Clinical Edge Journal Scan

Key clinical point: Both cinnarizine and amitriptyline effectively improved migraine symptoms in children and adolescents with migraine, but amitriptyline was a more preferable treatment option since it reduced headache frequency and duration more effectively than cinnarizine.

Major finding: Amitriptyline was more effective than cinnarizine in reducing headache frequency at 4 weeks (mean difference [MD] −8.81 attacks/months; P = .004) and headache duration at 4 (MD −123.0 minutes; P = .017), 8 (MD −110.3 minutes; P = .033), and 12 (MD −123.3 minutes; P = .018) weeks. However, there were no significant differences in headache severity and migraine-related disability between the groups at 4, 8, and 12 weeks (all P > .005).

Study details: Findings are from a randomized, double-blind controlled trial including 43 children with migraine (age 4-17 years) who were randomly assigned to receive cinnarizine (n = 22) and amitriptyline (n = 21).

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

Source: Olfat M, Hosseinpour S, Masoumi S, et al. A comparative study on prophylactic efficacy of cinnarizine and amitriptyline in childhood migraine: A randomized double-blind clinical trial. Cephalalgia. 2024 (Apr 20). doi: 10.1177/03331024241230963 Source

Key clinical point: Both cinnarizine and amitriptyline effectively improved migraine symptoms in children and adolescents with migraine, but amitriptyline was a more preferable treatment option since it reduced headache frequency and duration more effectively than cinnarizine.

Major finding: Amitriptyline was more effective than cinnarizine in reducing headache frequency at 4 weeks (mean difference [MD] −8.81 attacks/months; P = .004) and headache duration at 4 (MD −123.0 minutes; P = .017), 8 (MD −110.3 minutes; P = .033), and 12 (MD −123.3 minutes; P = .018) weeks. However, there were no significant differences in headache severity and migraine-related disability between the groups at 4, 8, and 12 weeks (all P > .005).

Study details: Findings are from a randomized, double-blind controlled trial including 43 children with migraine (age 4-17 years) who were randomly assigned to receive cinnarizine (n = 22) and amitriptyline (n = 21).

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

Source: Olfat M, Hosseinpour S, Masoumi S, et al. A comparative study on prophylactic efficacy of cinnarizine and amitriptyline in childhood migraine: A randomized double-blind clinical trial. Cephalalgia. 2024 (Apr 20). doi: 10.1177/03331024241230963 Source

Key clinical point: Both cinnarizine and amitriptyline effectively improved migraine symptoms in children and adolescents with migraine, but amitriptyline was a more preferable treatment option since it reduced headache frequency and duration more effectively than cinnarizine.

Major finding: Amitriptyline was more effective than cinnarizine in reducing headache frequency at 4 weeks (mean difference [MD] −8.81 attacks/months; P = .004) and headache duration at 4 (MD −123.0 minutes; P = .017), 8 (MD −110.3 minutes; P = .033), and 12 (MD −123.3 minutes; P = .018) weeks. However, there were no significant differences in headache severity and migraine-related disability between the groups at 4, 8, and 12 weeks (all P > .005).

Study details: Findings are from a randomized, double-blind controlled trial including 43 children with migraine (age 4-17 years) who were randomly assigned to receive cinnarizine (n = 22) and amitriptyline (n = 21).

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

Source: Olfat M, Hosseinpour S, Masoumi S, et al. A comparative study on prophylactic efficacy of cinnarizine and amitriptyline in childhood migraine: A randomized double-blind clinical trial. Cephalalgia. 2024 (Apr 20). doi: 10.1177/03331024241230963 Source

Key clinical point: This cross-sectional study demonstrated a significant association between severe headache or migraine and erectile dysfunction (ED) in adult men in the US; however, the results should be interpreted carefully as it did not investigate the effects of depression and anxiety on ED.

Major finding: Presence vs absence of severe headache or migraine was associated with 51% increased risk of ED (adjusted odd ratio 1.51; P = .0036). Age of 40-60 years (P = 0.0292), body mass index < 25 kg/m² (P = .0406) or ≥30 kg/m² (P = .0222), metabolic disorders, such as hypertension (P = .0029), diabetes mellitus (P < .001), and hyperlipidemia (P = .0281), were significant risk factors for ED in those with severe headache or migraine.

Study details: This cross-sectional study included 3117 adult men with (n = 582) and without (n = 2535) history of ED from the US National Health and Nutrition Examination Survey (2001-2 and 2003-4), of whom 16.85% had severe headache or migraine.

Disclosures: This study was funded by National Natural Science Foundation of China. The authors declared no competing interests.

Source: Wu X, Zhang Y, Liu G, et al. Association between severe headache or migraine and erectile dysfunction in American adults: A cross-sectional of data study from the NHANES. Int J Impot Res. 2024 (Apr 12). doi: 10.1038/s41443-024-00867-w Source

Key clinical point: This cross-sectional study demonstrated a significant association between severe headache or migraine and erectile dysfunction (ED) in adult men in the US; however, the results should be interpreted carefully as it did not investigate the effects of depression and anxiety on ED.

Major finding: Presence vs absence of severe headache or migraine was associated with 51% increased risk of ED (adjusted odd ratio 1.51; P = .0036). Age of 40-60 years (P = 0.0292), body mass index < 25 kg/m² (P = .0406) or ≥30 kg/m² (P = .0222), metabolic disorders, such as hypertension (P = .0029), diabetes mellitus (P < .001), and hyperlipidemia (P = .0281), were significant risk factors for ED in those with severe headache or migraine.

Study details: This cross-sectional study included 3117 adult men with (n = 582) and without (n = 2535) history of ED from the US National Health and Nutrition Examination Survey (2001-2 and 2003-4), of whom 16.85% had severe headache or migraine.

Disclosures: This study was funded by National Natural Science Foundation of China. The authors declared no competing interests.

Source: Wu X, Zhang Y, Liu G, et al. Association between severe headache or migraine and erectile dysfunction in American adults: A cross-sectional of data study from the NHANES. Int J Impot Res. 2024 (Apr 12). doi: 10.1038/s41443-024-00867-w Source

Key clinical point: This cross-sectional study demonstrated a significant association between severe headache or migraine and erectile dysfunction (ED) in adult men in the US; however, the results should be interpreted carefully as it did not investigate the effects of depression and anxiety on ED.

Major finding: Presence vs absence of severe headache or migraine was associated with 51% increased risk of ED (adjusted odd ratio 1.51; P = .0036). Age of 40-60 years (P = 0.0292), body mass index < 25 kg/m² (P = .0406) or ≥30 kg/m² (P = .0222), metabolic disorders, such as hypertension (P = .0029), diabetes mellitus (P < .001), and hyperlipidemia (P = .0281), were significant risk factors for ED in those with severe headache or migraine.

Study details: This cross-sectional study included 3117 adult men with (n = 582) and without (n = 2535) history of ED from the US National Health and Nutrition Examination Survey (2001-2 and 2003-4), of whom 16.85% had severe headache or migraine.

Disclosures: This study was funded by National Natural Science Foundation of China. The authors declared no competing interests.

Source: Wu X, Zhang Y, Liu G, et al. Association between severe headache or migraine and erectile dysfunction in American adults: A cross-sectional of data study from the NHANES. Int J Impot Res. 2024 (Apr 12). doi: 10.1038/s41443-024-00867-w Source

Key clinical point: Presence of migraine poses a strong risk for incident venous thromboembolism (VTE), whereas VTE is modest risk factor for the onset of migraine.

Major finding: The risk of developing VTE was significantly higher in patients with vs without migraine (odds ratio [OR] 96.155; P = .004). Conversely, the risk for migraine was modestly higher in patients with vs without VTE (OR 1.002; P = .016).

Study details: This two-sample bidirectional Mendelian randomization study evaluated the causal association between migraine and VTE using single-nucleotide polymorphisms as instrumental variables obtained from large-scale Genome-Wide Association Studies public databases (IEU Open GWAS project, FinnGen).

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

Source: Wang Y, Hu X, Wang X, et al. Exploring the two-way link between migraines and venous thromboembolism: A bidirectional two-sample Mendelian randomization study. Thromb Haemost. 2024 (Apr 24). doi: 10.1055/a-2313-0311 Source

Key clinical point: Presence of migraine poses a strong risk for incident venous thromboembolism (VTE), whereas VTE is modest risk factor for the onset of migraine.

Major finding: The risk of developing VTE was significantly higher in patients with vs without migraine (odds ratio [OR] 96.155; P = .004). Conversely, the risk for migraine was modestly higher in patients with vs without VTE (OR 1.002; P = .016).

Study details: This two-sample bidirectional Mendelian randomization study evaluated the causal association between migraine and VTE using single-nucleotide polymorphisms as instrumental variables obtained from large-scale Genome-Wide Association Studies public databases (IEU Open GWAS project, FinnGen).

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

Source: Wang Y, Hu X, Wang X, et al. Exploring the two-way link between migraines and venous thromboembolism: A bidirectional two-sample Mendelian randomization study. Thromb Haemost. 2024 (Apr 24). doi: 10.1055/a-2313-0311 Source

Key clinical point: Presence of migraine poses a strong risk for incident venous thromboembolism (VTE), whereas VTE is modest risk factor for the onset of migraine.

Major finding: The risk of developing VTE was significantly higher in patients with vs without migraine (odds ratio [OR] 96.155; P = .004). Conversely, the risk for migraine was modestly higher in patients with vs without VTE (OR 1.002; P = .016).

Study details: This two-sample bidirectional Mendelian randomization study evaluated the causal association between migraine and VTE using single-nucleotide polymorphisms as instrumental variables obtained from large-scale Genome-Wide Association Studies public databases (IEU Open GWAS project, FinnGen).

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

Source: Wang Y, Hu X, Wang X, et al. Exploring the two-way link between migraines and venous thromboembolism: A bidirectional two-sample Mendelian randomization study. Thromb Haemost. 2024 (Apr 24). doi: 10.1055/a-2313-0311 Source

Key clinical point: Very low-quality evidence showed that serum pituitary adenylates cyclase–activating polypeptide (PACAP) levels were lower in adults with a longer history of migraine.

Major finding: Serum levels of PACAP were inversely associated with history of migraine duration in adults with migraine (summary r −0.35; P < .01). It was also seen that serum PACAP levels were higher during the ictal vs interictal period in both adults and children with migraine (standardized mean difference 0.41; 95% CI 0.17-0.66).

Study details: Findings are from a meta-analysis of eight observational studies including 674 patients with migraine and 371 control individuals without migraine.

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

Source: Zhu G, Wang M, Kong F. Blood serum levels of PACAP and migraine onset: A systematic review and meta-analysis of observational studies. Headache. 2024 (Apr 24). doi: 10.1111/head.14711 Source

Key clinical point: Very low-quality evidence showed that serum pituitary adenylates cyclase–activating polypeptide (PACAP) levels were lower in adults with a longer history of migraine.

Major finding: Serum levels of PACAP were inversely associated with history of migraine duration in adults with migraine (summary r −0.35; P < .01). It was also seen that serum PACAP levels were higher during the ictal vs interictal period in both adults and children with migraine (standardized mean difference 0.41; 95% CI 0.17-0.66).

Study details: Findings are from a meta-analysis of eight observational studies including 674 patients with migraine and 371 control individuals without migraine.

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

Source: Zhu G, Wang M, Kong F. Blood serum levels of PACAP and migraine onset: A systematic review and meta-analysis of observational studies. Headache. 2024 (Apr 24). doi: 10.1111/head.14711 Source

Key clinical point: Very low-quality evidence showed that serum pituitary adenylates cyclase–activating polypeptide (PACAP) levels were lower in adults with a longer history of migraine.

Major finding: Serum levels of PACAP were inversely associated with history of migraine duration in adults with migraine (summary r −0.35; P < .01). It was also seen that serum PACAP levels were higher during the ictal vs interictal period in both adults and children with migraine (standardized mean difference 0.41; 95% CI 0.17-0.66).

Study details: Findings are from a meta-analysis of eight observational studies including 674 patients with migraine and 371 control individuals without migraine.

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

Source: Zhu G, Wang M, Kong F. Blood serum levels of PACAP and migraine onset: A systematic review and meta-analysis of observational studies. Headache. 2024 (Apr 24). doi: 10.1111/head.14711 Source

Key clinical point: Rimegepant orally disintegrating tablet (ODT) offers pain relief within 2 hours of treatment in adults with migraine, with a tolerable safety profile.

Major finding: At 2 hours post dose, rimegepant was more effective than placebo in providing freedom from pain (risk difference 7.6; P = .0004) and the most bothersome symptom (risk difference 16.2; P < .0001). The overall rates of treatment-emergent adverse events were comparable between the rimegepant and placebo groups (15.2% and 16.4%, respectively).

Study details: This subgroup analysis of a double-blind, randomized, placebo-controlled phase 3 clinical trial included 1075 patients with acute migraine with or without aura (age ≥ 18 years) who were randomly assigned to receive either 75 mg rimegepant ODT (n = 538) or placebo (n = 537).

Disclosures: This study was funded by BioShin, a wholly owned subsidiary of Biohaven Pharmaceuticals, which was acquired by Pfizer. Pfizer provided writing support. Five authors declared being employees or stock owners of Biohaven, BioShin, or Pfizer. The remaining authors declared no conflicts of interest.

Source: Yu S, Guo A, Wang Z, et al. Rimegepant orally disintegrating tablet 75 mg for acute treatment of migraine in adults from China: A subgroup analysis of a double-blind, randomized, placebo-controlled, phase 3 clinical trial. J Headache Pain. 2024;25:57 (Apr 16). Source

Key clinical point: Rimegepant orally disintegrating tablet (ODT) offers pain relief within 2 hours of treatment in adults with migraine, with a tolerable safety profile.

Major finding: At 2 hours post dose, rimegepant was more effective than placebo in providing freedom from pain (risk difference 7.6; P = .0004) and the most bothersome symptom (risk difference 16.2; P < .0001). The overall rates of treatment-emergent adverse events were comparable between the rimegepant and placebo groups (15.2% and 16.4%, respectively).

Study details: This subgroup analysis of a double-blind, randomized, placebo-controlled phase 3 clinical trial included 1075 patients with acute migraine with or without aura (age ≥ 18 years) who were randomly assigned to receive either 75 mg rimegepant ODT (n = 538) or placebo (n = 537).

Disclosures: This study was funded by BioShin, a wholly owned subsidiary of Biohaven Pharmaceuticals, which was acquired by Pfizer. Pfizer provided writing support. Five authors declared being employees or stock owners of Biohaven, BioShin, or Pfizer. The remaining authors declared no conflicts of interest.

Source: Yu S, Guo A, Wang Z, et al. Rimegepant orally disintegrating tablet 75 mg for acute treatment of migraine in adults from China: A subgroup analysis of a double-blind, randomized, placebo-controlled, phase 3 clinical trial. J Headache Pain. 2024;25:57 (Apr 16). Source

Key clinical point: Rimegepant orally disintegrating tablet (ODT) offers pain relief within 2 hours of treatment in adults with migraine, with a tolerable safety profile.

Major finding: At 2 hours post dose, rimegepant was more effective than placebo in providing freedom from pain (risk difference 7.6; P = .0004) and the most bothersome symptom (risk difference 16.2; P < .0001). The overall rates of treatment-emergent adverse events were comparable between the rimegepant and placebo groups (15.2% and 16.4%, respectively).

Study details: This subgroup analysis of a double-blind, randomized, placebo-controlled phase 3 clinical trial included 1075 patients with acute migraine with or without aura (age ≥ 18 years) who were randomly assigned to receive either 75 mg rimegepant ODT (n = 538) or placebo (n = 537).

Disclosures: This study was funded by BioShin, a wholly owned subsidiary of Biohaven Pharmaceuticals, which was acquired by Pfizer. Pfizer provided writing support. Five authors declared being employees or stock owners of Biohaven, BioShin, or Pfizer. The remaining authors declared no conflicts of interest.

Source: Yu S, Guo A, Wang Z, et al. Rimegepant orally disintegrating tablet 75 mg for acute treatment of migraine in adults from China: A subgroup analysis of a double-blind, randomized, placebo-controlled, phase 3 clinical trial. J Headache Pain. 2024;25:57 (Apr 16). Source

Key clinical point: Combination therapy with two parenteral agents or monotherapy with either neuroleptics or metoclopramide can be considered as a first-line treatment option for the management of acute migraine pain in the emergency department (ED) settings.

Major finding: Combination therapy of two parenteral agents vs placebo was an effective treatment option in reducing pain intensity scores (mean difference −3.36; 95% CI −4.64 to −2.08) and increasing the rate of achievement of pain relief (risk ratio 2.83; 95% CI 1.74-4.61). Monotherapy with neuroleptics and metoclopramide also provided pain relief and helped patients achieve pain-free status prior to discharge from the ED but increased the risk for adverse events, especially akathisia.

Study details: This meta-analysis of 97 randomized controlled trials evaluated the effectiveness of various parenteral agents for pain relief in patients with acute migraine presenting to the ED.

Disclosures: This study was funded by the Emergency Medicine Research Group, Canada. The authors declared no conflicts of interest.

Source: Kirkland SW, Visser L, Meyer J, et al. The effectiveness of parenteral agents for pain reduction in patients with migraine presenting to emergency settings: A systematic review and network analysis. Headache. 2024;64(4):424-447. doi: 10.1111/head.14704 Source

Key clinical point: Combination therapy with two parenteral agents or monotherapy with either neuroleptics or metoclopramide can be considered as a first-line treatment option for the management of acute migraine pain in the emergency department (ED) settings.

Major finding: Combination therapy of two parenteral agents vs placebo was an effective treatment option in reducing pain intensity scores (mean difference −3.36; 95% CI −4.64 to −2.08) and increasing the rate of achievement of pain relief (risk ratio 2.83; 95% CI 1.74-4.61). Monotherapy with neuroleptics and metoclopramide also provided pain relief and helped patients achieve pain-free status prior to discharge from the ED but increased the risk for adverse events, especially akathisia.

Study details: This meta-analysis of 97 randomized controlled trials evaluated the effectiveness of various parenteral agents for pain relief in patients with acute migraine presenting to the ED.

Disclosures: This study was funded by the Emergency Medicine Research Group, Canada. The authors declared no conflicts of interest.

Source: Kirkland SW, Visser L, Meyer J, et al. The effectiveness of parenteral agents for pain reduction in patients with migraine presenting to emergency settings: A systematic review and network analysis. Headache. 2024;64(4):424-447. doi: 10.1111/head.14704 Source

Key clinical point: Combination therapy with two parenteral agents or monotherapy with either neuroleptics or metoclopramide can be considered as a first-line treatment option for the management of acute migraine pain in the emergency department (ED) settings.

Major finding: Combination therapy of two parenteral agents vs placebo was an effective treatment option in reducing pain intensity scores (mean difference −3.36; 95% CI −4.64 to −2.08) and increasing the rate of achievement of pain relief (risk ratio 2.83; 95% CI 1.74-4.61). Monotherapy with neuroleptics and metoclopramide also provided pain relief and helped patients achieve pain-free status prior to discharge from the ED but increased the risk for adverse events, especially akathisia.

Study details: This meta-analysis of 97 randomized controlled trials evaluated the effectiveness of various parenteral agents for pain relief in patients with acute migraine presenting to the ED.

Disclosures: This study was funded by the Emergency Medicine Research Group, Canada. The authors declared no conflicts of interest.

Source: Kirkland SW, Visser L, Meyer J, et al. The effectiveness of parenteral agents for pain reduction in patients with migraine presenting to emergency settings: A systematic review and network analysis. Headache. 2024;64(4):424-447. doi: 10.1111/head.14704 Source

Key clinical point: Women with migraine tend to exclusively breastfeed their infants for a shorter duration than those without migraine.

Major finding: There was no significant difference between the proportions of women with and without migraine who did not breastfeed their infants (adjusted odds ratio [aOR] 1.03; 95% CI 0.74-1.27), but the odds of exclusively breastfeeding infants for 6 months and more were 16% lower in women with vs without migraine (aOR 0.84; 95% CI 0.71-0.99; P = .033).

Study details: Findings are from a cross-sectional study including 5282 women (age 20-49 years) who had given birth in the last 5 years, of whom 862 (16.3%) had migraine.

Disclosures: The study did not receive any specific funding. Christine Lay declared receiving research support from and serving on ad boards for various sources. The other authors declared no conflicts of interest.

Source: Vyas MV, Lee N, Lay C. Association between migraine and exclusive breastfeeding: A cross-sectional study. Headache. 2024 (Apr 21). doi: 10.1111/head.14713 Source

Key clinical point: Women with migraine tend to exclusively breastfeed their infants for a shorter duration than those without migraine.

Major finding: There was no significant difference between the proportions of women with and without migraine who did not breastfeed their infants (adjusted odds ratio [aOR] 1.03; 95% CI 0.74-1.27), but the odds of exclusively breastfeeding infants for 6 months and more were 16% lower in women with vs without migraine (aOR 0.84; 95% CI 0.71-0.99; P = .033).

Study details: Findings are from a cross-sectional study including 5282 women (age 20-49 years) who had given birth in the last 5 years, of whom 862 (16.3%) had migraine.

Disclosures: The study did not receive any specific funding. Christine Lay declared receiving research support from and serving on ad boards for various sources. The other authors declared no conflicts of interest.

Source: Vyas MV, Lee N, Lay C. Association between migraine and exclusive breastfeeding: A cross-sectional study. Headache. 2024 (Apr 21). doi: 10.1111/head.14713 Source

Key clinical point: Women with migraine tend to exclusively breastfeed their infants for a shorter duration than those without migraine.

Major finding: There was no significant difference between the proportions of women with and without migraine who did not breastfeed their infants (adjusted odds ratio [aOR] 1.03; 95% CI 0.74-1.27), but the odds of exclusively breastfeeding infants for 6 months and more were 16% lower in women with vs without migraine (aOR 0.84; 95% CI 0.71-0.99; P = .033).

Study details: Findings are from a cross-sectional study including 5282 women (age 20-49 years) who had given birth in the last 5 years, of whom 862 (16.3%) had migraine.

Disclosures: The study did not receive any specific funding. Christine Lay declared receiving research support from and serving on ad boards for various sources. The other authors declared no conflicts of interest.

Source: Vyas MV, Lee N, Lay C. Association between migraine and exclusive breastfeeding: A cross-sectional study. Headache. 2024 (Apr 21). doi: 10.1111/head.14713 Source

Key clinical point: In patients with migraine, greater severity of photophobia is significantly associated with worse sleep-related outcomes, such as sleep quality (SQ), sleep disturbance (SDi), sleep onset latency (SOL), sleep-related impairment (SRI), and insomnia.

Major finding: Compared with patients with migraine and without photophobia, those with migraine and photophobia presented significantly poorer SQ (β 0.15; P < .001), longer SOL (β 0.10; P = .011), higher levels of SDi (β 0.12; P < .001) and SRI (β 0.08; P = .020), and a higher prevalence of insomnia (β 0.11; P = .005).

Study details: This cross-sectional observational study evaluated the association between photophobia and sleep-related outcomes in 852 patients with migraine using data from the American Registry for Migraine Research.

Disclosures: This study did not receive any specific funding. Some authors declared receiving compensation for consulting from, serving as consultants for, or having other ties with various sources.

Source: Sharp N, Burish MJ, Digre KB, et al. Photophobia is associated with lower sleep quality in individuals with migraine: Results from the American Registry for Migraine Research (ARMR). J Headache Pain. 2024;25:55. doi: 10.1186/s10194-024-01756-9 Source

Key clinical point: In patients with migraine, greater severity of photophobia is significantly associated with worse sleep-related outcomes, such as sleep quality (SQ), sleep disturbance (SDi), sleep onset latency (SOL), sleep-related impairment (SRI), and insomnia.

Major finding: Compared with patients with migraine and without photophobia, those with migraine and photophobia presented significantly poorer SQ (β 0.15; P < .001), longer SOL (β 0.10; P = .011), higher levels of SDi (β 0.12; P < .001) and SRI (β 0.08; P = .020), and a higher prevalence of insomnia (β 0.11; P = .005).

Study details: This cross-sectional observational study evaluated the association between photophobia and sleep-related outcomes in 852 patients with migraine using data from the American Registry for Migraine Research.

Disclosures: This study did not receive any specific funding. Some authors declared receiving compensation for consulting from, serving as consultants for, or having other ties with various sources.

Source: Sharp N, Burish MJ, Digre KB, et al. Photophobia is associated with lower sleep quality in individuals with migraine: Results from the American Registry for Migraine Research (ARMR). J Headache Pain. 2024;25:55. doi: 10.1186/s10194-024-01756-9 Source

Key clinical point: In patients with migraine, greater severity of photophobia is significantly associated with worse sleep-related outcomes, such as sleep quality (SQ), sleep disturbance (SDi), sleep onset latency (SOL), sleep-related impairment (SRI), and insomnia.

Major finding: Compared with patients with migraine and without photophobia, those with migraine and photophobia presented significantly poorer SQ (β 0.15; P < .001), longer SOL (β 0.10; P = .011), higher levels of SDi (β 0.12; P < .001) and SRI (β 0.08; P = .020), and a higher prevalence of insomnia (β 0.11; P = .005).

Study details: This cross-sectional observational study evaluated the association between photophobia and sleep-related outcomes in 852 patients with migraine using data from the American Registry for Migraine Research.

Disclosures: This study did not receive any specific funding. Some authors declared receiving compensation for consulting from, serving as consultants for, or having other ties with various sources.

Source: Sharp N, Burish MJ, Digre KB, et al. Photophobia is associated with lower sleep quality in individuals with migraine: Results from the American Registry for Migraine Research (ARMR). J Headache Pain. 2024;25:55. doi: 10.1186/s10194-024-01756-9 Source

Key clinical point: Patients with migraine had an increased risk for vascular dementia (VaD), with the risk being significantly higher in those with chronic vs episodic migraine.

Major finding: Compared with individuals without migraine, patients with migraine had a 1.21-fold higher risk for VaD (adjusted hazard ratio [aHR] 1.21; 95% CI 1.17-1.25), with the cumulative incidence of migraine being significantly higher in patients with chronic vs episodic migraine (log-rank P < .001).

Study details: This 10-year retrospective population-based cohort study included 212,836 patients with migraine and 5,863,348 participants without migraine, of whom 3914 (1.8%) and 60,259 (1.0%), respectively, were diagnosed with VaD during the follow-up period.

Disclosures: This study was funded by a grant from the National Research Foundation, Republic of Korea, and others. The authors declared no conflicts of interest.

Source: Shin H, Ha WS, Kim J, et al. Association between migraine and the risk of vascular dementia: A nationwide longitudinal study in South Korea. PLoS One. 2024;19:e0300379. doi: 10.1371/journal.pone.0300379 Source

Key clinical point: Patients with migraine had an increased risk for vascular dementia (VaD), with the risk being significantly higher in those with chronic vs episodic migraine.

Major finding: Compared with individuals without migraine, patients with migraine had a 1.21-fold higher risk for VaD (adjusted hazard ratio [aHR] 1.21; 95% CI 1.17-1.25), with the cumulative incidence of migraine being significantly higher in patients with chronic vs episodic migraine (log-rank P < .001).

Study details: This 10-year retrospective population-based cohort study included 212,836 patients with migraine and 5,863,348 participants without migraine, of whom 3914 (1.8%) and 60,259 (1.0%), respectively, were diagnosed with VaD during the follow-up period.

Disclosures: This study was funded by a grant from the National Research Foundation, Republic of Korea, and others. The authors declared no conflicts of interest.

Source: Shin H, Ha WS, Kim J, et al. Association between migraine and the risk of vascular dementia: A nationwide longitudinal study in South Korea. PLoS One. 2024;19:e0300379. doi: 10.1371/journal.pone.0300379 Source

Key clinical point: Patients with migraine had an increased risk for vascular dementia (VaD), with the risk being significantly higher in those with chronic vs episodic migraine.

Major finding: Compared with individuals without migraine, patients with migraine had a 1.21-fold higher risk for VaD (adjusted hazard ratio [aHR] 1.21; 95% CI 1.17-1.25), with the cumulative incidence of migraine being significantly higher in patients with chronic vs episodic migraine (log-rank P < .001).

Study details: This 10-year retrospective population-based cohort study included 212,836 patients with migraine and 5,863,348 participants without migraine, of whom 3914 (1.8%) and 60,259 (1.0%), respectively, were diagnosed with VaD during the follow-up period.

Disclosures: This study was funded by a grant from the National Research Foundation, Republic of Korea, and others. The authors declared no conflicts of interest.

Source: Shin H, Ha WS, Kim J, et al. Association between migraine and the risk of vascular dementia: A nationwide longitudinal study in South Korea. PLoS One. 2024;19:e0300379. doi: 10.1371/journal.pone.0300379 Source

Traidl and colleagues report that obesity was linked to worse AD in German patients. The authors hit the nail on the head with their conclusions: "In this large and well-characterized AD patient cohort, obesity is significantly associated with physician- and patient-assessed measures of AD disease severity. However, the corresponding effect sizes were low and of questionable clinical relevance." What might account for the small difference in disease severity? Adherence to treatment is highly variable among patients with AD. A small tendency toward worse adherence in patients with obesity could easily explain the small differences seen in disease severity.

Eichenfeld and colleagues report that topical ruxolitinib maintained good efficacy over a year in open-label use. Topical ruxolitinib is a very effective treatment for AD. If real-life AD patients on topical ruxolitinib were to lose efficacy over time, I'd consider the possibility that they've developed mutant Janus kinase (JAK) enzymes that are no longer responsive to the drug. Just kidding. I doubt that such mutations ever occur. If topical ruxolitinib in AD patients were to lose efficacy over time, I'd strongly consider the possibility that patients' adherence to the treatment is no longer as good as it was before. Long-term adherence to topical treatment can be abysmal. Adherence in clinical trials is probably a lot better than in clinical practice. When we see topical treatments that are effective in clinical trials failing in real-life patients with AD, it may be prudent to address the possibility of poor adherence.

I'd love to see a head-to-head trial of tralokinumab vs dupilumab in the treatment of moderate to severe AD. Lacking that, Torres and colleagues report an indirect comparison of the two drugs in patients also treated with topical steroids. This study, funded by the manufacturer of tralokinumab, reported that the two drugs have similar efficacy. How much of the efficacy was due to the topical steroid use is not clear to me. I'd still love to see a head-to-head trial of tralokinumab vs dupilumab to have a better, more confident sense of their relative efficacy.

Is AD associated with brain cancer, as reported by Xin and colleagues? I'm not an expert in their methodology, but they did find a statistically significant increased risk, with an odds ratio of 1.0005. I understand the odds ratio for smoking and lung cancer to be about 80. Even if the increased odds of 1.005 — no, wait, that's 1.0005 — is truly due to AD, this tiny difference doesn't seem meaningful in any way.

Traidl and colleagues report that obesity was linked to worse AD in German patients. The authors hit the nail on the head with their conclusions: "In this large and well-characterized AD patient cohort, obesity is significantly associated with physician- and patient-assessed measures of AD disease severity. However, the corresponding effect sizes were low and of questionable clinical relevance." What might account for the small difference in disease severity? Adherence to treatment is highly variable among patients with AD. A small tendency toward worse adherence in patients with obesity could easily explain the small differences seen in disease severity.

Eichenfeld and colleagues report that topical ruxolitinib maintained good efficacy over a year in open-label use. Topical ruxolitinib is a very effective treatment for AD. If real-life AD patients on topical ruxolitinib were to lose efficacy over time, I'd consider the possibility that they've developed mutant Janus kinase (JAK) enzymes that are no longer responsive to the drug. Just kidding. I doubt that such mutations ever occur. If topical ruxolitinib in AD patients were to lose efficacy over time, I'd strongly consider the possibility that patients' adherence to the treatment is no longer as good as it was before. Long-term adherence to topical treatment can be abysmal. Adherence in clinical trials is probably a lot better than in clinical practice. When we see topical treatments that are effective in clinical trials failing in real-life patients with AD, it may be prudent to address the possibility of poor adherence.

I'd love to see a head-to-head trial of tralokinumab vs dupilumab in the treatment of moderate to severe AD. Lacking that, Torres and colleagues report an indirect comparison of the two drugs in patients also treated with topical steroids. This study, funded by the manufacturer of tralokinumab, reported that the two drugs have similar efficacy. How much of the efficacy was due to the topical steroid use is not clear to me. I'd still love to see a head-to-head trial of tralokinumab vs dupilumab to have a better, more confident sense of their relative efficacy.

Is AD associated with brain cancer, as reported by Xin and colleagues? I'm not an expert in their methodology, but they did find a statistically significant increased risk, with an odds ratio of 1.0005. I understand the odds ratio for smoking and lung cancer to be about 80. Even if the increased odds of 1.005 — no, wait, that's 1.0005 — is truly due to AD, this tiny difference doesn't seem meaningful in any way.

Traidl and colleagues report that obesity was linked to worse AD in German patients. The authors hit the nail on the head with their conclusions: "In this large and well-characterized AD patient cohort, obesity is significantly associated with physician- and patient-assessed measures of AD disease severity. However, the corresponding effect sizes were low and of questionable clinical relevance." What might account for the small difference in disease severity? Adherence to treatment is highly variable among patients with AD. A small tendency toward worse adherence in patients with obesity could easily explain the small differences seen in disease severity.

Eichenfeld and colleagues report that topical ruxolitinib maintained good efficacy over a year in open-label use. Topical ruxolitinib is a very effective treatment for AD. If real-life AD patients on topical ruxolitinib were to lose efficacy over time, I'd consider the possibility that they've developed mutant Janus kinase (JAK) enzymes that are no longer responsive to the drug. Just kidding. I doubt that such mutations ever occur. If topical ruxolitinib in AD patients were to lose efficacy over time, I'd strongly consider the possibility that patients' adherence to the treatment is no longer as good as it was before. Long-term adherence to topical treatment can be abysmal. Adherence in clinical trials is probably a lot better than in clinical practice. When we see topical treatments that are effective in clinical trials failing in real-life patients with AD, it may be prudent to address the possibility of poor adherence.

I'd love to see a head-to-head trial of tralokinumab vs dupilumab in the treatment of moderate to severe AD. Lacking that, Torres and colleagues report an indirect comparison of the two drugs in patients also treated with topical steroids. This study, funded by the manufacturer of tralokinumab, reported that the two drugs have similar efficacy. How much of the efficacy was due to the topical steroid use is not clear to me. I'd still love to see a head-to-head trial of tralokinumab vs dupilumab to have a better, more confident sense of their relative efficacy.

Is AD associated with brain cancer, as reported by Xin and colleagues? I'm not an expert in their methodology, but they did find a statistically significant increased risk, with an odds ratio of 1.0005. I understand the odds ratio for smoking and lung cancer to be about 80. Even if the increased odds of 1.005 — no, wait, that's 1.0005 — is truly due to AD, this tiny difference doesn't seem meaningful in any way.