Clinical Edge Journal Scan

Key clinical point: Patients with migraine experienced considerable neck pain–related disability, with the effect being more prominent among patients with chronic vs episodic migraine.

Major findings: Patients with migraine reported a mean Neck Disability Index (NDI) score of 16.2, indicative of moderate disability. The NDI scores were 12.1 points higher among patients with migraine vs control individuals without headache (P < .001) and 5.5 points higher among patients with chronic vs episodic migraine (P < .001).

Study details: Findings are from a meta-analysis of 33 observational studies including patients with migraine, patients with tension-type headache, and healthy individuals without headache.

Disclosure: The study did not receive any funding. Four authors declared receiving personal fees or honoraria for consultation from or having other ties with various sources; others declared no conflicts of interest.

Source: Al-Khazali HM, Al-Sayegh Z, Younis S, et al. Systematic review and meta-analysis of Neck Disability Index and Numeric Pain Rating Scale in patients with migraine and tension-type headache. Cephalalgia. 2024 (Aug 28). doi: 10.1177/033310242412742 Source

Key clinical point: Patients with migraine experienced considerable neck pain–related disability, with the effect being more prominent among patients with chronic vs episodic migraine.

Major findings: Patients with migraine reported a mean Neck Disability Index (NDI) score of 16.2, indicative of moderate disability. The NDI scores were 12.1 points higher among patients with migraine vs control individuals without headache (P < .001) and 5.5 points higher among patients with chronic vs episodic migraine (P < .001).

Study details: Findings are from a meta-analysis of 33 observational studies including patients with migraine, patients with tension-type headache, and healthy individuals without headache.

Disclosure: The study did not receive any funding. Four authors declared receiving personal fees or honoraria for consultation from or having other ties with various sources; others declared no conflicts of interest.

Source: Al-Khazali HM, Al-Sayegh Z, Younis S, et al. Systematic review and meta-analysis of Neck Disability Index and Numeric Pain Rating Scale in patients with migraine and tension-type headache. Cephalalgia. 2024 (Aug 28). doi: 10.1177/033310242412742 Source

Key clinical point: Patients with migraine experienced considerable neck pain–related disability, with the effect being more prominent among patients with chronic vs episodic migraine.

Major findings: Patients with migraine reported a mean Neck Disability Index (NDI) score of 16.2, indicative of moderate disability. The NDI scores were 12.1 points higher among patients with migraine vs control individuals without headache (P < .001) and 5.5 points higher among patients with chronic vs episodic migraine (P < .001).

Study details: Findings are from a meta-analysis of 33 observational studies including patients with migraine, patients with tension-type headache, and healthy individuals without headache.

Disclosure: The study did not receive any funding. Four authors declared receiving personal fees or honoraria for consultation from or having other ties with various sources; others declared no conflicts of interest.

Source: Al-Khazali HM, Al-Sayegh Z, Younis S, et al. Systematic review and meta-analysis of Neck Disability Index and Numeric Pain Rating Scale in patients with migraine and tension-type headache. Cephalalgia. 2024 (Aug 28). doi: 10.1177/033310242412742 Source

Key clinical point: When administered during the prodrome, ubrogepant was more effective than placebo in improving normal functioning, reducing activity limitations, and increasing treatment satisfaction in patients with acute migraine.

Major findings: A significantly higher proportion of patients were able to function normally as early as 2 hours after receiving ubrogepant vs placebo (odds ratio [OR] 1.76; P = .0001), with the effects being sustained through 24 hours. The patients also experienced reduced activity limitations (OR 2.07; P < .0001) and greater treatment satisfaction (OR 2.32; P < .0001) at 24 hours after receiving ubrogepant vs placebo.

Study details: This PRODROME trial included 477 adult patients with acute migraine who were randomly assigned to receive either placebo followed by 100 mg ubrogepant for the first and second prodrome events, respectively, or vice versa.

Disclosure: The study was funded by AbbVie. Seven authors reported being employees of AbbVie and may hold stock in the company. Other authors declared having other ties with various sources, including AbbVie.

Source: Lipton RB, Harriott AM, Ma JY, et al. Effect of ubrogepant on patient-reported outcomes when administered during the migraine prodrome: Results from the randomized PRODROME trial. Neurology. 2024;103(6):e209745 (Aug 28). doi: 10.1212/WNL.00000000002097 Source

Key clinical point: When administered during the prodrome, ubrogepant was more effective than placebo in improving normal functioning, reducing activity limitations, and increasing treatment satisfaction in patients with acute migraine.

Major findings: A significantly higher proportion of patients were able to function normally as early as 2 hours after receiving ubrogepant vs placebo (odds ratio [OR] 1.76; P = .0001), with the effects being sustained through 24 hours. The patients also experienced reduced activity limitations (OR 2.07; P < .0001) and greater treatment satisfaction (OR 2.32; P < .0001) at 24 hours after receiving ubrogepant vs placebo.

Study details: This PRODROME trial included 477 adult patients with acute migraine who were randomly assigned to receive either placebo followed by 100 mg ubrogepant for the first and second prodrome events, respectively, or vice versa.

Disclosure: The study was funded by AbbVie. Seven authors reported being employees of AbbVie and may hold stock in the company. Other authors declared having other ties with various sources, including AbbVie.

Source: Lipton RB, Harriott AM, Ma JY, et al. Effect of ubrogepant on patient-reported outcomes when administered during the migraine prodrome: Results from the randomized PRODROME trial. Neurology. 2024;103(6):e209745 (Aug 28). doi: 10.1212/WNL.00000000002097 Source

Key clinical point: When administered during the prodrome, ubrogepant was more effective than placebo in improving normal functioning, reducing activity limitations, and increasing treatment satisfaction in patients with acute migraine.

Major findings: A significantly higher proportion of patients were able to function normally as early as 2 hours after receiving ubrogepant vs placebo (odds ratio [OR] 1.76; P = .0001), with the effects being sustained through 24 hours. The patients also experienced reduced activity limitations (OR 2.07; P < .0001) and greater treatment satisfaction (OR 2.32; P < .0001) at 24 hours after receiving ubrogepant vs placebo.

Study details: This PRODROME trial included 477 adult patients with acute migraine who were randomly assigned to receive either placebo followed by 100 mg ubrogepant for the first and second prodrome events, respectively, or vice versa.

Disclosure: The study was funded by AbbVie. Seven authors reported being employees of AbbVie and may hold stock in the company. Other authors declared having other ties with various sources, including AbbVie.

Source: Lipton RB, Harriott AM, Ma JY, et al. Effect of ubrogepant on patient-reported outcomes when administered during the migraine prodrome: Results from the randomized PRODROME trial. Neurology. 2024;103(6):e209745 (Aug 28). doi: 10.1212/WNL.00000000002097 Source

Key clinical point: Middle-aged and older women showed no significant association between migraine, and the risk for Parkinson disease (PD), irrespective of migraine subtypes and frequency.

Major findings: Compared to women with without migraine, those with migraine did not show a risk of PD (adjusted hazard ratio [aHR] 1.07; 95% CI 0.88-1.29) irrespective of the presence of aura. No risk was seen even if patients had monthly migraine frequency (aHR 1.09; 95% CI 0.64-1.87), or a weekly or greater migraine frequency (aHR 1.10; 95% CI 0.44-2.75).

Study details: This study involved 39,312 women (age > 45 years) of whom 7321 had migraines, including 2153 with a history of migraine and 5168 with migraine with or without aura. None had a history of PD.

Disclosure: This study was supported by grants from the US National Cancer Institute and the US National Heart, Lung, and Blood Institute. Two authors declared receiving research grants or personal compensation from various sources.

Source: Schulz RS, Glatz T, Buring Jeet al. Migraine and risk of Parkinson disease in women: A cohort study. Neurology. 2024;103(6):e209747 (Aug 21). doi: 10.1212/WNL.0000000000209747 Source

Key clinical point: Middle-aged and older women showed no significant association between migraine, and the risk for Parkinson disease (PD), irrespective of migraine subtypes and frequency.

Major findings: Compared to women with without migraine, those with migraine did not show a risk of PD (adjusted hazard ratio [aHR] 1.07; 95% CI 0.88-1.29) irrespective of the presence of aura. No risk was seen even if patients had monthly migraine frequency (aHR 1.09; 95% CI 0.64-1.87), or a weekly or greater migraine frequency (aHR 1.10; 95% CI 0.44-2.75).

Study details: This study involved 39,312 women (age > 45 years) of whom 7321 had migraines, including 2153 with a history of migraine and 5168 with migraine with or without aura. None had a history of PD.

Disclosure: This study was supported by grants from the US National Cancer Institute and the US National Heart, Lung, and Blood Institute. Two authors declared receiving research grants or personal compensation from various sources.

Source: Schulz RS, Glatz T, Buring Jeet al. Migraine and risk of Parkinson disease in women: A cohort study. Neurology. 2024;103(6):e209747 (Aug 21). doi: 10.1212/WNL.0000000000209747 Source

Key clinical point: Middle-aged and older women showed no significant association between migraine, and the risk for Parkinson disease (PD), irrespective of migraine subtypes and frequency.

Major findings: Compared to women with without migraine, those with migraine did not show a risk of PD (adjusted hazard ratio [aHR] 1.07; 95% CI 0.88-1.29) irrespective of the presence of aura. No risk was seen even if patients had monthly migraine frequency (aHR 1.09; 95% CI 0.64-1.87), or a weekly or greater migraine frequency (aHR 1.10; 95% CI 0.44-2.75).

Study details: This study involved 39,312 women (age > 45 years) of whom 7321 had migraines, including 2153 with a history of migraine and 5168 with migraine with or without aura. None had a history of PD.

Disclosure: This study was supported by grants from the US National Cancer Institute and the US National Heart, Lung, and Blood Institute. Two authors declared receiving research grants or personal compensation from various sources.

Source: Schulz RS, Glatz T, Buring Jeet al. Migraine and risk of Parkinson disease in women: A cohort study. Neurology. 2024;103(6):e209747 (Aug 21). doi: 10.1212/WNL.0000000000209747 Source

Key clinical point: A single infusion of Lu AG09222, a humanized monoclonal antibody targeting the pituitary adenylate cyclase-activating polypeptide, was more effective than placebo in reducing migraine frequency over 4 weeks in adults with episodic or chronic migraine.

Major findings: Through week 4, a single infusion of 750 mg Lu AG09222 vs placebo led to a significantly greater reduction in monthly migraine days (−6.2 vs −4.2 days; difference −2 days; P = .02). Most adverse events were mild, with COVID-19, nasopharyngitis, and fatigue being more prevalent in those receiving 750 mg Lu AG09222 vs placebo.

Study details: This phase 2 trial included 237 adults with migraine who did not respond to two to four previous treatments and were assigned to receive either Lu AG09222 (750 mg or 100 mg) or placebo for 4 weeks.

Disclosure: The study was supported by H. Lundbeck A/S. Three authors declared being employees of H. Lundbeck A/S, of whom one held stock options. One author reported receiving consulting, speaker, and advisory board fees from various sources, including H. Lundbeck A/S.

Source: Ashina M, Phul R, Khodaie M, et al. A monoclonal antibody to PACAP for migraine prevention. N Engl J Med. 2024;391(9):800-809 (Sept 4). doi: 10.1056/NEJMoa2314577 Source

Key clinical point: A single infusion of Lu AG09222, a humanized monoclonal antibody targeting the pituitary adenylate cyclase-activating polypeptide, was more effective than placebo in reducing migraine frequency over 4 weeks in adults with episodic or chronic migraine.

Major findings: Through week 4, a single infusion of 750 mg Lu AG09222 vs placebo led to a significantly greater reduction in monthly migraine days (−6.2 vs −4.2 days; difference −2 days; P = .02). Most adverse events were mild, with COVID-19, nasopharyngitis, and fatigue being more prevalent in those receiving 750 mg Lu AG09222 vs placebo.

Study details: This phase 2 trial included 237 adults with migraine who did not respond to two to four previous treatments and were assigned to receive either Lu AG09222 (750 mg or 100 mg) or placebo for 4 weeks.

Disclosure: The study was supported by H. Lundbeck A/S. Three authors declared being employees of H. Lundbeck A/S, of whom one held stock options. One author reported receiving consulting, speaker, and advisory board fees from various sources, including H. Lundbeck A/S.

Source: Ashina M, Phul R, Khodaie M, et al. A monoclonal antibody to PACAP for migraine prevention. N Engl J Med. 2024;391(9):800-809 (Sept 4). doi: 10.1056/NEJMoa2314577 Source

Key clinical point: A single infusion of Lu AG09222, a humanized monoclonal antibody targeting the pituitary adenylate cyclase-activating polypeptide, was more effective than placebo in reducing migraine frequency over 4 weeks in adults with episodic or chronic migraine.

Major findings: Through week 4, a single infusion of 750 mg Lu AG09222 vs placebo led to a significantly greater reduction in monthly migraine days (−6.2 vs −4.2 days; difference −2 days; P = .02). Most adverse events were mild, with COVID-19, nasopharyngitis, and fatigue being more prevalent in those receiving 750 mg Lu AG09222 vs placebo.

Study details: This phase 2 trial included 237 adults with migraine who did not respond to two to four previous treatments and were assigned to receive either Lu AG09222 (750 mg or 100 mg) or placebo for 4 weeks.

Disclosure: The study was supported by H. Lundbeck A/S. Three authors declared being employees of H. Lundbeck A/S, of whom one held stock options. One author reported receiving consulting, speaker, and advisory board fees from various sources, including H. Lundbeck A/S.

Source: Ashina M, Phul R, Khodaie M, et al. A monoclonal antibody to PACAP for migraine prevention. N Engl J Med. 2024;391(9):800-809 (Sept 4). doi: 10.1056/NEJMoa2314577 Source

The question of whether effective targeted therapies for psoriasis reduce the incidence or "prevent" psoriatic arthritis (PsA) has increasingly become a topic of interest. Also of interest is whether there are differences between different drug classes for treating psoriasis and PsA. To evaluate whether there is a difference between patients treated with interleukin (IL)-23 vs IL-12/23 inhibitors, Tsai and colleagues conducted a retrospective cohort study that included the propensity score–matched data of patients with psoriasis from the TriNetX database who were treated with either IL-23 inhibitors (n = 2142) or IL-12/23 inhibitors (n = 2142). Patients treated with IL-23 inhibitors vs IL-12/23 inhibitors demonstrated no significant difference in the risk for PsA (hazard ratio 0.96; P = .812) and cumulative incidence of PsA (P = .812). Given the many drawbacks of administrative database-based retrospective studies, I would ideally like to see prospective studies conducted to evaluate the differential risk for PsA between targeted therapies for psoriasis. However, patients can be assured that the beneficial effect, if any, is likely to be similar between these two drug classes in regard to PsA prevention.

One important question when treating patients with PsA with biologic therapies is whether treatment with methotrexate needs to be continued. In a post hoc analysis of phase 3 trials (BE OPTIMAL, BE COMPLETE, and BE VITAL) that included patients with PsA who were biologic-naive (n = 852) or had an incomplete response to a tumor necrosis factor (TNF) inhibitor (n = 400), McInnes and colleagues evaluated the efficacy and safety of bimekizumab in patients with active PsA with or without concomitant methotrexate treatment at baseline. They demonstrated that through week 52, nearly half of the patients receiving bimekizumab with or without methotrexate achieved a ≥50% improvement in American College of Rheumatology response (biologic-naive ~55%; TNF inhibitor ~48-56%) and minimal disease activity (biologic-naive ~55%; TNF inhibitor ~47%). Thus, bimekizumab demonstrated similar sustained efficacy for 52 weeks, regardless of concomitant methotrexate use. Therefore, concomitant treatment with methotrexate may not be necessary when treating PsA patients with bimekizumab.

Nonpharmacologic interventions, such as diet and exercise, are likely to be of benefit to PsA patients, but studies on such therapies are lacking. In a cross-sectional study that enrolled 279 patients with PsA and 76 patients with psoriasis, Katsimbri and colleagues showed that patients reporting high vs low levels of exercise had significantly lower median values of Disease Activity Index for PsA and erythrocyte sedimentation rate, and fewer tender and swollen joints. Similarly, high vs low adherence to the Mediterranean diet was associated with a lower Psoriasis Area and Severity Index and body surface area affected by psoriasis. Thus, exercise and a Mediterranean diet may improve disease activity outcomes in PsA, and may be an important adjunct to immunomodulatory therapy. However, prospective interventional trials are required.

Finally, a study evaluated whether the initiation of targeted therapies, such as biologics, led to a decrease in the use of other arthritis-related treatments and healthcare use in PsA. Using data from the French health insurance database, Pina Vegas and colleagues evaluated the difference in the proportion of users of associated treatments, hospitalizations, and sick leaves between 6 months before and 3-9 months after treatment initiation. In a cohort of 9793 patients, they found that first-line targeted therapy significantly reduced the use of nonsteroidal anti-inflammatory drugs (NSAID; −15%), prednisone (−9%), methotrexate (−15%), and mood disorder treatments (−2%), and lowered the rate of hospitalizations (−12%) and sick leave (−4%; all P < 10^-4). TNF inhibitors showed greater reductions in NSAID and prednisone use compared with IL-17 inhibitors, with similar outcomes for IL-12/23 inhibitors.

The question of whether effective targeted therapies for psoriasis reduce the incidence or "prevent" psoriatic arthritis (PsA) has increasingly become a topic of interest. Also of interest is whether there are differences between different drug classes for treating psoriasis and PsA. To evaluate whether there is a difference between patients treated with interleukin (IL)-23 vs IL-12/23 inhibitors, Tsai and colleagues conducted a retrospective cohort study that included the propensity score–matched data of patients with psoriasis from the TriNetX database who were treated with either IL-23 inhibitors (n = 2142) or IL-12/23 inhibitors (n = 2142). Patients treated with IL-23 inhibitors vs IL-12/23 inhibitors demonstrated no significant difference in the risk for PsA (hazard ratio 0.96; P = .812) and cumulative incidence of PsA (P = .812). Given the many drawbacks of administrative database-based retrospective studies, I would ideally like to see prospective studies conducted to evaluate the differential risk for PsA between targeted therapies for psoriasis. However, patients can be assured that the beneficial effect, if any, is likely to be similar between these two drug classes in regard to PsA prevention.

One important question when treating patients with PsA with biologic therapies is whether treatment with methotrexate needs to be continued. In a post hoc analysis of phase 3 trials (BE OPTIMAL, BE COMPLETE, and BE VITAL) that included patients with PsA who were biologic-naive (n = 852) or had an incomplete response to a tumor necrosis factor (TNF) inhibitor (n = 400), McInnes and colleagues evaluated the efficacy and safety of bimekizumab in patients with active PsA with or without concomitant methotrexate treatment at baseline. They demonstrated that through week 52, nearly half of the patients receiving bimekizumab with or without methotrexate achieved a ≥50% improvement in American College of Rheumatology response (biologic-naive ~55%; TNF inhibitor ~48-56%) and minimal disease activity (biologic-naive ~55%; TNF inhibitor ~47%). Thus, bimekizumab demonstrated similar sustained efficacy for 52 weeks, regardless of concomitant methotrexate use. Therefore, concomitant treatment with methotrexate may not be necessary when treating PsA patients with bimekizumab.

Nonpharmacologic interventions, such as diet and exercise, are likely to be of benefit to PsA patients, but studies on such therapies are lacking. In a cross-sectional study that enrolled 279 patients with PsA and 76 patients with psoriasis, Katsimbri and colleagues showed that patients reporting high vs low levels of exercise had significantly lower median values of Disease Activity Index for PsA and erythrocyte sedimentation rate, and fewer tender and swollen joints. Similarly, high vs low adherence to the Mediterranean diet was associated with a lower Psoriasis Area and Severity Index and body surface area affected by psoriasis. Thus, exercise and a Mediterranean diet may improve disease activity outcomes in PsA, and may be an important adjunct to immunomodulatory therapy. However, prospective interventional trials are required.

Finally, a study evaluated whether the initiation of targeted therapies, such as biologics, led to a decrease in the use of other arthritis-related treatments and healthcare use in PsA. Using data from the French health insurance database, Pina Vegas and colleagues evaluated the difference in the proportion of users of associated treatments, hospitalizations, and sick leaves between 6 months before and 3-9 months after treatment initiation. In a cohort of 9793 patients, they found that first-line targeted therapy significantly reduced the use of nonsteroidal anti-inflammatory drugs (NSAID; −15%), prednisone (−9%), methotrexate (−15%), and mood disorder treatments (−2%), and lowered the rate of hospitalizations (−12%) and sick leave (−4%; all P < 10^-4). TNF inhibitors showed greater reductions in NSAID and prednisone use compared with IL-17 inhibitors, with similar outcomes for IL-12/23 inhibitors.

The question of whether effective targeted therapies for psoriasis reduce the incidence or "prevent" psoriatic arthritis (PsA) has increasingly become a topic of interest. Also of interest is whether there are differences between different drug classes for treating psoriasis and PsA. To evaluate whether there is a difference between patients treated with interleukin (IL)-23 vs IL-12/23 inhibitors, Tsai and colleagues conducted a retrospective cohort study that included the propensity score–matched data of patients with psoriasis from the TriNetX database who were treated with either IL-23 inhibitors (n = 2142) or IL-12/23 inhibitors (n = 2142). Patients treated with IL-23 inhibitors vs IL-12/23 inhibitors demonstrated no significant difference in the risk for PsA (hazard ratio 0.96; P = .812) and cumulative incidence of PsA (P = .812). Given the many drawbacks of administrative database-based retrospective studies, I would ideally like to see prospective studies conducted to evaluate the differential risk for PsA between targeted therapies for psoriasis. However, patients can be assured that the beneficial effect, if any, is likely to be similar between these two drug classes in regard to PsA prevention.

One important question when treating patients with PsA with biologic therapies is whether treatment with methotrexate needs to be continued. In a post hoc analysis of phase 3 trials (BE OPTIMAL, BE COMPLETE, and BE VITAL) that included patients with PsA who were biologic-naive (n = 852) or had an incomplete response to a tumor necrosis factor (TNF) inhibitor (n = 400), McInnes and colleagues evaluated the efficacy and safety of bimekizumab in patients with active PsA with or without concomitant methotrexate treatment at baseline. They demonstrated that through week 52, nearly half of the patients receiving bimekizumab with or without methotrexate achieved a ≥50% improvement in American College of Rheumatology response (biologic-naive ~55%; TNF inhibitor ~48-56%) and minimal disease activity (biologic-naive ~55%; TNF inhibitor ~47%). Thus, bimekizumab demonstrated similar sustained efficacy for 52 weeks, regardless of concomitant methotrexate use. Therefore, concomitant treatment with methotrexate may not be necessary when treating PsA patients with bimekizumab.

Nonpharmacologic interventions, such as diet and exercise, are likely to be of benefit to PsA patients, but studies on such therapies are lacking. In a cross-sectional study that enrolled 279 patients with PsA and 76 patients with psoriasis, Katsimbri and colleagues showed that patients reporting high vs low levels of exercise had significantly lower median values of Disease Activity Index for PsA and erythrocyte sedimentation rate, and fewer tender and swollen joints. Similarly, high vs low adherence to the Mediterranean diet was associated with a lower Psoriasis Area and Severity Index and body surface area affected by psoriasis. Thus, exercise and a Mediterranean diet may improve disease activity outcomes in PsA, and may be an important adjunct to immunomodulatory therapy. However, prospective interventional trials are required.

Finally, a study evaluated whether the initiation of targeted therapies, such as biologics, led to a decrease in the use of other arthritis-related treatments and healthcare use in PsA. Using data from the French health insurance database, Pina Vegas and colleagues evaluated the difference in the proportion of users of associated treatments, hospitalizations, and sick leaves between 6 months before and 3-9 months after treatment initiation. In a cohort of 9793 patients, they found that first-line targeted therapy significantly reduced the use of nonsteroidal anti-inflammatory drugs (NSAID; −15%), prednisone (−9%), methotrexate (−15%), and mood disorder treatments (−2%), and lowered the rate of hospitalizations (−12%) and sick leave (−4%; all P < 10^-4). TNF inhibitors showed greater reductions in NSAID and prednisone use compared with IL-17 inhibitors, with similar outcomes for IL-12/23 inhibitors.

Migraine pathophysiology has been shown to be associated with vascular and inflammatory processes. Diet and lifestyle can have an effect on an individual's inflammatory process, and research regarding the steps between these factors and inflammation is vague and nonspecific. The Dietary Inflammation Score (DIS), which is calculated on the basis of a questionnaire, is used to score the inflammatory potential of an individual's diet. The Dietary and Lifestyle Inflammation Score (DLIS) includes the DIS questions, and also incorporates body mass index (BMI), physical activity, smoking, and alcohol consumption. A recent study, based on a secondary analysis of previous data, examined the correlation between migraine and DIS and DLIS among 285 women, 40% of whom had a chronic migraine diagnosis. Results published in Scientific Reports in July 2024 noted that participants with chronic migraine had a significantly higher DIS and DLIS than those who were not diagnosed with chronic migraine. It is important to note that migraine-associated inflammation can also result from genetic factors. A previous study, published in 2023 in Nature Genetics, described a correlation between genetic markers of inflammatory disorders, such as endometriosis, asthma, and migraine.¹ These results, consistent with our current understanding of the genetic contribution to migraine risk, emphasize that lifestyle modifications alone are not usually adequate for complete management of migraines.

Patients who experience chronic migraine may be inclined to reduce their time spent exercising and engaging in physical activity, as these activities can exacerbate migraine symptoms. Additionally, after recovering from a migraine, patients often need to catch up on tasks and responsibilities, which can squeeze out time for physical activity and exercise (often considered luxuries that can be done during leisure time). Results of a small cross-sectional retrospective study published in Scientific Reports in 2024 suggested a correlation between daily walking steps and response to calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb). According to the study, which included 22 patients who were diagnosed with migraine and treated with CGRP mAb, patients who experienced an improvement of their migraine symptoms also increased their average daily steps by almost 1000 steps per day. The authors suggested that steps can be used as a marker of treatment response in migraine.

Screen time is often blamed as a cause for a number of different ailments, including obesity, anxiety, depression, insomnia, and migraine. An article published in June 2024 in European Journal of Pain described results of a meta-analysis examining the association between sedentary lifestyle and migraine. The authors noted that time spent watching television could be causally associated with an increased risk for migraine.²Another study, with results published in July 2024 in The Journal of Headache and Pain, examined the relationship between migraine and leisure screen time. The researchers used data from 661,399 European individuals from 53 studies to look at genetically predicted leisure screen time, rather than actual leisure screen time. They reported that genetically predicted leisure screen time was associated with a 27.7% increase in migraine risk. While the results are consistent with what is already widely accepted about screen time and migraine, the inclusion of genetic predisposition to screen time is interesting in suggesting that some underlying drive could be contributing to increased screen time among patients who have migraine.

The results of these studies reemphasize the importance of the link between lifestyle factors and migraine but warn against oversimplifying the correlation. There is a bidirectional relationship between migraine and inflammation. We know that inflammation is mediated by diet as well as physical activity. During a migraine, patients may turn to foods that have a high inflammatory potential. Furthermore, migraine can influence a person's inclination to participate in physical activity, as the pain and discomfort can make it difficult engage in exercise. During a migraine, patients may prefer sedentary activities. Screen time can be appealing or relaxing while recovering from a migraine. Genetic predisposition is an interesting additional contributor to this link. Acknowledging genetic predisposition to inflammation or sedentary activity can be a step in helping patients recognize that it could be challenging to overcome these genetically inherent drives or conditions, while providing encouragement regarding the potential benefits of doing so.

Additional References

1. Rahmioglu N, Mortlock S, Ghiasi M, et al. The genetic basis of endometriosis and comorbidity with other pain and inflammatory conditions. Nat Genet. 2023;55(3):423-436. Doi: 10.1038/s41588-023-01323-z Source

2. Li P, Li J, Zhu H, et al. Causal effects of sedentary behaviours on the risk of migraine: A univariable and multivariable Mendelian randomization study. Eur J Pain. 2024 (Jun 4). Doi: 10.1002/ejp.2296  Source

Migraine pathophysiology has been shown to be associated with vascular and inflammatory processes. Diet and lifestyle can have an effect on an individual's inflammatory process, and research regarding the steps between these factors and inflammation is vague and nonspecific. The Dietary Inflammation Score (DIS), which is calculated on the basis of a questionnaire, is used to score the inflammatory potential of an individual's diet. The Dietary and Lifestyle Inflammation Score (DLIS) includes the DIS questions, and also incorporates body mass index (BMI), physical activity, smoking, and alcohol consumption. A recent study, based on a secondary analysis of previous data, examined the correlation between migraine and DIS and DLIS among 285 women, 40% of whom had a chronic migraine diagnosis. Results published in Scientific Reports in July 2024 noted that participants with chronic migraine had a significantly higher DIS and DLIS than those who were not diagnosed with chronic migraine. It is important to note that migraine-associated inflammation can also result from genetic factors. A previous study, published in 2023 in Nature Genetics, described a correlation between genetic markers of inflammatory disorders, such as endometriosis, asthma, and migraine.¹ These results, consistent with our current understanding of the genetic contribution to migraine risk, emphasize that lifestyle modifications alone are not usually adequate for complete management of migraines.

Patients who experience chronic migraine may be inclined to reduce their time spent exercising and engaging in physical activity, as these activities can exacerbate migraine symptoms. Additionally, after recovering from a migraine, patients often need to catch up on tasks and responsibilities, which can squeeze out time for physical activity and exercise (often considered luxuries that can be done during leisure time). Results of a small cross-sectional retrospective study published in Scientific Reports in 2024 suggested a correlation between daily walking steps and response to calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb). According to the study, which included 22 patients who were diagnosed with migraine and treated with CGRP mAb, patients who experienced an improvement of their migraine symptoms also increased their average daily steps by almost 1000 steps per day. The authors suggested that steps can be used as a marker of treatment response in migraine.

Screen time is often blamed as a cause for a number of different ailments, including obesity, anxiety, depression, insomnia, and migraine. An article published in June 2024 in European Journal of Pain described results of a meta-analysis examining the association between sedentary lifestyle and migraine. The authors noted that time spent watching television could be causally associated with an increased risk for migraine.²Another study, with results published in July 2024 in The Journal of Headache and Pain, examined the relationship between migraine and leisure screen time. The researchers used data from 661,399 European individuals from 53 studies to look at genetically predicted leisure screen time, rather than actual leisure screen time. They reported that genetically predicted leisure screen time was associated with a 27.7% increase in migraine risk. While the results are consistent with what is already widely accepted about screen time and migraine, the inclusion of genetic predisposition to screen time is interesting in suggesting that some underlying drive could be contributing to increased screen time among patients who have migraine.

The results of these studies reemphasize the importance of the link between lifestyle factors and migraine but warn against oversimplifying the correlation. There is a bidirectional relationship between migraine and inflammation. We know that inflammation is mediated by diet as well as physical activity. During a migraine, patients may turn to foods that have a high inflammatory potential. Furthermore, migraine can influence a person's inclination to participate in physical activity, as the pain and discomfort can make it difficult engage in exercise. During a migraine, patients may prefer sedentary activities. Screen time can be appealing or relaxing while recovering from a migraine. Genetic predisposition is an interesting additional contributor to this link. Acknowledging genetic predisposition to inflammation or sedentary activity can be a step in helping patients recognize that it could be challenging to overcome these genetically inherent drives or conditions, while providing encouragement regarding the potential benefits of doing so.

Additional References

1. Rahmioglu N, Mortlock S, Ghiasi M, et al. The genetic basis of endometriosis and comorbidity with other pain and inflammatory conditions. Nat Genet. 2023;55(3):423-436. Doi: 10.1038/s41588-023-01323-z Source

2. Li P, Li J, Zhu H, et al. Causal effects of sedentary behaviours on the risk of migraine: A univariable and multivariable Mendelian randomization study. Eur J Pain. 2024 (Jun 4). Doi: 10.1002/ejp.2296  Source

Migraine pathophysiology has been shown to be associated with vascular and inflammatory processes. Diet and lifestyle can have an effect on an individual's inflammatory process, and research regarding the steps between these factors and inflammation is vague and nonspecific. The Dietary Inflammation Score (DIS), which is calculated on the basis of a questionnaire, is used to score the inflammatory potential of an individual's diet. The Dietary and Lifestyle Inflammation Score (DLIS) includes the DIS questions, and also incorporates body mass index (BMI), physical activity, smoking, and alcohol consumption. A recent study, based on a secondary analysis of previous data, examined the correlation between migraine and DIS and DLIS among 285 women, 40% of whom had a chronic migraine diagnosis. Results published in Scientific Reports in July 2024 noted that participants with chronic migraine had a significantly higher DIS and DLIS than those who were not diagnosed with chronic migraine. It is important to note that migraine-associated inflammation can also result from genetic factors. A previous study, published in 2023 in Nature Genetics, described a correlation between genetic markers of inflammatory disorders, such as endometriosis, asthma, and migraine.¹ These results, consistent with our current understanding of the genetic contribution to migraine risk, emphasize that lifestyle modifications alone are not usually adequate for complete management of migraines.

Patients who experience chronic migraine may be inclined to reduce their time spent exercising and engaging in physical activity, as these activities can exacerbate migraine symptoms. Additionally, after recovering from a migraine, patients often need to catch up on tasks and responsibilities, which can squeeze out time for physical activity and exercise (often considered luxuries that can be done during leisure time). Results of a small cross-sectional retrospective study published in Scientific Reports in 2024 suggested a correlation between daily walking steps and response to calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb). According to the study, which included 22 patients who were diagnosed with migraine and treated with CGRP mAb, patients who experienced an improvement of their migraine symptoms also increased their average daily steps by almost 1000 steps per day. The authors suggested that steps can be used as a marker of treatment response in migraine.

Screen time is often blamed as a cause for a number of different ailments, including obesity, anxiety, depression, insomnia, and migraine. An article published in June 2024 in European Journal of Pain described results of a meta-analysis examining the association between sedentary lifestyle and migraine. The authors noted that time spent watching television could be causally associated with an increased risk for migraine.²Another study, with results published in July 2024 in The Journal of Headache and Pain, examined the relationship between migraine and leisure screen time. The researchers used data from 661,399 European individuals from 53 studies to look at genetically predicted leisure screen time, rather than actual leisure screen time. They reported that genetically predicted leisure screen time was associated with a 27.7% increase in migraine risk. While the results are consistent with what is already widely accepted about screen time and migraine, the inclusion of genetic predisposition to screen time is interesting in suggesting that some underlying drive could be contributing to increased screen time among patients who have migraine.

The results of these studies reemphasize the importance of the link between lifestyle factors and migraine but warn against oversimplifying the correlation. There is a bidirectional relationship between migraine and inflammation. We know that inflammation is mediated by diet as well as physical activity. During a migraine, patients may turn to foods that have a high inflammatory potential. Furthermore, migraine can influence a person's inclination to participate in physical activity, as the pain and discomfort can make it difficult engage in exercise. During a migraine, patients may prefer sedentary activities. Screen time can be appealing or relaxing while recovering from a migraine. Genetic predisposition is an interesting additional contributor to this link. Acknowledging genetic predisposition to inflammation or sedentary activity can be a step in helping patients recognize that it could be challenging to overcome these genetically inherent drives or conditions, while providing encouragement regarding the potential benefits of doing so.

Additional References

1. Rahmioglu N, Mortlock S, Ghiasi M, et al. The genetic basis of endometriosis and comorbidity with other pain and inflammatory conditions. Nat Genet. 2023;55(3):423-436. Doi: 10.1038/s41588-023-01323-z Source

2. Li P, Li J, Zhu H, et al. Causal effects of sedentary behaviours on the risk of migraine: A univariable and multivariable Mendelian randomization study. Eur J Pain. 2024 (Jun 4). Doi: 10.1002/ejp.2296  Source

Key clinical point: A Mendelian randomization analysis revealed that psoriatic arthritis (PsA) was a significant risk factor for ulcerative colitis (UC) and vice versa.

Major finding: UC was associated with a 45.8% increased risk for PsA (odds ratio [OR] 1.458; P = .0013); conversely, PsA was associated with a 32.9% increased risk for UC (OR 1.329; P < .001).

Study details: This Mendelian randomization study evaluated the causal association between PsA, UC, and psoriasis using 123 single nucleotide polymorphisms from genome-wide association studies as genetic instrumental variables.

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

Source: Pan J, Lv Y, Wang L, et al. Mendelian randomization analysis of psoriasis and psoriatic arthritis associated with risks of ulcerative colitis. Skin Res Technol. 2024;30:e13795 (Jul 12). Doi: 10.3390/jcm13154567 Source

Key clinical point: A Mendelian randomization analysis revealed that psoriatic arthritis (PsA) was a significant risk factor for ulcerative colitis (UC) and vice versa.

Major finding: UC was associated with a 45.8% increased risk for PsA (odds ratio [OR] 1.458; P = .0013); conversely, PsA was associated with a 32.9% increased risk for UC (OR 1.329; P < .001).

Study details: This Mendelian randomization study evaluated the causal association between PsA, UC, and psoriasis using 123 single nucleotide polymorphisms from genome-wide association studies as genetic instrumental variables.

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

Source: Pan J, Lv Y, Wang L, et al. Mendelian randomization analysis of psoriasis and psoriatic arthritis associated with risks of ulcerative colitis. Skin Res Technol. 2024;30:e13795 (Jul 12). Doi: 10.3390/jcm13154567 Source

Key clinical point: A Mendelian randomization analysis revealed that psoriatic arthritis (PsA) was a significant risk factor for ulcerative colitis (UC) and vice versa.

Major finding: UC was associated with a 45.8% increased risk for PsA (odds ratio [OR] 1.458; P = .0013); conversely, PsA was associated with a 32.9% increased risk for UC (OR 1.329; P < .001).

Study details: This Mendelian randomization study evaluated the causal association between PsA, UC, and psoriasis using 123 single nucleotide polymorphisms from genome-wide association studies as genetic instrumental variables.

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

Source: Pan J, Lv Y, Wang L, et al. Mendelian randomization analysis of psoriasis and psoriatic arthritis associated with risks of ulcerative colitis. Skin Res Technol. 2024;30:e13795 (Jul 12). Doi: 10.3390/jcm13154567 Source

Key clinical point: Ultrasound detected active enthesitis and synovitis in a non-negligible proportion of patients with psoriatic arthritis (PsA) who achieved remission or low disease activity with biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARD).

Major finding: Despite achieving the Disease Activity Index for Psoriatic Arthritis (DAPSA) treatment target, 21.6% patients had at least one painful enthesis on clinical examination. Ultrasound showed evidence of active enthesitis in 19.6% and active synovitis in 15.7% patients.

Study details: This cross-sectional study included 51 patients with PsA who met the DAPSA treatment target after at least 6 months of therapy with b/tsDMARD and underwent bilateral ultrasound and clinical examination of entheses and joints.

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

Source: Agache M, Popescu CC, Enache L, et al. Additional value of ultrasound in patients with psoriatic arthritis within treatment target. J Clin Med. 2024;13(5):4567 (Aug 5). Doi: 10.3390/jcm13154567 Source

Key clinical point: Ultrasound detected active enthesitis and synovitis in a non-negligible proportion of patients with psoriatic arthritis (PsA) who achieved remission or low disease activity with biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARD).

Major finding: Despite achieving the Disease Activity Index for Psoriatic Arthritis (DAPSA) treatment target, 21.6% patients had at least one painful enthesis on clinical examination. Ultrasound showed evidence of active enthesitis in 19.6% and active synovitis in 15.7% patients.

Study details: This cross-sectional study included 51 patients with PsA who met the DAPSA treatment target after at least 6 months of therapy with b/tsDMARD and underwent bilateral ultrasound and clinical examination of entheses and joints.

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

Source: Agache M, Popescu CC, Enache L, et al. Additional value of ultrasound in patients with psoriatic arthritis within treatment target. J Clin Med. 2024;13(5):4567 (Aug 5). Doi: 10.3390/jcm13154567 Source

Key clinical point: Ultrasound detected active enthesitis and synovitis in a non-negligible proportion of patients with psoriatic arthritis (PsA) who achieved remission or low disease activity with biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARD).

Major finding: Despite achieving the Disease Activity Index for Psoriatic Arthritis (DAPSA) treatment target, 21.6% patients had at least one painful enthesis on clinical examination. Ultrasound showed evidence of active enthesitis in 19.6% and active synovitis in 15.7% patients.

Study details: This cross-sectional study included 51 patients with PsA who met the DAPSA treatment target after at least 6 months of therapy with b/tsDMARD and underwent bilateral ultrasound and clinical examination of entheses and joints.

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

Source: Agache M, Popescu CC, Enache L, et al. Additional value of ultrasound in patients with psoriatic arthritis within treatment target. J Clin Med. 2024;13(5):4567 (Aug 5). Doi: 10.3390/jcm13154567 Source

Key clinical point: Exercise and a Mediterranean diet improved disease activity outcomes pertaining to skin and joints in patients with psoriatic arthritis (PsA), indicating that combining lifestyle changes with conventional medical treatment can benefit patients with PsA.

Major finding: High vs low levels of exercise were associated with lower median values of Disease Activity in PsA Score (10.6 vs 28.5; P = .004), erythrocyte sedimentation rate (9 vs 16; P = .001), and fewer tender (1.5 vs 10; P = .003) and swollen (1.5 vs 9; P = .016) joints. Similarly, high vs low adherence to the Mediterranean diet was associated with a lower Psoriasis Area and Severity Index (0.9 vs 1.5; P = .001) and body surface area (1 vs 2; P = .009).

Study details: This cross-sectional study enrolled 355 patients with psoriatic disease (age > 18 years), including 279 patients with PsA and 76 patients with psoriasis.

Disclosures: No funding sources were declared for this study. The authors did not declare any conflicts of interest.

Source: Katsimbri P, Grivas A, Papadavid E, et al. Mediterranean diet and exercise are associated with better disease control in psoriatic arthritis. Clin Rheumatol. 2024 (Jul 25). Doi: 10.1007/s10067-024-07080-6 Source

Key clinical point: Exercise and a Mediterranean diet improved disease activity outcomes pertaining to skin and joints in patients with psoriatic arthritis (PsA), indicating that combining lifestyle changes with conventional medical treatment can benefit patients with PsA.

Major finding: High vs low levels of exercise were associated with lower median values of Disease Activity in PsA Score (10.6 vs 28.5; P = .004), erythrocyte sedimentation rate (9 vs 16; P = .001), and fewer tender (1.5 vs 10; P = .003) and swollen (1.5 vs 9; P = .016) joints. Similarly, high vs low adherence to the Mediterranean diet was associated with a lower Psoriasis Area and Severity Index (0.9 vs 1.5; P = .001) and body surface area (1 vs 2; P = .009).

Study details: This cross-sectional study enrolled 355 patients with psoriatic disease (age > 18 years), including 279 patients with PsA and 76 patients with psoriasis.

Disclosures: No funding sources were declared for this study. The authors did not declare any conflicts of interest.

Source: Katsimbri P, Grivas A, Papadavid E, et al. Mediterranean diet and exercise are associated with better disease control in psoriatic arthritis. Clin Rheumatol. 2024 (Jul 25). Doi: 10.1007/s10067-024-07080-6 Source

Key clinical point: Exercise and a Mediterranean diet improved disease activity outcomes pertaining to skin and joints in patients with psoriatic arthritis (PsA), indicating that combining lifestyle changes with conventional medical treatment can benefit patients with PsA.

Major finding: High vs low levels of exercise were associated with lower median values of Disease Activity in PsA Score (10.6 vs 28.5; P = .004), erythrocyte sedimentation rate (9 vs 16; P = .001), and fewer tender (1.5 vs 10; P = .003) and swollen (1.5 vs 9; P = .016) joints. Similarly, high vs low adherence to the Mediterranean diet was associated with a lower Psoriasis Area and Severity Index (0.9 vs 1.5; P = .001) and body surface area (1 vs 2; P = .009).

Study details: This cross-sectional study enrolled 355 patients with psoriatic disease (age > 18 years), including 279 patients with PsA and 76 patients with psoriasis.

Disclosures: No funding sources were declared for this study. The authors did not declare any conflicts of interest.

Source: Katsimbri P, Grivas A, Papadavid E, et al. Mediterranean diet and exercise are associated with better disease control in psoriatic arthritis. Clin Rheumatol. 2024 (Jul 25). Doi: 10.1007/s10067-024-07080-6 Source

Key clinical point: Patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), ankylosing spondylitis (AS), and certain other autoimmune diseases (AID) may have an increased risk of developing psoriatic arthritis (PsA).

Major finding: The risk factors for PsA included RA (inverse variance weighting odds ratio [OR_IVW] 1.11; P = .0205), SLE (OR_IVW 1.04; P = .0107), AS (OR_IVW 2.18; P = .000155), Crohn's disease (CD; OR_IVW 1.07; P = .01), Hashimoto's thyroiditis (HT; OR_IVW 1.23; P = .00143), and vitiligo (OR_IVW 1.27; P = .0000267). However, PsA did not increase the risk for these AID.

Study details: This bidirectional two-sample Mendelian randomization study used genome-wide association data for PsA (3186 cases and 240,862 control individuals and  an additional 5065 cases and 21,286 control individuals), psoriasis, and AID.

Disclosures: This study was supported by two research projects from China. The authors declared no conflicts of interest.

Source: Duan K, Wang J, Chen S, et al. Causal associations between both psoriasis and psoriatic arthritis and multiple autoimmune diseases: A bidirectional two-sample Mendelian randomization study. Front. Immunol. 2024;15:1422626 (Jul 24). Doi: 10.3389/fimmu.2024.1422626 Source

Key clinical point: Patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), ankylosing spondylitis (AS), and certain other autoimmune diseases (AID) may have an increased risk of developing psoriatic arthritis (PsA).

Major finding: The risk factors for PsA included RA (inverse variance weighting odds ratio [OR_IVW] 1.11; P = .0205), SLE (OR_IVW 1.04; P = .0107), AS (OR_IVW 2.18; P = .000155), Crohn's disease (CD; OR_IVW 1.07; P = .01), Hashimoto's thyroiditis (HT; OR_IVW 1.23; P = .00143), and vitiligo (OR_IVW 1.27; P = .0000267). However, PsA did not increase the risk for these AID.

Study details: This bidirectional two-sample Mendelian randomization study used genome-wide association data for PsA (3186 cases and 240,862 control individuals and  an additional 5065 cases and 21,286 control individuals), psoriasis, and AID.

Disclosures: This study was supported by two research projects from China. The authors declared no conflicts of interest.

Source: Duan K, Wang J, Chen S, et al. Causal associations between both psoriasis and psoriatic arthritis and multiple autoimmune diseases: A bidirectional two-sample Mendelian randomization study. Front. Immunol. 2024;15:1422626 (Jul 24). Doi: 10.3389/fimmu.2024.1422626 Source

Key clinical point: Patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), ankylosing spondylitis (AS), and certain other autoimmune diseases (AID) may have an increased risk of developing psoriatic arthritis (PsA).

Major finding: The risk factors for PsA included RA (inverse variance weighting odds ratio [OR_IVW] 1.11; P = .0205), SLE (OR_IVW 1.04; P = .0107), AS (OR_IVW 2.18; P = .000155), Crohn's disease (CD; OR_IVW 1.07; P = .01), Hashimoto's thyroiditis (HT; OR_IVW 1.23; P = .00143), and vitiligo (OR_IVW 1.27; P = .0000267). However, PsA did not increase the risk for these AID.

Study details: This bidirectional two-sample Mendelian randomization study used genome-wide association data for PsA (3186 cases and 240,862 control individuals and  an additional 5065 cases and 21,286 control individuals), psoriasis, and AID.

Disclosures: This study was supported by two research projects from China. The authors declared no conflicts of interest.

Source: Duan K, Wang J, Chen S, et al. Causal associations between both psoriasis and psoriatic arthritis and multiple autoimmune diseases: A bidirectional two-sample Mendelian randomization study. Front. Immunol. 2024;15:1422626 (Jul 24). Doi: 10.3389/fimmu.2024.1422626 Source