE) administration using an inpatient protocol seemed effective and tolerable in patients with refractory chronic migraine (rCM), even in those at an elevated risk for atherosclerotic cardiovascular disease (ASCVD).

Major finding: The elevated-ASCVD vs low-ASCVD risk group had fewer patients receiving the maximum dose of DHE (42.2% vs 64.4%; P = .002) and lower median doses of DHE on discharge (0.75 vs 1.00 mg; P < .001). Both groups experienced significant pain reduction, but it was more pronounced in the low-ASCVD risk group (P = .037). No significant cardiovascular adverse events or electrocardiogram abnormalities were reported in either group.

Study details: This single-center retrospective cohort study included 347 patients with rCM who received inpatient intravenous DHE, of whom 64 and 163 patients had elevated and low ASCVD risk, respectively.

Disclosures: This study was partially funded by Impel Pharmaceuticals, Inc. Two authors declared being full-time employees and stockowners of Impel Pharmaceuticals. Some authors declared ties with various sources, including Impel Pharmaceuticals.

Source: Wang VS et al. Safety, tolerability, and effectiveness of repetitive intravenous dihydroergotamine for refractory chronic migraine with cardiovascular risk factors: A retrospective study. Headache. 2023;63(9):1251-1258 (Sep 23). doi: 10.1111/head.14636