Clinical Edge Journal Scan

Key clinical point: The meta-analysis showed that atogepant was effective and well tolerated in patients with migraine in a non–dose-dependent manner, with rare incidences of serious treatment-emergent adverse events (TEAE) reported.

Major findings: Atogepant vs placebo led to a significant reduction in monthly migraine days (standardized mean difference [SMD] −0.40; P = .00001) and headache days (SMD −0.39; P = .00001), with consistent results observed across all dosage groups. The risk for TEAE (relative risk [RR] 1.11; P = .02) was significantly higher in the atogepant vs placebo group, with constipation (RR 2.55; P < .00001), nausea (RR 2.19; P < .00001), and urinary tract infection (RR 1.49; P = .03) being the most common.

Study details: This meta-analysis of four randomized controlled trials included 2813 patients with migraine who were treated with atogepant (10 mg, 30 mg, or 60 mg).

Disclosures: This study was supported by the Chongqing Clinical Pharmacy Key Specialties Construction Project, China. The authors declared no conflicts of interest.

Source: Hou M, Luo X, He S, et al. Efficacy and safety of atogepant, a small molecule CGRP receptor antagonist, for the preventive treatment of migraine: A systematic review and meta-analysis. J Headache Pain. 2024;25:116 (Jul 19). Doi: 10.1186/s10194-024-01822-2 Source

Key clinical point: The meta-analysis showed that atogepant was effective and well tolerated in patients with migraine in a non–dose-dependent manner, with rare incidences of serious treatment-emergent adverse events (TEAE) reported.

Major findings: Atogepant vs placebo led to a significant reduction in monthly migraine days (standardized mean difference [SMD] −0.40; P = .00001) and headache days (SMD −0.39; P = .00001), with consistent results observed across all dosage groups. The risk for TEAE (relative risk [RR] 1.11; P = .02) was significantly higher in the atogepant vs placebo group, with constipation (RR 2.55; P < .00001), nausea (RR 2.19; P < .00001), and urinary tract infection (RR 1.49; P = .03) being the most common.

Study details: This meta-analysis of four randomized controlled trials included 2813 patients with migraine who were treated with atogepant (10 mg, 30 mg, or 60 mg).

Disclosures: This study was supported by the Chongqing Clinical Pharmacy Key Specialties Construction Project, China. The authors declared no conflicts of interest.

Source: Hou M, Luo X, He S, et al. Efficacy and safety of atogepant, a small molecule CGRP receptor antagonist, for the preventive treatment of migraine: A systematic review and meta-analysis. J Headache Pain. 2024;25:116 (Jul 19). Doi: 10.1186/s10194-024-01822-2 Source

Key clinical point: The meta-analysis showed that atogepant was effective and well tolerated in patients with migraine in a non–dose-dependent manner, with rare incidences of serious treatment-emergent adverse events (TEAE) reported.

Major findings: Atogepant vs placebo led to a significant reduction in monthly migraine days (standardized mean difference [SMD] −0.40; P = .00001) and headache days (SMD −0.39; P = .00001), with consistent results observed across all dosage groups. The risk for TEAE (relative risk [RR] 1.11; P = .02) was significantly higher in the atogepant vs placebo group, with constipation (RR 2.55; P < .00001), nausea (RR 2.19; P < .00001), and urinary tract infection (RR 1.49; P = .03) being the most common.

Study details: This meta-analysis of four randomized controlled trials included 2813 patients with migraine who were treated with atogepant (10 mg, 30 mg, or 60 mg).

Disclosures: This study was supported by the Chongqing Clinical Pharmacy Key Specialties Construction Project, China. The authors declared no conflicts of interest.

Source: Hou M, Luo X, He S, et al. Efficacy and safety of atogepant, a small molecule CGRP receptor antagonist, for the preventive treatment of migraine: A systematic review and meta-analysis. J Headache Pain. 2024;25:116 (Jul 19). Doi: 10.1186/s10194-024-01822-2 Source

Key clinical point: The presence of migraine aura exacerbated migraine-related disability, mainly due to concurrent non-pain symptoms of migraine rather than the aura itself.

Major findings: The presence of aura on the first day of the migraine episode was significantly associated with increased odds of disability across all migraine days (odds ratio [OR] 1.40; P < .001); and non-pain symptoms, such as allodynia, photophobia, phonophobia, and nausea or vomiting (P < .001 for all). No association was observed between aura and headache-related migraine symptoms.

Study details: This observational prospective cohort study included 554 adults with episodic migraine, with complete data on migraine symptoms and psychological variables collected daily for 90 days using the N-1 Headache™ digital app (N = 11,156 total migraine days).

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

Source: Denney DE, Lee AA, Landy SH, Smitherman TA. Headache-related disability as a function of migraine aura: A daily diary study. Headache. 2024 (Aug 1). Doi: 10.1111/head.14796 Source

Key clinical point: The presence of migraine aura exacerbated migraine-related disability, mainly due to concurrent non-pain symptoms of migraine rather than the aura itself.

Major findings: The presence of aura on the first day of the migraine episode was significantly associated with increased odds of disability across all migraine days (odds ratio [OR] 1.40; P < .001); and non-pain symptoms, such as allodynia, photophobia, phonophobia, and nausea or vomiting (P < .001 for all). No association was observed between aura and headache-related migraine symptoms.

Study details: This observational prospective cohort study included 554 adults with episodic migraine, with complete data on migraine symptoms and psychological variables collected daily for 90 days using the N-1 Headache™ digital app (N = 11,156 total migraine days).

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

Source: Denney DE, Lee AA, Landy SH, Smitherman TA. Headache-related disability as a function of migraine aura: A daily diary study. Headache. 2024 (Aug 1). Doi: 10.1111/head.14796 Source

Key clinical point: The presence of migraine aura exacerbated migraine-related disability, mainly due to concurrent non-pain symptoms of migraine rather than the aura itself.

Major findings: The presence of aura on the first day of the migraine episode was significantly associated with increased odds of disability across all migraine days (odds ratio [OR] 1.40; P < .001); and non-pain symptoms, such as allodynia, photophobia, phonophobia, and nausea or vomiting (P < .001 for all). No association was observed between aura and headache-related migraine symptoms.

Study details: This observational prospective cohort study included 554 adults with episodic migraine, with complete data on migraine symptoms and psychological variables collected daily for 90 days using the N-1 Headache™ digital app (N = 11,156 total migraine days).

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

Source: Denney DE, Lee AA, Landy SH, Smitherman TA. Headache-related disability as a function of migraine aura: A daily diary study. Headache. 2024 (Aug 1). Doi: 10.1111/head.14796 Source

Key clinical point: Patients with migraine and a history of abuse had a greater migraine burden than those without a history of abuse, with this association being mediated by depression and anxiety.

Major findings: Patients with migraine who did vs did not have a history of abuse had significantly higher migraine-specific disability (68 vs 49), subjective cognitive impairment (10 vs 7), and pain interference (65 vs 62.5) scores, as well as greater overall work impairment (47.6% vs 38.6%) and activity impairment (49.3% vs 39.3%; all P < .001). Depression and anxiety mediated the association between history of abuse and migraine burden.

Study details: This cross-sectional study included 866 patients with migraine from the American Registry for Migraine Research, of whom 316 (36.5 %) had a history of abuse.

Disclosures: This study was supported by the American Migraine Foundation and American Academy of Neurology. Some authors declared receiving research funding from or having other ties with various sources.

Source: Trivedi M, Dumkrieger G, Chong CD, et al. A history of abuse is associated with more severe migraine- and pain-related disability: Results from the American Registry for Migraine Research. Headache. 2024 (Jul 25). Doi: 10.1111/head.14787 Source

Key clinical point: Patients with migraine and a history of abuse had a greater migraine burden than those without a history of abuse, with this association being mediated by depression and anxiety.

Major findings: Patients with migraine who did vs did not have a history of abuse had significantly higher migraine-specific disability (68 vs 49), subjective cognitive impairment (10 vs 7), and pain interference (65 vs 62.5) scores, as well as greater overall work impairment (47.6% vs 38.6%) and activity impairment (49.3% vs 39.3%; all P < .001). Depression and anxiety mediated the association between history of abuse and migraine burden.

Study details: This cross-sectional study included 866 patients with migraine from the American Registry for Migraine Research, of whom 316 (36.5 %) had a history of abuse.

Disclosures: This study was supported by the American Migraine Foundation and American Academy of Neurology. Some authors declared receiving research funding from or having other ties with various sources.

Source: Trivedi M, Dumkrieger G, Chong CD, et al. A history of abuse is associated with more severe migraine- and pain-related disability: Results from the American Registry for Migraine Research. Headache. 2024 (Jul 25). Doi: 10.1111/head.14787 Source

Key clinical point: Patients with migraine and a history of abuse had a greater migraine burden than those without a history of abuse, with this association being mediated by depression and anxiety.

Major findings: Patients with migraine who did vs did not have a history of abuse had significantly higher migraine-specific disability (68 vs 49), subjective cognitive impairment (10 vs 7), and pain interference (65 vs 62.5) scores, as well as greater overall work impairment (47.6% vs 38.6%) and activity impairment (49.3% vs 39.3%; all P < .001). Depression and anxiety mediated the association between history of abuse and migraine burden.

Study details: This cross-sectional study included 866 patients with migraine from the American Registry for Migraine Research, of whom 316 (36.5 %) had a history of abuse.

Disclosures: This study was supported by the American Migraine Foundation and American Academy of Neurology. Some authors declared receiving research funding from or having other ties with various sources.

Source: Trivedi M, Dumkrieger G, Chong CD, et al. A history of abuse is associated with more severe migraine- and pain-related disability: Results from the American Registry for Migraine Research. Headache. 2024 (Jul 25). Doi: 10.1111/head.14787 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were effective and showed a similar time to onset in patients with chronic migraine (CM), irrespective of disease duration.

Major findings: At 10-12 months of follow-up, anti-CGRP mAb reduced monthly migraine days by an average of 12 days across all tertiles of CM duration (P = .946). Additionally, monthly headache days and acute medication use significantly decreased from baseline to 10-12 months (P < .001) across all tertiles of CM duration, indicating no difference in the time to onset of anti-CGRP mAb across tertiles.

Study details: This cohort study included 335 patients with CM treated with anti-CGRP mAb for at least 12 months. Patients were categorized into different tertiles of CM duration: 0-7 years, 8-18 years, and 18-60 years.

Disclosures: This study did not disclose any funding sources. Four authors declared receiving personal fees from or having other ties with various sources.

Source: Ornello R, Baldini F, Onofri A, et al. Impact of duration of chronic migraine on long-term effectiveness of monoclonal antibodies targeting the calcitonin gene-related peptide pathway-A real-world study. Headache. 2024 (Jul 16). Doi: 10.1111/head.14788 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were effective and showed a similar time to onset in patients with chronic migraine (CM), irrespective of disease duration.

Major findings: At 10-12 months of follow-up, anti-CGRP mAb reduced monthly migraine days by an average of 12 days across all tertiles of CM duration (P = .946). Additionally, monthly headache days and acute medication use significantly decreased from baseline to 10-12 months (P < .001) across all tertiles of CM duration, indicating no difference in the time to onset of anti-CGRP mAb across tertiles.

Study details: This cohort study included 335 patients with CM treated with anti-CGRP mAb for at least 12 months. Patients were categorized into different tertiles of CM duration: 0-7 years, 8-18 years, and 18-60 years.

Disclosures: This study did not disclose any funding sources. Four authors declared receiving personal fees from or having other ties with various sources.

Source: Ornello R, Baldini F, Onofri A, et al. Impact of duration of chronic migraine on long-term effectiveness of monoclonal antibodies targeting the calcitonin gene-related peptide pathway-A real-world study. Headache. 2024 (Jul 16). Doi: 10.1111/head.14788 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were effective and showed a similar time to onset in patients with chronic migraine (CM), irrespective of disease duration.

Major findings: At 10-12 months of follow-up, anti-CGRP mAb reduced monthly migraine days by an average of 12 days across all tertiles of CM duration (P = .946). Additionally, monthly headache days and acute medication use significantly decreased from baseline to 10-12 months (P < .001) across all tertiles of CM duration, indicating no difference in the time to onset of anti-CGRP mAb across tertiles.

Study details: This cohort study included 335 patients with CM treated with anti-CGRP mAb for at least 12 months. Patients were categorized into different tertiles of CM duration: 0-7 years, 8-18 years, and 18-60 years.

Disclosures: This study did not disclose any funding sources. Four authors declared receiving personal fees from or having other ties with various sources.

Source: Ornello R, Baldini F, Onofri A, et al. Impact of duration of chronic migraine on long-term effectiveness of monoclonal antibodies targeting the calcitonin gene-related peptide pathway-A real-world study. Headache. 2024 (Jul 16). Doi: 10.1111/head.14788 Source

Key clinical point: Childhood abuse was significantly associated with an increased risk for migraine, with specific types such as physical, sexual, and emotional abuse showing a positive association with migraine onset.

Major findings: Individuals who experienced childhood abuse had a higher risk for migraine than those who did not (odd ratio [OR] 1.60; 95% CI 1.49-1.71). This risk was increased in those who were exposed to sexual abuse (OR 1.71; 95% CI 1.43-2.04), physical abuse (OR 1.47; 95% CI 1.38-1.56), and emotional abuse (OR 1.71; 95% CI 1.52-1.93).

Study details: This meta-analysis of 12 studies evaluated the association between childhood abuse and migraine in 110,776 patients with migraine.

Disclosures: No funding source was disclosed for this study. The authors declared no conflicts of interest.

Source: Liu J, Guo Y, Huang Z, et al. Childhood abuse and risk of migraine: A systematic review and meta-analysis. Child Abuse Negl. 2024;155:106961 (Aug 2).  Doi: 10.1016/j.chiabu.2024.106961 Source

Key clinical point: Childhood abuse was significantly associated with an increased risk for migraine, with specific types such as physical, sexual, and emotional abuse showing a positive association with migraine onset.

Major findings: Individuals who experienced childhood abuse had a higher risk for migraine than those who did not (odd ratio [OR] 1.60; 95% CI 1.49-1.71). This risk was increased in those who were exposed to sexual abuse (OR 1.71; 95% CI 1.43-2.04), physical abuse (OR 1.47; 95% CI 1.38-1.56), and emotional abuse (OR 1.71; 95% CI 1.52-1.93).

Study details: This meta-analysis of 12 studies evaluated the association between childhood abuse and migraine in 110,776 patients with migraine.

Disclosures: No funding source was disclosed for this study. The authors declared no conflicts of interest.

Source: Liu J, Guo Y, Huang Z, et al. Childhood abuse and risk of migraine: A systematic review and meta-analysis. Child Abuse Negl. 2024;155:106961 (Aug 2).  Doi: 10.1016/j.chiabu.2024.106961 Source

Key clinical point: Childhood abuse was significantly associated with an increased risk for migraine, with specific types such as physical, sexual, and emotional abuse showing a positive association with migraine onset.

Major findings: Individuals who experienced childhood abuse had a higher risk for migraine than those who did not (odd ratio [OR] 1.60; 95% CI 1.49-1.71). This risk was increased in those who were exposed to sexual abuse (OR 1.71; 95% CI 1.43-2.04), physical abuse (OR 1.47; 95% CI 1.38-1.56), and emotional abuse (OR 1.71; 95% CI 1.52-1.93).

Study details: This meta-analysis of 12 studies evaluated the association between childhood abuse and migraine in 110,776 patients with migraine.

Disclosures: No funding source was disclosed for this study. The authors declared no conflicts of interest.

Source: Liu J, Guo Y, Huang Z, et al. Childhood abuse and risk of migraine: A systematic review and meta-analysis. Child Abuse Negl. 2024;155:106961 (Aug 2).  Doi: 10.1016/j.chiabu.2024.106961 Source

Key clinical point: The daily step count increased noticeably after initiating treatment with anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) in adults with chronic migraine, with a positive association seen between the increase in daily steps and the treatment response to CGRP mAbs.

Major findings: The average number of steps per day increased from 4421 before initiation of anti-CGRP mAb treatment to 5241 at 3 months after initiation of treatment (P = .039), reflecting a mean percentage increase of 21.3% (95% CI 0.5-42.1). There was a positive association between an increase in daily steps and a reduction in monthly migraine days (correlation coefficient 0.521; P = .013).

Study details: This single-center, cross-sectional, retrospective study included 22 patients with chronic migraine who were treated with anti-CGRP mAbs (erenumab or fremanezumab).

Disclosures: The study was supported by the Lundbeck Foundation. Several authors declared receiving grants, honoraria, or personal fees from or having other ties with various sources.

Source: Jantzen FT, Chaudhry BA, Younis S, et al. Average steps per day as marker of treatment response with anti-CGRP mAbs in adults with chronic migraine: A pilot study. Sci Rep. 2024;14:18068 (Aug 5). Doi: 10.1038/s41598-024-68915-5 Source

Key clinical point: The daily step count increased noticeably after initiating treatment with anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) in adults with chronic migraine, with a positive association seen between the increase in daily steps and the treatment response to CGRP mAbs.

Major findings: The average number of steps per day increased from 4421 before initiation of anti-CGRP mAb treatment to 5241 at 3 months after initiation of treatment (P = .039), reflecting a mean percentage increase of 21.3% (95% CI 0.5-42.1). There was a positive association between an increase in daily steps and a reduction in monthly migraine days (correlation coefficient 0.521; P = .013).

Study details: This single-center, cross-sectional, retrospective study included 22 patients with chronic migraine who were treated with anti-CGRP mAbs (erenumab or fremanezumab).

Disclosures: The study was supported by the Lundbeck Foundation. Several authors declared receiving grants, honoraria, or personal fees from or having other ties with various sources.

Source: Jantzen FT, Chaudhry BA, Younis S, et al. Average steps per day as marker of treatment response with anti-CGRP mAbs in adults with chronic migraine: A pilot study. Sci Rep. 2024;14:18068 (Aug 5). Doi: 10.1038/s41598-024-68915-5 Source

Key clinical point: The daily step count increased noticeably after initiating treatment with anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) in adults with chronic migraine, with a positive association seen between the increase in daily steps and the treatment response to CGRP mAbs.

Major findings: The average number of steps per day increased from 4421 before initiation of anti-CGRP mAb treatment to 5241 at 3 months after initiation of treatment (P = .039), reflecting a mean percentage increase of 21.3% (95% CI 0.5-42.1). There was a positive association between an increase in daily steps and a reduction in monthly migraine days (correlation coefficient 0.521; P = .013).

Study details: This single-center, cross-sectional, retrospective study included 22 patients with chronic migraine who were treated with anti-CGRP mAbs (erenumab or fremanezumab).

Disclosures: The study was supported by the Lundbeck Foundation. Several authors declared receiving grants, honoraria, or personal fees from or having other ties with various sources.

Source: Jantzen FT, Chaudhry BA, Younis S, et al. Average steps per day as marker of treatment response with anti-CGRP mAbs in adults with chronic migraine: A pilot study. Sci Rep. 2024;14:18068 (Aug 5). Doi: 10.1038/s41598-024-68915-5 Source

Key clinical point: Women with an increased adherence to a pro-inflammatory diet, as measured using a dietary inflammation score (DIS), had an increased risk for chronic migraine (CM).

Major findings: Women with CM had a significantly higher DIS than those with episodic migraine (EM) (0.08 vs 0.62; P = .002). The risk for CM was two times higher in women with a high DIS than in those with a low DIS (adjusted odd ratio 2.02; P_trend = .03).

Study details: This cross-sectional study included 285 women with migraine, of whom 169 (59.3%) had EM and 116 (40.7%) had CM.

Disclosures: This study was supported by the Student Research Committee of Ahvaz Jundishapur University of Medical Sciences. The authors declared no conflicts of interest.

Source: Bakhshimoghaddam F, Shalilahmadi D, Mahdavi R, et al. Association of dietary and lifestyle inflammation score (DLIS) with chronic migraine in women: A cross-sectional study. Sci Rep. 2024;14:16406 (Jul 16). Doi: 10.1038/s41598-024-66776-6 Source

Key clinical point: Women with an increased adherence to a pro-inflammatory diet, as measured using a dietary inflammation score (DIS), had an increased risk for chronic migraine (CM).

Major findings: Women with CM had a significantly higher DIS than those with episodic migraine (EM) (0.08 vs 0.62; P = .002). The risk for CM was two times higher in women with a high DIS than in those with a low DIS (adjusted odd ratio 2.02; P_trend = .03).

Study details: This cross-sectional study included 285 women with migraine, of whom 169 (59.3%) had EM and 116 (40.7%) had CM.

Disclosures: This study was supported by the Student Research Committee of Ahvaz Jundishapur University of Medical Sciences. The authors declared no conflicts of interest.

Source: Bakhshimoghaddam F, Shalilahmadi D, Mahdavi R, et al. Association of dietary and lifestyle inflammation score (DLIS) with chronic migraine in women: A cross-sectional study. Sci Rep. 2024;14:16406 (Jul 16). Doi: 10.1038/s41598-024-66776-6 Source

Key clinical point: Women with an increased adherence to a pro-inflammatory diet, as measured using a dietary inflammation score (DIS), had an increased risk for chronic migraine (CM).

Major findings: Women with CM had a significantly higher DIS than those with episodic migraine (EM) (0.08 vs 0.62; P = .002). The risk for CM was two times higher in women with a high DIS than in those with a low DIS (adjusted odd ratio 2.02; P_trend = .03).

Study details: This cross-sectional study included 285 women with migraine, of whom 169 (59.3%) had EM and 116 (40.7%) had CM.

Disclosures: This study was supported by the Student Research Committee of Ahvaz Jundishapur University of Medical Sciences. The authors declared no conflicts of interest.

Source: Bakhshimoghaddam F, Shalilahmadi D, Mahdavi R, et al. Association of dietary and lifestyle inflammation score (DLIS) with chronic migraine in women: A cross-sectional study. Sci Rep. 2024;14:16406 (Jul 16). Doi: 10.1038/s41598-024-66776-6 Source

Key clinical point: Cardiovascular risk factors (CVRF), such as current smoking status and diabetes mellitus, were associated with a decreased prevalence of migraine in middle-aged and older-aged women, whereas elevated diastolic blood pressure (BP) was associated with an increased prevalence.

Major findings: Among women, current smokers (odds ratio [OR] 0.72; 95% CI 0.58-0.90) and those with diabetes mellitus (OR 0.74; 95% CI 0.56-0.98) had a decreased prevalence of migraine. Conversely, women with elevated diastolic BP had an increased prevalence of migraine (OR per standard deviation increase 1.16; 95% CI 1.04-1.29). No significant association was observed between CVRF and migraine in men.

Study details: This cross-sectional analysis assessed sex-specific associations of CVRF with migraine in 7266 middle-aged and older participants (4181 women and 3085 men) from the Rotterdam Study.

Disclosures: The Rotterdam Study was funded by the Erasmus Medical Center, Erasmus University Rotterdam, and others. Antoinette MaassenVanDenBrink declared receiving research grants or consultation fees from various sources.

Source: Al-Hassany L, Acarsoy C, Ikram MK, et al. Sex-specific association of cardiovascular risk factors with migraine: The Population-Based Rotterdam Study. Neurology. 2024;103:e209700 (Aug 27). Doi: 10.1212/WNL.0000000000209700 Source

Key clinical point: Cardiovascular risk factors (CVRF), such as current smoking status and diabetes mellitus, were associated with a decreased prevalence of migraine in middle-aged and older-aged women, whereas elevated diastolic blood pressure (BP) was associated with an increased prevalence.

Major findings: Among women, current smokers (odds ratio [OR] 0.72; 95% CI 0.58-0.90) and those with diabetes mellitus (OR 0.74; 95% CI 0.56-0.98) had a decreased prevalence of migraine. Conversely, women with elevated diastolic BP had an increased prevalence of migraine (OR per standard deviation increase 1.16; 95% CI 1.04-1.29). No significant association was observed between CVRF and migraine in men.

Study details: This cross-sectional analysis assessed sex-specific associations of CVRF with migraine in 7266 middle-aged and older participants (4181 women and 3085 men) from the Rotterdam Study.

Disclosures: The Rotterdam Study was funded by the Erasmus Medical Center, Erasmus University Rotterdam, and others. Antoinette MaassenVanDenBrink declared receiving research grants or consultation fees from various sources.

Source: Al-Hassany L, Acarsoy C, Ikram MK, et al. Sex-specific association of cardiovascular risk factors with migraine: The Population-Based Rotterdam Study. Neurology. 2024;103:e209700 (Aug 27). Doi: 10.1212/WNL.0000000000209700 Source

Key clinical point: Cardiovascular risk factors (CVRF), such as current smoking status and diabetes mellitus, were associated with a decreased prevalence of migraine in middle-aged and older-aged women, whereas elevated diastolic blood pressure (BP) was associated with an increased prevalence.

Major findings: Among women, current smokers (odds ratio [OR] 0.72; 95% CI 0.58-0.90) and those with diabetes mellitus (OR 0.74; 95% CI 0.56-0.98) had a decreased prevalence of migraine. Conversely, women with elevated diastolic BP had an increased prevalence of migraine (OR per standard deviation increase 1.16; 95% CI 1.04-1.29). No significant association was observed between CVRF and migraine in men.

Study details: This cross-sectional analysis assessed sex-specific associations of CVRF with migraine in 7266 middle-aged and older participants (4181 women and 3085 men) from the Rotterdam Study.

Disclosures: The Rotterdam Study was funded by the Erasmus Medical Center, Erasmus University Rotterdam, and others. Antoinette MaassenVanDenBrink declared receiving research grants or consultation fees from various sources.

Source: Al-Hassany L, Acarsoy C, Ikram MK, et al. Sex-specific association of cardiovascular risk factors with migraine: The Population-Based Rotterdam Study. Neurology. 2024;103:e209700 (Aug 27). Doi: 10.1212/WNL.0000000000209700 Source

Age at psoriasis onset may influence the risk of developing PsA. Cheemalavagu and colleagues aimed to identify clinical factors associated with PsA development in patients with psoriasis. Using data from a registry that included 384 patients diagnosed with PsA either after or concurrently with their psoriasis diagnosis, they demonstrated that patients with psoriasis onset at the age of 42.6 vs 18.9 years had a 62% shorter time interval between psoriasis and PsA diagnoses and were ~4.6 times more likely to have a concurrent onset of PsA within 6 months of having psoriasis. Thus, older age at onset of psoriasis may indicate a higher risk of developing PsA. This result is consistent with the observation that psoriasis patients carrying the human leukocyte antigen (HLA) C*06:02 allele (associated with early-onset psoriasis) are at lower risk of developing PsA.

Most patients with PsA have psoriasis vulgaris. The differential risk of PsA with different psoriasis phenotypes is less well studied. Therefore, Gershater and colleagues conducted a population-based retrospective cohort study that included patients with psoriasis vulgaris (n = 35,281), pustulosis palmoplantaris (n = 9639), or generalized pustular psoriasis (n = 2281), and who were propensity score–matched with an equal number of control individuals without psoriasis. They demonstrated that compared with control individuals without psoriasis, patients with psoriasis vulgaris had the highest risk for incident PsA (hazard ratio [HR] 87.7), followed by those with generalized pustular psoriasis (HR 26.8) and pustulosis palmoplantaris (HR 15.3). Thus, the study confirms the highest risk for PsA with psoriasis vulgaris, as well as the estimated risk for other, less common forms of psoriasis.

Finally, a cross-sectional study by Toledano and colleagues showed that PsA patients with a sedentary lifestyle (<90 min of physical activity per week) had more enthesitis, fatigue, pain, higher disease activity, greater disease impact, and lower functionality compared with those having a nonsedentary lifestyle. The study indicates that PsA patients would benefit from >90 minutes of physical activity per week.

Additional References

1. Davies NM, Holmes MV, Davey Smith G. Reading Mendelian randomisation studies: A guide, glossary, and checklist for clinicians. BMJ. 2018;362:k601. doi: 10.1136/bmj.k601 Source
2. Zhao H, Zhou Y, Wang Z, et al. Plasma proteins and psoriatic arthritis: A proteome-wide Mendelian randomization study. Front Immunol. 2024;15:1417564. doi: 10.3389/fimmu.2024.1417564 Source

Age at psoriasis onset may influence the risk of developing PsA. Cheemalavagu and colleagues aimed to identify clinical factors associated with PsA development in patients with psoriasis. Using data from a registry that included 384 patients diagnosed with PsA either after or concurrently with their psoriasis diagnosis, they demonstrated that patients with psoriasis onset at the age of 42.6 vs 18.9 years had a 62% shorter time interval between psoriasis and PsA diagnoses and were ~4.6 times more likely to have a concurrent onset of PsA within 6 months of having psoriasis. Thus, older age at onset of psoriasis may indicate a higher risk of developing PsA. This result is consistent with the observation that psoriasis patients carrying the human leukocyte antigen (HLA) C*06:02 allele (associated with early-onset psoriasis) are at lower risk of developing PsA.

Most patients with PsA have psoriasis vulgaris. The differential risk of PsA with different psoriasis phenotypes is less well studied. Therefore, Gershater and colleagues conducted a population-based retrospective cohort study that included patients with psoriasis vulgaris (n = 35,281), pustulosis palmoplantaris (n = 9639), or generalized pustular psoriasis (n = 2281), and who were propensity score–matched with an equal number of control individuals without psoriasis. They demonstrated that compared with control individuals without psoriasis, patients with psoriasis vulgaris had the highest risk for incident PsA (hazard ratio [HR] 87.7), followed by those with generalized pustular psoriasis (HR 26.8) and pustulosis palmoplantaris (HR 15.3). Thus, the study confirms the highest risk for PsA with psoriasis vulgaris, as well as the estimated risk for other, less common forms of psoriasis.

Finally, a cross-sectional study by Toledano and colleagues showed that PsA patients with a sedentary lifestyle (<90 min of physical activity per week) had more enthesitis, fatigue, pain, higher disease activity, greater disease impact, and lower functionality compared with those having a nonsedentary lifestyle. The study indicates that PsA patients would benefit from >90 minutes of physical activity per week.

Additional References

1. Davies NM, Holmes MV, Davey Smith G. Reading Mendelian randomisation studies: A guide, glossary, and checklist for clinicians. BMJ. 2018;362:k601. doi: 10.1136/bmj.k601 Source
2. Zhao H, Zhou Y, Wang Z, et al. Plasma proteins and psoriatic arthritis: A proteome-wide Mendelian randomization study. Front Immunol. 2024;15:1417564. doi: 10.3389/fimmu.2024.1417564 Source

Age at psoriasis onset may influence the risk of developing PsA. Cheemalavagu and colleagues aimed to identify clinical factors associated with PsA development in patients with psoriasis. Using data from a registry that included 384 patients diagnosed with PsA either after or concurrently with their psoriasis diagnosis, they demonstrated that patients with psoriasis onset at the age of 42.6 vs 18.9 years had a 62% shorter time interval between psoriasis and PsA diagnoses and were ~4.6 times more likely to have a concurrent onset of PsA within 6 months of having psoriasis. Thus, older age at onset of psoriasis may indicate a higher risk of developing PsA. This result is consistent with the observation that psoriasis patients carrying the human leukocyte antigen (HLA) C*06:02 allele (associated with early-onset psoriasis) are at lower risk of developing PsA.

Most patients with PsA have psoriasis vulgaris. The differential risk of PsA with different psoriasis phenotypes is less well studied. Therefore, Gershater and colleagues conducted a population-based retrospective cohort study that included patients with psoriasis vulgaris (n = 35,281), pustulosis palmoplantaris (n = 9639), or generalized pustular psoriasis (n = 2281), and who were propensity score–matched with an equal number of control individuals without psoriasis. They demonstrated that compared with control individuals without psoriasis, patients with psoriasis vulgaris had the highest risk for incident PsA (hazard ratio [HR] 87.7), followed by those with generalized pustular psoriasis (HR 26.8) and pustulosis palmoplantaris (HR 15.3). Thus, the study confirms the highest risk for PsA with psoriasis vulgaris, as well as the estimated risk for other, less common forms of psoriasis.

Finally, a cross-sectional study by Toledano and colleagues showed that PsA patients with a sedentary lifestyle (<90 min of physical activity per week) had more enthesitis, fatigue, pain, higher disease activity, greater disease impact, and lower functionality compared with those having a nonsedentary lifestyle. The study indicates that PsA patients would benefit from >90 minutes of physical activity per week.

Additional References

1. Davies NM, Holmes MV, Davey Smith G. Reading Mendelian randomisation studies: A guide, glossary, and checklist for clinicians. BMJ. 2018;362:k601. doi: 10.1136/bmj.k601 Source
2. Zhao H, Zhou Y, Wang Z, et al. Plasma proteins and psoriatic arthritis: A proteome-wide Mendelian randomization study. Front Immunol. 2024;15:1417564. doi: 10.3389/fimmu.2024.1417564 Source

MOH involves many of the same features as migraine headaches: photophobia, nausea, vomiting, and sleep disturbances.¹ Additionally, patients with migraine and comorbid MOH are at a higher risk for anxiety, depression, and emotional stress. MOH is difficult to treat, and symptom relapse after treatment is common. Results of a retrospective analysis published in July 2024 in The Journal of Headache and Facial Pain confirmed the effectiveness of calcitonin gene-related peptide (CGRP) antibody treatment in a real-world setting among migraine patients who had MOH. The study included a total of 291 patients who had been treated with either erenumab, fremanezumab, or galcanezumab. The majority of patients experienced a significant decline in monthly headache days, monthly migraine days, and monthly acute medication intake at 1 year. The researchers found that only 15.4% of the patients who initially met the criterion of chronic migraine with MOH relapsed, meeting the criterion for chronic migraine/MOH at the end of the 1-year follow-up period.

Lifestyle factors, such as diet, should be addressed when discussing migraine therapy with patients. Dietary factors, including a low–glycemic index diet, have been associated with promising results in migraine control. Results of a 10,359-patient cross-sectional study published in 2023 in the journal Nutrition confirmed that the inflammatory potential of patients' diet is associated with severe headache or migraine in US adults.²A more recent study, published in Frontiers in Nutrition in July 2024, examined dietary vitamin C intake of 13,445 individuals, of whom 20.42% had a severe headache or migraine. Vitamin C is a naturally occurring antioxidant and is also anti-inflammatory, found in foods such as citrus fruit, mangoes, strawberries, broccoli, and peppers. A subgroup analysis showed a significant association between vitamin C intake and severe headaches or migraines, with a reduced risk for severe headaches or migraines associated with an increased consumption of vitamin C. The authors noted that "each 1 mg/day increase in dietary vitamin C intake was significantly associated with a 6% lower risk for severe headache or migraine." Real-life application of this result for patients can involve encouraging patients to swap processed, low-nutrient foods in favor of fresh, nutrient-dense foods.

When treating migraine patients who are also parents, it is crucial to be persistent in searching for effective therapies to treat migraine and to treat or prevent MOH. According to a study published in 2018 in Headache, adolescents reported that parental migraine affected these factors in their lives: loss of parental support, reverse caregiving, emotional experience, interference with school, and missed activities and events.³ According to the authors of a more recent study, published in July 2024 in the Annals of General Psychiatry, parental migraine was significantly associated with an increased risk for attention-deficit/hyperactivity disorder, bipolar disorder, and depressive disorder among offspring of parents with migraine when compared with offspring of parents without migraine. The study authors noted that these outcomes could be the result of multiple factors, including psychosocial interactions, the burden of migraine on the family, and hereditary genetic traits. Nevertheless, even for offspring who may have a predisposition to these conditions because of genetic factors, effective treatment of parental migraine can relieve the day-to-day burden on the family, potentially reducing the effect of parental migraine on children. Parents who have migraine can become better equipped to provide attention to their children when their migraine symptoms are effectively treated. Furthermore, parents who have experienced improvement of their own migraine symptoms can offer hope and support if their children experience migraines, as migraine can be hereditary.

Additional References

1. Göçmez Yılmaz G, Ghouri R, et al. Complicated form of medication overuse headache is severe version of chronic migraine. J Clin Med. 2024;13(13):3696. doi: 10.3390/jcm13133696 Source

2. Liu H, Wang D, Wu F, et al. Association between inflammatory potential of diet and self-reported severe headache or migraine: A cross-sectional study of the National Health and Nutrition Examination Survey. Nutrition. 2023;113:112098. doi: 10.1016/j.nut.2023.112098 Source

3. Buse DC, Powers SW, Gelfand AA, et al. Adolescent perspectives on the burden of a parent's migraine: Results from the CaMEO Study. Headache. 2018;58(4):512-524. doi: 10.1111/head.13254 Source

MOH involves many of the same features as migraine headaches: photophobia, nausea, vomiting, and sleep disturbances.¹ Additionally, patients with migraine and comorbid MOH are at a higher risk for anxiety, depression, and emotional stress. MOH is difficult to treat, and symptom relapse after treatment is common. Results of a retrospective analysis published in July 2024 in The Journal of Headache and Facial Pain confirmed the effectiveness of calcitonin gene-related peptide (CGRP) antibody treatment in a real-world setting among migraine patients who had MOH. The study included a total of 291 patients who had been treated with either erenumab, fremanezumab, or galcanezumab. The majority of patients experienced a significant decline in monthly headache days, monthly migraine days, and monthly acute medication intake at 1 year. The researchers found that only 15.4% of the patients who initially met the criterion of chronic migraine with MOH relapsed, meeting the criterion for chronic migraine/MOH at the end of the 1-year follow-up period.

Lifestyle factors, such as diet, should be addressed when discussing migraine therapy with patients. Dietary factors, including a low–glycemic index diet, have been associated with promising results in migraine control. Results of a 10,359-patient cross-sectional study published in 2023 in the journal Nutrition confirmed that the inflammatory potential of patients' diet is associated with severe headache or migraine in US adults.²A more recent study, published in Frontiers in Nutrition in July 2024, examined dietary vitamin C intake of 13,445 individuals, of whom 20.42% had a severe headache or migraine. Vitamin C is a naturally occurring antioxidant and is also anti-inflammatory, found in foods such as citrus fruit, mangoes, strawberries, broccoli, and peppers. A subgroup analysis showed a significant association between vitamin C intake and severe headaches or migraines, with a reduced risk for severe headaches or migraines associated with an increased consumption of vitamin C. The authors noted that "each 1 mg/day increase in dietary vitamin C intake was significantly associated with a 6% lower risk for severe headache or migraine." Real-life application of this result for patients can involve encouraging patients to swap processed, low-nutrient foods in favor of fresh, nutrient-dense foods.

When treating migraine patients who are also parents, it is crucial to be persistent in searching for effective therapies to treat migraine and to treat or prevent MOH. According to a study published in 2018 in Headache, adolescents reported that parental migraine affected these factors in their lives: loss of parental support, reverse caregiving, emotional experience, interference with school, and missed activities and events.³ According to the authors of a more recent study, published in July 2024 in the Annals of General Psychiatry, parental migraine was significantly associated with an increased risk for attention-deficit/hyperactivity disorder, bipolar disorder, and depressive disorder among offspring of parents with migraine when compared with offspring of parents without migraine. The study authors noted that these outcomes could be the result of multiple factors, including psychosocial interactions, the burden of migraine on the family, and hereditary genetic traits. Nevertheless, even for offspring who may have a predisposition to these conditions because of genetic factors, effective treatment of parental migraine can relieve the day-to-day burden on the family, potentially reducing the effect of parental migraine on children. Parents who have migraine can become better equipped to provide attention to their children when their migraine symptoms are effectively treated. Furthermore, parents who have experienced improvement of their own migraine symptoms can offer hope and support if their children experience migraines, as migraine can be hereditary.

Additional References

1. Göçmez Yılmaz G, Ghouri R, et al. Complicated form of medication overuse headache is severe version of chronic migraine. J Clin Med. 2024;13(13):3696. doi: 10.3390/jcm13133696 Source

2. Liu H, Wang D, Wu F, et al. Association between inflammatory potential of diet and self-reported severe headache or migraine: A cross-sectional study of the National Health and Nutrition Examination Survey. Nutrition. 2023;113:112098. doi: 10.1016/j.nut.2023.112098 Source

3. Buse DC, Powers SW, Gelfand AA, et al. Adolescent perspectives on the burden of a parent's migraine: Results from the CaMEO Study. Headache. 2018;58(4):512-524. doi: 10.1111/head.13254 Source

MOH involves many of the same features as migraine headaches: photophobia, nausea, vomiting, and sleep disturbances.¹ Additionally, patients with migraine and comorbid MOH are at a higher risk for anxiety, depression, and emotional stress. MOH is difficult to treat, and symptom relapse after treatment is common. Results of a retrospective analysis published in July 2024 in The Journal of Headache and Facial Pain confirmed the effectiveness of calcitonin gene-related peptide (CGRP) antibody treatment in a real-world setting among migraine patients who had MOH. The study included a total of 291 patients who had been treated with either erenumab, fremanezumab, or galcanezumab. The majority of patients experienced a significant decline in monthly headache days, monthly migraine days, and monthly acute medication intake at 1 year. The researchers found that only 15.4% of the patients who initially met the criterion of chronic migraine with MOH relapsed, meeting the criterion for chronic migraine/MOH at the end of the 1-year follow-up period.

Lifestyle factors, such as diet, should be addressed when discussing migraine therapy with patients. Dietary factors, including a low–glycemic index diet, have been associated with promising results in migraine control. Results of a 10,359-patient cross-sectional study published in 2023 in the journal Nutrition confirmed that the inflammatory potential of patients' diet is associated with severe headache or migraine in US adults.²A more recent study, published in Frontiers in Nutrition in July 2024, examined dietary vitamin C intake of 13,445 individuals, of whom 20.42% had a severe headache or migraine. Vitamin C is a naturally occurring antioxidant and is also anti-inflammatory, found in foods such as citrus fruit, mangoes, strawberries, broccoli, and peppers. A subgroup analysis showed a significant association between vitamin C intake and severe headaches or migraines, with a reduced risk for severe headaches or migraines associated with an increased consumption of vitamin C. The authors noted that "each 1 mg/day increase in dietary vitamin C intake was significantly associated with a 6% lower risk for severe headache or migraine." Real-life application of this result for patients can involve encouraging patients to swap processed, low-nutrient foods in favor of fresh, nutrient-dense foods.

When treating migraine patients who are also parents, it is crucial to be persistent in searching for effective therapies to treat migraine and to treat or prevent MOH. According to a study published in 2018 in Headache, adolescents reported that parental migraine affected these factors in their lives: loss of parental support, reverse caregiving, emotional experience, interference with school, and missed activities and events.³ According to the authors of a more recent study, published in July 2024 in the Annals of General Psychiatry, parental migraine was significantly associated with an increased risk for attention-deficit/hyperactivity disorder, bipolar disorder, and depressive disorder among offspring of parents with migraine when compared with offspring of parents without migraine. The study authors noted that these outcomes could be the result of multiple factors, including psychosocial interactions, the burden of migraine on the family, and hereditary genetic traits. Nevertheless, even for offspring who may have a predisposition to these conditions because of genetic factors, effective treatment of parental migraine can relieve the day-to-day burden on the family, potentially reducing the effect of parental migraine on children. Parents who have migraine can become better equipped to provide attention to their children when their migraine symptoms are effectively treated. Furthermore, parents who have experienced improvement of their own migraine symptoms can offer hope and support if their children experience migraines, as migraine can be hereditary.

Additional References

1. Göçmez Yılmaz G, Ghouri R, et al. Complicated form of medication overuse headache is severe version of chronic migraine. J Clin Med. 2024;13(13):3696. doi: 10.3390/jcm13133696 Source

2. Liu H, Wang D, Wu F, et al. Association between inflammatory potential of diet and self-reported severe headache or migraine: A cross-sectional study of the National Health and Nutrition Examination Survey. Nutrition. 2023;113:112098. doi: 10.1016/j.nut.2023.112098 Source

3. Buse DC, Powers SW, Gelfand AA, et al. Adolescent perspectives on the burden of a parent's migraine: Results from the CaMEO Study. Headache. 2018;58(4):512-524. doi: 10.1111/head.13254 Source