Key clinical point: Prophylactic treatment with monthly or quarterly fremanezumab demonstrated favorable efficacy and tolerability in a real-world cohort of patients with episodic migraine (EM) or chronic migraine (CM).

Major finding: After initiating fremanezumab, the monthly migraine days reduced by 6.1, 7.7, and 8.5 days at 1, 3, and 6 months, respectively, with similar reductions observed when categorized by EM or CM (all P < .001). At 6 months, ≥50%, ≥75%, and 100% response rates were achieved by 67.6%, 22.5%, and 5.4% of patients in the overall cohort, respectively, with 48.0% of patients with CM experiencing remission to EM after 1-month fremanezumab treatment. Overall, 9.5% of the patients experienced adverse reactions, which were mostly mild.

Study details: Findings are from a retrospective study that included 127 patients with migraine (EM n = 54; CM n = 73) who received monthly or quarterly fremanezumab doses over 6 months.

Disclosures: This study received no specific funding from any source. Four authors declared receiving lecture fees from various sources.

Source: Suzuki S et al. Real-world experience with monthly and quarterly dosing of fremanezumab for the treatment of patients with migraine in Japan. Front Neurol. 2023;14:1220285 (Jul 6). Doi: 10.3389/fneur.2023.1220285

Key clinical point: Prophylactic treatment with monthly or quarterly fremanezumab demonstrated favorable efficacy and tolerability in a real-world cohort of patients with episodic migraine (EM) or chronic migraine (CM).

Major finding: After initiating fremanezumab, the monthly migraine days reduced by 6.1, 7.7, and 8.5 days at 1, 3, and 6 months, respectively, with similar reductions observed when categorized by EM or CM (all P < .001). At 6 months, ≥50%, ≥75%, and 100% response rates were achieved by 67.6%, 22.5%, and 5.4% of patients in the overall cohort, respectively, with 48.0% of patients with CM experiencing remission to EM after 1-month fremanezumab treatment. Overall, 9.5% of the patients experienced adverse reactions, which were mostly mild.

Study details: Findings are from a retrospective study that included 127 patients with migraine (EM n = 54; CM n = 73) who received monthly or quarterly fremanezumab doses over 6 months.

Disclosures: This study received no specific funding from any source. Four authors declared receiving lecture fees from various sources.

Source: Suzuki S et al. Real-world experience with monthly and quarterly dosing of fremanezumab for the treatment of patients with migraine in Japan. Front Neurol. 2023;14:1220285 (Jul 6). Doi: 10.3389/fneur.2023.1220285

Key clinical point: Prophylactic treatment with monthly or quarterly fremanezumab demonstrated favorable efficacy and tolerability in a real-world cohort of patients with episodic migraine (EM) or chronic migraine (CM).

Major finding: After initiating fremanezumab, the monthly migraine days reduced by 6.1, 7.7, and 8.5 days at 1, 3, and 6 months, respectively, with similar reductions observed when categorized by EM or CM (all P < .001). At 6 months, ≥50%, ≥75%, and 100% response rates were achieved by 67.6%, 22.5%, and 5.4% of patients in the overall cohort, respectively, with 48.0% of patients with CM experiencing remission to EM after 1-month fremanezumab treatment. Overall, 9.5% of the patients experienced adverse reactions, which were mostly mild.

Study details: Findings are from a retrospective study that included 127 patients with migraine (EM n = 54; CM n = 73) who received monthly or quarterly fremanezumab doses over 6 months.

Disclosures: This study received no specific funding from any source. Four authors declared receiving lecture fees from various sources.

Source: Suzuki S et al. Real-world experience with monthly and quarterly dosing of fremanezumab for the treatment of patients with migraine in Japan. Front Neurol. 2023;14:1220285 (Jul 6). Doi: 10.3389/fneur.2023.1220285

Key clinical point: Higher intake of dietary caffeine was positively associated with a higher prevalence of severe headaches or migraines in US adults.

Major finding: Overall, the incidence of severe headaches or migraines increased by 5% with each 100 mg/day increase in dietary caffeine intake (odds ratio [OR] 1.05; P < .001), with the risk increasing by 42% with caffeine intake ≥ 400 mg/day vs ≥0 to <40 mg/day (OR 1.42; P < .001).

Study details: This cross-sectional study evaluated the association between dietary caffeine intake and severe headaches or migraines in 8993 U.S. adults age ≥ 20 years.

Disclosures: This study was funded by the Shandong Traditional Chinese Medicine Science and Technology Development Project, China. The authors declared no conflicts of interest.

Source: Zhang L et al. Association between dietary caffeine intake and severe headache or migraine in US adults. Sci Rep. 2023;13:10220 (Jun 23). Doi: 10.1038/s41598-023-36325-8

Key clinical point: Higher intake of dietary caffeine was positively associated with a higher prevalence of severe headaches or migraines in US adults.

Major finding: Overall, the incidence of severe headaches or migraines increased by 5% with each 100 mg/day increase in dietary caffeine intake (odds ratio [OR] 1.05; P < .001), with the risk increasing by 42% with caffeine intake ≥ 400 mg/day vs ≥0 to <40 mg/day (OR 1.42; P < .001).

Study details: This cross-sectional study evaluated the association between dietary caffeine intake and severe headaches or migraines in 8993 U.S. adults age ≥ 20 years.

Disclosures: This study was funded by the Shandong Traditional Chinese Medicine Science and Technology Development Project, China. The authors declared no conflicts of interest.

Source: Zhang L et al. Association between dietary caffeine intake and severe headache or migraine in US adults. Sci Rep. 2023;13:10220 (Jun 23). Doi: 10.1038/s41598-023-36325-8

Key clinical point: Higher intake of dietary caffeine was positively associated with a higher prevalence of severe headaches or migraines in US adults.

Major finding: Overall, the incidence of severe headaches or migraines increased by 5% with each 100 mg/day increase in dietary caffeine intake (odds ratio [OR] 1.05; P < .001), with the risk increasing by 42% with caffeine intake ≥ 400 mg/day vs ≥0 to <40 mg/day (OR 1.42; P < .001).

Study details: This cross-sectional study evaluated the association between dietary caffeine intake and severe headaches or migraines in 8993 U.S. adults age ≥ 20 years.

Disclosures: This study was funded by the Shandong Traditional Chinese Medicine Science and Technology Development Project, China. The authors declared no conflicts of interest.

Source: Zhang L et al. Association between dietary caffeine intake and severe headache or migraine in US adults. Sci Rep. 2023;13:10220 (Jun 23). Doi: 10.1038/s41598-023-36325-8

Key clinical point: Long-term erenumab treatment demonstrated sustained efficacy and safety in patients with chronic migraine (CM) with and without acute medication overuse (AMO), with erenumab reducing acute medication consumption and many patients moving to non-AMO status.

Major finding: Among baseline acute migraine-specific medication users at 52 weeks, the mean monthly migraine-specific medication days reduced by 7.4 (95% CI 6.4-8.3) days and 5.4 (95% CI 4.7-6.1) days in the AMO and non-AMO groups, respectively, with 66.1% of patients in the AMO group moving to the non-AMO group.

Study details: This post hoc subgroup analysis of a 52-week open-label extension study following a 12-week double-blind study included 469 patients with CM stratified by AMO status who were randomly assigned to receive placebo or erenumab (70 or 140 mg) throughout or switch from 70 to 140 mg erenumab.

Disclosures: This study was funded by Amgen Inc. Some authors declared being employees or stockholders of Amgen. The other authors declared ties with various sources, including Amgen.

Source: Tepper SJ et al. Long-term efficacy and safety of erenumab in patients with chronic migraine and acute medication overuse: A subgroup analysis. Headache. 2023;63(6):730-742 (Jun 14). Doi: 10.1111/head.14536

Key clinical point: Long-term erenumab treatment demonstrated sustained efficacy and safety in patients with chronic migraine (CM) with and without acute medication overuse (AMO), with erenumab reducing acute medication consumption and many patients moving to non-AMO status.

Major finding: Among baseline acute migraine-specific medication users at 52 weeks, the mean monthly migraine-specific medication days reduced by 7.4 (95% CI 6.4-8.3) days and 5.4 (95% CI 4.7-6.1) days in the AMO and non-AMO groups, respectively, with 66.1% of patients in the AMO group moving to the non-AMO group.

Study details: This post hoc subgroup analysis of a 52-week open-label extension study following a 12-week double-blind study included 469 patients with CM stratified by AMO status who were randomly assigned to receive placebo or erenumab (70 or 140 mg) throughout or switch from 70 to 140 mg erenumab.

Disclosures: This study was funded by Amgen Inc. Some authors declared being employees or stockholders of Amgen. The other authors declared ties with various sources, including Amgen.

Source: Tepper SJ et al. Long-term efficacy and safety of erenumab in patients with chronic migraine and acute medication overuse: A subgroup analysis. Headache. 2023;63(6):730-742 (Jun 14). Doi: 10.1111/head.14536

Key clinical point: Long-term erenumab treatment demonstrated sustained efficacy and safety in patients with chronic migraine (CM) with and without acute medication overuse (AMO), with erenumab reducing acute medication consumption and many patients moving to non-AMO status.

Major finding: Among baseline acute migraine-specific medication users at 52 weeks, the mean monthly migraine-specific medication days reduced by 7.4 (95% CI 6.4-8.3) days and 5.4 (95% CI 4.7-6.1) days in the AMO and non-AMO groups, respectively, with 66.1% of patients in the AMO group moving to the non-AMO group.

Study details: This post hoc subgroup analysis of a 52-week open-label extension study following a 12-week double-blind study included 469 patients with CM stratified by AMO status who were randomly assigned to receive placebo or erenumab (70 or 140 mg) throughout or switch from 70 to 140 mg erenumab.

Disclosures: This study was funded by Amgen Inc. Some authors declared being employees or stockholders of Amgen. The other authors declared ties with various sources, including Amgen.

Source: Tepper SJ et al. Long-term efficacy and safety of erenumab in patients with chronic migraine and acute medication overuse: A subgroup analysis. Headache. 2023;63(6):730-742 (Jun 14). Doi: 10.1111/head.14536

Key clinical point: Ultrasound-guided stellate ganglion block (SGB) appeared to be safe and effective in reducing pain intensity, headache frequency and duration, and the need for adjunctive anti-migraine medications in elderly patients with migraine.

Major finding: At 3 months after ultrasound-guided SGB treatment, the mean Numerical Rating Scale score reduced from 7.3 at baseline to 3.6 (P < .001), the mean headache frequency per month reduced from 23.1 days at baseline to 14.0 days (P = .001), and the mean headache duration decreased from 22.7 hours at baseline to 14.3 hours (P = .001), with 64% of patients experiencing ≥50% reduction in anti-migraine medication consumption. No procedure-related serious adverse events were reported.

Study details: Findings are from a retrospective observational case series study including 52 elderly patients (age ≥ 65 years) with migraine who received ultrasound-guided SGB treatment for headache management.

Disclosures: This study did not disclose the funding source. The authors declared no conflicts of interest.

Source: Yu B et al. Ultrasound-guided stellate ganglion block for the treatment of migraine in elderly patients: A retrospective and observational study. Headache. 2023;63(6):763-770 (Jun 14). Doi: 10.1111/head.14537

Key clinical point: Ultrasound-guided stellate ganglion block (SGB) appeared to be safe and effective in reducing pain intensity, headache frequency and duration, and the need for adjunctive anti-migraine medications in elderly patients with migraine.

Major finding: At 3 months after ultrasound-guided SGB treatment, the mean Numerical Rating Scale score reduced from 7.3 at baseline to 3.6 (P < .001), the mean headache frequency per month reduced from 23.1 days at baseline to 14.0 days (P = .001), and the mean headache duration decreased from 22.7 hours at baseline to 14.3 hours (P = .001), with 64% of patients experiencing ≥50% reduction in anti-migraine medication consumption. No procedure-related serious adverse events were reported.

Study details: Findings are from a retrospective observational case series study including 52 elderly patients (age ≥ 65 years) with migraine who received ultrasound-guided SGB treatment for headache management.

Disclosures: This study did not disclose the funding source. The authors declared no conflicts of interest.

Source: Yu B et al. Ultrasound-guided stellate ganglion block for the treatment of migraine in elderly patients: A retrospective and observational study. Headache. 2023;63(6):763-770 (Jun 14). Doi: 10.1111/head.14537

Key clinical point: Ultrasound-guided stellate ganglion block (SGB) appeared to be safe and effective in reducing pain intensity, headache frequency and duration, and the need for adjunctive anti-migraine medications in elderly patients with migraine.

Major finding: At 3 months after ultrasound-guided SGB treatment, the mean Numerical Rating Scale score reduced from 7.3 at baseline to 3.6 (P < .001), the mean headache frequency per month reduced from 23.1 days at baseline to 14.0 days (P = .001), and the mean headache duration decreased from 22.7 hours at baseline to 14.3 hours (P = .001), with 64% of patients experiencing ≥50% reduction in anti-migraine medication consumption. No procedure-related serious adverse events were reported.

Study details: Findings are from a retrospective observational case series study including 52 elderly patients (age ≥ 65 years) with migraine who received ultrasound-guided SGB treatment for headache management.

Disclosures: This study did not disclose the funding source. The authors declared no conflicts of interest.

Source: Yu B et al. Ultrasound-guided stellate ganglion block for the treatment of migraine in elderly patients: A retrospective and observational study. Headache. 2023;63(6):763-770 (Jun 14). Doi: 10.1111/head.14537

Key clinical point: In patients with migraine, treatment with anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) reduced visual hypersensitivity, and this reduction was positively associated with a decrease in monthly migraine days (MMD).

Major finding: After 3 months of treatment with anti-CGRP mAb, the mean ictal Leiden Visual Sensitivity Scale (L-VISS) score decreased from 20.1 to 19.2 (P = .042) and the mean interictal L-VISS score decreased from 11.8 to 11.1 (P = .050), and a positive correlation was observed between the reduction in MMD and the decrease in ictal L-VISS (β 0.3; P = .001) and interictal L-VISS (β 0.2; P = .010) scores.

Study details: This prospective follow-up study included 205 patients with migraine who were treated with either erenumab (n = 105) or fremanezumab (n = 100).

Disclosures: This study did not disclose the funding source. Three authors declared receiving consultancy or industry and independent support from various sources. The other authors declared no conflicts of interest.

Source: de Vries Lentsch S et al. Visual hypersensitivity in patients treated with anti-calcitonin gene-related peptide (receptor) monoclonal antibodies. Headache. 2023;63(7):926-933 (Jun 26). Doi: 10.1111/head.14531

Key clinical point: In patients with migraine, treatment with anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) reduced visual hypersensitivity, and this reduction was positively associated with a decrease in monthly migraine days (MMD).

Major finding: After 3 months of treatment with anti-CGRP mAb, the mean ictal Leiden Visual Sensitivity Scale (L-VISS) score decreased from 20.1 to 19.2 (P = .042) and the mean interictal L-VISS score decreased from 11.8 to 11.1 (P = .050), and a positive correlation was observed between the reduction in MMD and the decrease in ictal L-VISS (β 0.3; P = .001) and interictal L-VISS (β 0.2; P = .010) scores.

Study details: This prospective follow-up study included 205 patients with migraine who were treated with either erenumab (n = 105) or fremanezumab (n = 100).

Disclosures: This study did not disclose the funding source. Three authors declared receiving consultancy or industry and independent support from various sources. The other authors declared no conflicts of interest.

Source: de Vries Lentsch S et al. Visual hypersensitivity in patients treated with anti-calcitonin gene-related peptide (receptor) monoclonal antibodies. Headache. 2023;63(7):926-933 (Jun 26). Doi: 10.1111/head.14531

Key clinical point: In patients with migraine, treatment with anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) reduced visual hypersensitivity, and this reduction was positively associated with a decrease in monthly migraine days (MMD).

Major finding: After 3 months of treatment with anti-CGRP mAb, the mean ictal Leiden Visual Sensitivity Scale (L-VISS) score decreased from 20.1 to 19.2 (P = .042) and the mean interictal L-VISS score decreased from 11.8 to 11.1 (P = .050), and a positive correlation was observed between the reduction in MMD and the decrease in ictal L-VISS (β 0.3; P = .001) and interictal L-VISS (β 0.2; P = .010) scores.

Study details: This prospective follow-up study included 205 patients with migraine who were treated with either erenumab (n = 105) or fremanezumab (n = 100).

Disclosures: This study did not disclose the funding source. Three authors declared receiving consultancy or industry and independent support from various sources. The other authors declared no conflicts of interest.

Source: de Vries Lentsch S et al. Visual hypersensitivity in patients treated with anti-calcitonin gene-related peptide (receptor) monoclonal antibodies. Headache. 2023;63(7):926-933 (Jun 26). Doi: 10.1111/head.14531

Key clinical point: Meta-analysis confirmed better therapeutic efficacy of rimegepant compared with placebo in patients with episodic migraine (EM), along with no significant difference in adverse events.

Major finding: Rimegepant was more effective than placebo in terms of achieving pain freedom and pain relief at 2 hours (odds ratio [OR] 1.84 and 1.80, respectively), 2-24 hours (OR 2.44 and 2.10, respectively), and 2-48 hours (OR 2.27 and 1.92, respectively; all P < .00001) post-dose. The occurrence of adverse events was not significantly different between the rimegepant and control arms (P = .06).

Study details: The data come from a systematic review and meta-analysis of 4 randomized controlled trials including 4230 patients with EM.

Disclosures: This study did not declare the source of funding. The authors declared no conflicts of interest.

Source: Wang Q et al. Clinical efficacy and safety of rimegepant in the treatment of migraine: A meta-analysis of randomized controlled trials. Front Neurol. 2023;14:1205778 (Jun 20). Doi: 10.3389/fneur.2023.1205778

Key clinical point: Meta-analysis confirmed better therapeutic efficacy of rimegepant compared with placebo in patients with episodic migraine (EM), along with no significant difference in adverse events.

Major finding: Rimegepant was more effective than placebo in terms of achieving pain freedom and pain relief at 2 hours (odds ratio [OR] 1.84 and 1.80, respectively), 2-24 hours (OR 2.44 and 2.10, respectively), and 2-48 hours (OR 2.27 and 1.92, respectively; all P < .00001) post-dose. The occurrence of adverse events was not significantly different between the rimegepant and control arms (P = .06).

Study details: The data come from a systematic review and meta-analysis of 4 randomized controlled trials including 4230 patients with EM.

Disclosures: This study did not declare the source of funding. The authors declared no conflicts of interest.

Source: Wang Q et al. Clinical efficacy and safety of rimegepant in the treatment of migraine: A meta-analysis of randomized controlled trials. Front Neurol. 2023;14:1205778 (Jun 20). Doi: 10.3389/fneur.2023.1205778

Key clinical point: Meta-analysis confirmed better therapeutic efficacy of rimegepant compared with placebo in patients with episodic migraine (EM), along with no significant difference in adverse events.

Major finding: Rimegepant was more effective than placebo in terms of achieving pain freedom and pain relief at 2 hours (odds ratio [OR] 1.84 and 1.80, respectively), 2-24 hours (OR 2.44 and 2.10, respectively), and 2-48 hours (OR 2.27 and 1.92, respectively; all P < .00001) post-dose. The occurrence of adverse events was not significantly different between the rimegepant and control arms (P = .06).

Study details: The data come from a systematic review and meta-analysis of 4 randomized controlled trials including 4230 patients with EM.

Disclosures: This study did not declare the source of funding. The authors declared no conflicts of interest.

Source: Wang Q et al. Clinical efficacy and safety of rimegepant in the treatment of migraine: A meta-analysis of randomized controlled trials. Front Neurol. 2023;14:1205778 (Jun 20). Doi: 10.3389/fneur.2023.1205778

Key clinical point: Disability, anxiety, and comorbid mental disorders moderated the long-term effect of migraine-specific cognitive behavioral therapy (miCBT) or relaxation training (RLX) on headache days in patients with migraine, with those having higher and lower burden benefitting more from miCBT and RLX, respectively.

Major finding: Patients with higher headache-related disability (B −0.41; P = .047), anxiety (B −0.66; P = .056), and comorbid mental disorders (B −4.98; P = .053) benefited more from miCBT, whereas those with relatively lower headache-related disability and anxiety and without any comorbid mental disorder benefited more from RLX at 12 months of follow-up.

Study details: This secondary analysis of an open-label randomized controlled trial included 121 patients with migraine who were randomly assigned to the miCBT (n = 40), RLX (n = 41), or waiting-list control (n = 40) group.

Disclosures: This study received no specific funding. C Gaul and E Liesering-Latta declared receiving consulting and lecture honoraria from various sources. C Gaul declared serving as an honorary secretary of the German Migraine and Headache Society. The other authors declared no conflicts of interest.

Source: Klan T et al. Behavioral treatment for migraine prophylaxis in adults: Moderator analysis of a randomized controlled trial. Cephalalgia. 2023;43(6) (Jun 8). Doi: 10.1177/03331024231178237

Key clinical point: Disability, anxiety, and comorbid mental disorders moderated the long-term effect of migraine-specific cognitive behavioral therapy (miCBT) or relaxation training (RLX) on headache days in patients with migraine, with those having higher and lower burden benefitting more from miCBT and RLX, respectively.

Major finding: Patients with higher headache-related disability (B −0.41; P = .047), anxiety (B −0.66; P = .056), and comorbid mental disorders (B −4.98; P = .053) benefited more from miCBT, whereas those with relatively lower headache-related disability and anxiety and without any comorbid mental disorder benefited more from RLX at 12 months of follow-up.

Study details: This secondary analysis of an open-label randomized controlled trial included 121 patients with migraine who were randomly assigned to the miCBT (n = 40), RLX (n = 41), or waiting-list control (n = 40) group.

Disclosures: This study received no specific funding. C Gaul and E Liesering-Latta declared receiving consulting and lecture honoraria from various sources. C Gaul declared serving as an honorary secretary of the German Migraine and Headache Society. The other authors declared no conflicts of interest.

Source: Klan T et al. Behavioral treatment for migraine prophylaxis in adults: Moderator analysis of a randomized controlled trial. Cephalalgia. 2023;43(6) (Jun 8). Doi: 10.1177/03331024231178237

Key clinical point: Disability, anxiety, and comorbid mental disorders moderated the long-term effect of migraine-specific cognitive behavioral therapy (miCBT) or relaxation training (RLX) on headache days in patients with migraine, with those having higher and lower burden benefitting more from miCBT and RLX, respectively.

Major finding: Patients with higher headache-related disability (B −0.41; P = .047), anxiety (B −0.66; P = .056), and comorbid mental disorders (B −4.98; P = .053) benefited more from miCBT, whereas those with relatively lower headache-related disability and anxiety and without any comorbid mental disorder benefited more from RLX at 12 months of follow-up.

Study details: This secondary analysis of an open-label randomized controlled trial included 121 patients with migraine who were randomly assigned to the miCBT (n = 40), RLX (n = 41), or waiting-list control (n = 40) group.

Disclosures: This study received no specific funding. C Gaul and E Liesering-Latta declared receiving consulting and lecture honoraria from various sources. C Gaul declared serving as an honorary secretary of the German Migraine and Headache Society. The other authors declared no conflicts of interest.

Source: Klan T et al. Behavioral treatment for migraine prophylaxis in adults: Moderator analysis of a randomized controlled trial. Cephalalgia. 2023;43(6) (Jun 8). Doi: 10.1177/03331024231178237

Key clinical point: A broad category of blood pressure (BP)-lowering medication classes and drugs effectively reduced headache frequency in patients with episodic migraine.

Major finding: Compared with placebo, headache days per month reduced significantly with alpha-blockers (P = .023), angiotensin II receptor blockers (P = .024), beta-blockers (P = .035), and calcium channel blockers (P = .025). Specific BP-lowering drugs, such as clonidine (P = .026), candesartan (P = .001), atenolol (P = .010), bisoprolol (P = .000), propranolol (P = .000), timolol (P = .000), nicardipine (P = .001), and verapamil (P = .016), also effectively reduced the number of headache days per month.

Study details: Findings are from a systematic review and meta-analysis of 50 studies including 4310 participants.

Disclosures: This study received no specific funding. LR Griffiths reported receiving migraine research funding from the Australian National Health and Medical Research Council. AS Zagami declared being an associate editor for Cephalalgia. A Rodgers declared being an inventor for George Health Enterprises. The other authors declared no conflicts of interest.

Source: Carcel C, Haghdoost F, et al. The effect of blood pressure lowering medications on the prevention of episodic migraine: A systematic review and meta-analysis. Cephalalgia. 2023 (Jun 23). Doi: 10.1177/03331024231183166

Key clinical point: A broad category of blood pressure (BP)-lowering medication classes and drugs effectively reduced headache frequency in patients with episodic migraine.

Major finding: Compared with placebo, headache days per month reduced significantly with alpha-blockers (P = .023), angiotensin II receptor blockers (P = .024), beta-blockers (P = .035), and calcium channel blockers (P = .025). Specific BP-lowering drugs, such as clonidine (P = .026), candesartan (P = .001), atenolol (P = .010), bisoprolol (P = .000), propranolol (P = .000), timolol (P = .000), nicardipine (P = .001), and verapamil (P = .016), also effectively reduced the number of headache days per month.

Study details: Findings are from a systematic review and meta-analysis of 50 studies including 4310 participants.

Disclosures: This study received no specific funding. LR Griffiths reported receiving migraine research funding from the Australian National Health and Medical Research Council. AS Zagami declared being an associate editor for Cephalalgia. A Rodgers declared being an inventor for George Health Enterprises. The other authors declared no conflicts of interest.

Source: Carcel C, Haghdoost F, et al. The effect of blood pressure lowering medications on the prevention of episodic migraine: A systematic review and meta-analysis. Cephalalgia. 2023 (Jun 23). Doi: 10.1177/03331024231183166

Key clinical point: A broad category of blood pressure (BP)-lowering medication classes and drugs effectively reduced headache frequency in patients with episodic migraine.

Major finding: Compared with placebo, headache days per month reduced significantly with alpha-blockers (P = .023), angiotensin II receptor blockers (P = .024), beta-blockers (P = .035), and calcium channel blockers (P = .025). Specific BP-lowering drugs, such as clonidine (P = .026), candesartan (P = .001), atenolol (P = .010), bisoprolol (P = .000), propranolol (P = .000), timolol (P = .000), nicardipine (P = .001), and verapamil (P = .016), also effectively reduced the number of headache days per month.

Study details: Findings are from a systematic review and meta-analysis of 50 studies including 4310 participants.

Disclosures: This study received no specific funding. LR Griffiths reported receiving migraine research funding from the Australian National Health and Medical Research Council. AS Zagami declared being an associate editor for Cephalalgia. A Rodgers declared being an inventor for George Health Enterprises. The other authors declared no conflicts of interest.

Source: Carcel C, Haghdoost F, et al. The effect of blood pressure lowering medications on the prevention of episodic migraine: A systematic review and meta-analysis. Cephalalgia. 2023 (Jun 23). Doi: 10.1177/03331024231183166

Key clinical point: Migraine increased the risk for premature ischemic stroke similarly among women and men aged ≤60 years; however, the effect of migraine on the risk for premature myocardial infarction (MI) and hemorrhagic stroke was greater only in women but not in men with migraine.

Major finding: Compared with those without migraine, women (adjusted HR [aHR] 1.21) and men (aHR 1.23; both P < .001) with migraine showed a similar increase in the risk for premature ischemic stroke. However, the risk for premature MI (aHR 1.22; 95% CI 1.14-1.31; P < .001) and hemorrhagic stroke (aHR 1.13; 95% CI 1.02-1.24; P = .014) was significantly higher in women with vs without migraine but not in men.

Study details: This nationwide population-based cohort study included 179,680 women and 40,757 men with migraine.

Disclosures: This study did not receive any specific funding. CH Fuglsang declared owning stock in Novo Nordisk, and M Schmidt declared being supported by the Novo Nordisk Foundation.

Source: Fuglsang CH et al. Migraine and risk of premature myocardial infarction and stroke among men and women: A Danish population-based cohort study. PLoS Med. 2023;20(6):e1004238 (Jun 13). Doi: 10.1371/journal.pmed.1004238

Key clinical point: Migraine increased the risk for premature ischemic stroke similarly among women and men aged ≤60 years; however, the effect of migraine on the risk for premature myocardial infarction (MI) and hemorrhagic stroke was greater only in women but not in men with migraine.

Major finding: Compared with those without migraine, women (adjusted HR [aHR] 1.21) and men (aHR 1.23; both P < .001) with migraine showed a similar increase in the risk for premature ischemic stroke. However, the risk for premature MI (aHR 1.22; 95% CI 1.14-1.31; P < .001) and hemorrhagic stroke (aHR 1.13; 95% CI 1.02-1.24; P = .014) was significantly higher in women with vs without migraine but not in men.

Study details: This nationwide population-based cohort study included 179,680 women and 40,757 men with migraine.

Disclosures: This study did not receive any specific funding. CH Fuglsang declared owning stock in Novo Nordisk, and M Schmidt declared being supported by the Novo Nordisk Foundation.

Source: Fuglsang CH et al. Migraine and risk of premature myocardial infarction and stroke among men and women: A Danish population-based cohort study. PLoS Med. 2023;20(6):e1004238 (Jun 13). Doi: 10.1371/journal.pmed.1004238

Key clinical point: Migraine increased the risk for premature ischemic stroke similarly among women and men aged ≤60 years; however, the effect of migraine on the risk for premature myocardial infarction (MI) and hemorrhagic stroke was greater only in women but not in men with migraine.

Major finding: Compared with those without migraine, women (adjusted HR [aHR] 1.21) and men (aHR 1.23; both P < .001) with migraine showed a similar increase in the risk for premature ischemic stroke. However, the risk for premature MI (aHR 1.22; 95% CI 1.14-1.31; P < .001) and hemorrhagic stroke (aHR 1.13; 95% CI 1.02-1.24; P = .014) was significantly higher in women with vs without migraine but not in men.

Study details: This nationwide population-based cohort study included 179,680 women and 40,757 men with migraine.

Disclosures: This study did not receive any specific funding. CH Fuglsang declared owning stock in Novo Nordisk, and M Schmidt declared being supported by the Novo Nordisk Foundation.

Source: Fuglsang CH et al. Migraine and risk of premature myocardial infarction and stroke among men and women: A Danish population-based cohort study. PLoS Med. 2023;20(6):e1004238 (Jun 13). Doi: 10.1371/journal.pmed.1004238

Among more than 1,000 skin biopsies performed over the last 6 years by pediatric dermatologists at the University of California, San Francisco (UCSF), the three most common biopsy results were compound nevus, pyogenic granuloma, and spongiotic dermatitis.

In addition, fewer biopsies were performed in the first 3 years of the global COVID-19 pandemic than in the previous 3 years.

These findings from a retrospective analysis were presented during a poster session at the annual meeting of the Society for Pediatric Dermatology. The analysis set out to evaluate which patients required biopsy, which skin conditions were sampled, and if practice patterns changed following the start of the COVID-19 pandemic.

“The work is important because very few pediatric patients, relative to adult patients seen in dermatology clinics, have a biopsy done,” Kelly M. Cordoro, MD, one of the study authors, told this news organization.

“Approximately 1%-4% of pediatric patients visiting a dermatology clinic will have a biopsy done as compared to 30%-50% of adult patients. Understanding what is being biopsied in children sheds light on the medical decision-making required to decide when a biopsy is necessary,” said Dr. Cordoro, chief of pediatric dermatology at UCSF.

For the study, the researchers retrospectively reviewed 1,196 biopsy specimens from 1,080 unique patients that were performed by pediatric dermatologists at UCSF from 2017 to 2022. Half of the patients were female, their mean age was 11.5 years, and they ranged in age from 1 day to 61 years. Nearly half of biopsies (47%) were performed in patients aged 12-18 years and one-quarter (25.6%) were performed in those aged 6-11 years. In the remaining biopsies, 6.6% came from patients younger than 1 year, 5.8% of those aged 1-2 years, 7.3% from those aged 3-5 years, and 3.9% each in those aged 19-21 years and in those older than 21 years.

The five most common biopsy results were compound nevus (99 biopsies), pyogenic granuloma (96), spongiotic dermatitis (57), intradermal nevus (53), and pilomatricoma (40).

The researchers identified 30 malignant diagnoses in 28 unique patients, most commonly mycosis fungoides (in 16 patients with a median age of 12.5 years), basal cell carcinoma (in 5 patients with a median age of 9 years), and dermatofibrosarcoma protuberans (in 4 patients with a median age of 2 years).

There was no significant sex-based difference in the number of biopsies performed at a given age (P = .47), but Dr. Cordoro and colleagues noted a statistically significant decrease in the number of biopsies during the pandemic compared with the 3 years prior to the pandemic (P = .04).

“There was a slight uptick in 2022, although it remains to be seen whether this trend will continue,” they wrote in their abstract. “While the most common diagnoses in the years leading up to – versus following the start of the pandemic – were similar, there was one clear outlier. The histopathologic diagnosis of pernio spiked in 2020, reflecting the ‘COVID toes’ phenomenon”.

In an interview, Dr. Cordoro said that growths and rashes in children of all ages can, and should, be biopsied, but special considerations are necessary depending on the patient’s age and context. 

“Our data showed that neoplastic conditions were biopsied more often than inflammatory conditions, with an emphasis on lesions that required removal (such as pyogenic granuloma), raised concerns for atypia (nevi), or had implications for systemic management (such as Langerhans cell histiocytosis and graft-versus-host disease). Importantly, cutaneous malignancies in children are rare but do occur, and a high index of suspicion is required when approaching any child with a complex neoplasm or rash.”

Dr. Cordoro characterized the medical decision making and rationale for biopsying skin lesions and rashes in children as “a complex process that involves weighing the risks of the biopsy itself against the benefit of the information it will provide; shared decision-making with the caregivers, the patient (if age-appropriate), and other members of the health care team; age of the child and clinical context; and whether the biopsy can be done at the bedside or requires sedation.”

Based on the study results, Dr. Cordoro said, the rationale to proceed with a biopsy boils down to three main goals: To make or confirm a diagnosis, to make decisions about management, and/or the biopsy itself is therapeutic. 

UCSF dermatopathology fellow Suzanne W. Birmingham, MD, performed the study in collaboration with Dr. Cordoro and UCSF dermatopathologist Thaddeus W. Mully, MD. Additional analyses of this data set are in progress. The researchers reported having no relevant financial disclosures.

Among more than 1,000 skin biopsies performed over the last 6 years by pediatric dermatologists at the University of California, San Francisco (UCSF), the three most common biopsy results were compound nevus, pyogenic granuloma, and spongiotic dermatitis.

In addition, fewer biopsies were performed in the first 3 years of the global COVID-19 pandemic than in the previous 3 years.

These findings from a retrospective analysis were presented during a poster session at the annual meeting of the Society for Pediatric Dermatology. The analysis set out to evaluate which patients required biopsy, which skin conditions were sampled, and if practice patterns changed following the start of the COVID-19 pandemic.

“The work is important because very few pediatric patients, relative to adult patients seen in dermatology clinics, have a biopsy done,” Kelly M. Cordoro, MD, one of the study authors, told this news organization.

“Approximately 1%-4% of pediatric patients visiting a dermatology clinic will have a biopsy done as compared to 30%-50% of adult patients. Understanding what is being biopsied in children sheds light on the medical decision-making required to decide when a biopsy is necessary,” said Dr. Cordoro, chief of pediatric dermatology at UCSF.

For the study, the researchers retrospectively reviewed 1,196 biopsy specimens from 1,080 unique patients that were performed by pediatric dermatologists at UCSF from 2017 to 2022. Half of the patients were female, their mean age was 11.5 years, and they ranged in age from 1 day to 61 years. Nearly half of biopsies (47%) were performed in patients aged 12-18 years and one-quarter (25.6%) were performed in those aged 6-11 years. In the remaining biopsies, 6.6% came from patients younger than 1 year, 5.8% of those aged 1-2 years, 7.3% from those aged 3-5 years, and 3.9% each in those aged 19-21 years and in those older than 21 years.

The five most common biopsy results were compound nevus (99 biopsies), pyogenic granuloma (96), spongiotic dermatitis (57), intradermal nevus (53), and pilomatricoma (40).

The researchers identified 30 malignant diagnoses in 28 unique patients, most commonly mycosis fungoides (in 16 patients with a median age of 12.5 years), basal cell carcinoma (in 5 patients with a median age of 9 years), and dermatofibrosarcoma protuberans (in 4 patients with a median age of 2 years).

There was no significant sex-based difference in the number of biopsies performed at a given age (P = .47), but Dr. Cordoro and colleagues noted a statistically significant decrease in the number of biopsies during the pandemic compared with the 3 years prior to the pandemic (P = .04).

“There was a slight uptick in 2022, although it remains to be seen whether this trend will continue,” they wrote in their abstract. “While the most common diagnoses in the years leading up to – versus following the start of the pandemic – were similar, there was one clear outlier. The histopathologic diagnosis of pernio spiked in 2020, reflecting the ‘COVID toes’ phenomenon”.

In an interview, Dr. Cordoro said that growths and rashes in children of all ages can, and should, be biopsied, but special considerations are necessary depending on the patient’s age and context. 

“Our data showed that neoplastic conditions were biopsied more often than inflammatory conditions, with an emphasis on lesions that required removal (such as pyogenic granuloma), raised concerns for atypia (nevi), or had implications for systemic management (such as Langerhans cell histiocytosis and graft-versus-host disease). Importantly, cutaneous malignancies in children are rare but do occur, and a high index of suspicion is required when approaching any child with a complex neoplasm or rash.”

Dr. Cordoro characterized the medical decision making and rationale for biopsying skin lesions and rashes in children as “a complex process that involves weighing the risks of the biopsy itself against the benefit of the information it will provide; shared decision-making with the caregivers, the patient (if age-appropriate), and other members of the health care team; age of the child and clinical context; and whether the biopsy can be done at the bedside or requires sedation.”

Based on the study results, Dr. Cordoro said, the rationale to proceed with a biopsy boils down to three main goals: To make or confirm a diagnosis, to make decisions about management, and/or the biopsy itself is therapeutic. 

UCSF dermatopathology fellow Suzanne W. Birmingham, MD, performed the study in collaboration with Dr. Cordoro and UCSF dermatopathologist Thaddeus W. Mully, MD. Additional analyses of this data set are in progress. The researchers reported having no relevant financial disclosures.

Among more than 1,000 skin biopsies performed over the last 6 years by pediatric dermatologists at the University of California, San Francisco (UCSF), the three most common biopsy results were compound nevus, pyogenic granuloma, and spongiotic dermatitis.

In addition, fewer biopsies were performed in the first 3 years of the global COVID-19 pandemic than in the previous 3 years.

These findings from a retrospective analysis were presented during a poster session at the annual meeting of the Society for Pediatric Dermatology. The analysis set out to evaluate which patients required biopsy, which skin conditions were sampled, and if practice patterns changed following the start of the COVID-19 pandemic.

“The work is important because very few pediatric patients, relative to adult patients seen in dermatology clinics, have a biopsy done,” Kelly M. Cordoro, MD, one of the study authors, told this news organization.

“Approximately 1%-4% of pediatric patients visiting a dermatology clinic will have a biopsy done as compared to 30%-50% of adult patients. Understanding what is being biopsied in children sheds light on the medical decision-making required to decide when a biopsy is necessary,” said Dr. Cordoro, chief of pediatric dermatology at UCSF.

For the study, the researchers retrospectively reviewed 1,196 biopsy specimens from 1,080 unique patients that were performed by pediatric dermatologists at UCSF from 2017 to 2022. Half of the patients were female, their mean age was 11.5 years, and they ranged in age from 1 day to 61 years. Nearly half of biopsies (47%) were performed in patients aged 12-18 years and one-quarter (25.6%) were performed in those aged 6-11 years. In the remaining biopsies, 6.6% came from patients younger than 1 year, 5.8% of those aged 1-2 years, 7.3% from those aged 3-5 years, and 3.9% each in those aged 19-21 years and in those older than 21 years.

The five most common biopsy results were compound nevus (99 biopsies), pyogenic granuloma (96), spongiotic dermatitis (57), intradermal nevus (53), and pilomatricoma (40).

The researchers identified 30 malignant diagnoses in 28 unique patients, most commonly mycosis fungoides (in 16 patients with a median age of 12.5 years), basal cell carcinoma (in 5 patients with a median age of 9 years), and dermatofibrosarcoma protuberans (in 4 patients with a median age of 2 years).

There was no significant sex-based difference in the number of biopsies performed at a given age (P = .47), but Dr. Cordoro and colleagues noted a statistically significant decrease in the number of biopsies during the pandemic compared with the 3 years prior to the pandemic (P = .04).

“There was a slight uptick in 2022, although it remains to be seen whether this trend will continue,” they wrote in their abstract. “While the most common diagnoses in the years leading up to – versus following the start of the pandemic – were similar, there was one clear outlier. The histopathologic diagnosis of pernio spiked in 2020, reflecting the ‘COVID toes’ phenomenon”.

In an interview, Dr. Cordoro said that growths and rashes in children of all ages can, and should, be biopsied, but special considerations are necessary depending on the patient’s age and context. 

“Our data showed that neoplastic conditions were biopsied more often than inflammatory conditions, with an emphasis on lesions that required removal (such as pyogenic granuloma), raised concerns for atypia (nevi), or had implications for systemic management (such as Langerhans cell histiocytosis and graft-versus-host disease). Importantly, cutaneous malignancies in children are rare but do occur, and a high index of suspicion is required when approaching any child with a complex neoplasm or rash.”

Dr. Cordoro characterized the medical decision making and rationale for biopsying skin lesions and rashes in children as “a complex process that involves weighing the risks of the biopsy itself against the benefit of the information it will provide; shared decision-making with the caregivers, the patient (if age-appropriate), and other members of the health care team; age of the child and clinical context; and whether the biopsy can be done at the bedside or requires sedation.”

Based on the study results, Dr. Cordoro said, the rationale to proceed with a biopsy boils down to three main goals: To make or confirm a diagnosis, to make decisions about management, and/or the biopsy itself is therapeutic. 

UCSF dermatopathology fellow Suzanne W. Birmingham, MD, performed the study in collaboration with Dr. Cordoro and UCSF dermatopathologist Thaddeus W. Mully, MD. Additional analyses of this data set are in progress. The researchers reported having no relevant financial disclosures.