Headache & Migraine

Prednisolone may be an effective bridge therapy to ease withdrawal symptoms and improve reversal for patients with migraine whose headaches persist despite them taking an abundance of acute headache medications, a condition known as medication-overuse headache (MOH), an observational study out of South Korea has found.

The study, a post-hoc analysis of the RELEASE multicenter observational cohort study of MOH patients in South Korea, found that patients who took prednisolone as a bridge therapy in the early phase of withdrawal from headache medications, or detoxification, had statistically significant higher rates of MOH reversal at 3 months after enrollment than those who did not, 73.8% versus 57.8% (P = .034)  

Seoul National Univeristy College of Medicine

The reversal trend also was noted at 1 month after treatment, the study authors, led by Mi Ji Lee, MD, PhD, an assistant professor at Seoul National University Hospital, Seoul, South Korea, wrote. “Although an observational study cannot draw a definitive conclusion, our study supports the use of prednisolone for the treatment of MOH in a real-world setting,” Dr. Lee and colleagues wrote.
 

Study methods

The study was a post hoc analysis of the RELEASE study, which stands for Registry for Load and Management of Medication Overuse Headache. RELEASE is a multicenter observational cohort study that has been ongoing in South Korea since April 2020. The post hoc analysis included 309 patients, 59 of whom received prednisolone at a varying dose of 10-40 mg a day, with a varying course of 5-14 days. About 74% of patients (228 of 309) completed the 3-month follow-up period, including 41 in the prednisolone group.

The study used three different forms of medication withdrawal before the patients started prednisolone therapy: abrupt discontinuation; gradual discontinuation concurrent with starting prednisolone; and no withdrawal.

Because of the observational nature of the RELEASE study, participating physicians prescribed prednisolone at their own discretion. The study authors noted prednisolone use was neither randomized nor controlled, which they acknowledged as a limitation.

Dr. Lee and colleagues also acknowledged that newer calcitonin gene–related peptide (CGRP) receptor antagonists may not require detoxification to reverse MOH, but that those therapies are not always available for a variety of reasons, such as reimbursement restrictions, regional distribution issues, and financial issues.

The study also evaluated a number of secondary outcomes. For example, 72% of prednisolone patients achieved MOH reversal 1 month after starting treatment versus 54.9% of the nonprednisolone patients. (P = .33). Prednisolone users also had greater reductions in acute medication days (AMD) at 1 month and scores on headache impact test-6 (HIT-6) at 6 months.

Dr. Lee and colleagues noted that the concept of detoxification, or discontinuing medication overuse, as a treatment for MOH has been controversial due to a lack of high-quality evidence to support the approach. “Nevertheless,” they wrote, “several experts still put withdrawal of medication overuse as an important step of MOH treatment in clinical practice despite limited evidence.”
 

Commentary

Alan Rapoport, MD, a clinical professor of neurology at the David Geffen School of Medicine at University of California, Los Angeles, noted a number of limitations with the study. “It wasn’t a unified population of patients,” he said, “which makes it a little harder to say this medicine worked — worked on whom?” The lack of a treatment regimen — the varied dosing and treatment durations, along with the different withdrawal approaches — are further limitations, Dr. Rapoport said.

Nonetheless, the study is an important addition to the evidence on how to manage medication withdrawal in MOH, said Dr. Rapoport, a past president of the International Headache Society and founder and director emeritus of the New England Center for Headache in Stamford, Connecticut, who has a keen interest in MOH research.

“I think this shows to some extent, although it doesn’t prove it because it’s a whole mixture of patients who were all treated differently by different doctors, but when you put them all together the patients who took steroids did better than the patients who did not,” he said. “The study authors did the best they could with the information they had.”

He termed the study “well-done by well-known authors in South Korea.” As medications such as CGRP receptor antagonists and monoclonal antibodies that target CGRP and its receptors become more available, MOH patients “may not need actual detoxification or steroids in their treatment,” Dr. Rapoport said.

Dr. Lee and co-authors have no disclosures. Dr. Rapoport is editor-in-chief of Neurology Reviews. He disclosed relationships with AbbVie, Biohaven, Cala Health, Dr. Reddy’s, Pfizer, Satsuma, Teva Pharmaceutical Industries, and Theranica.

Prednisolone may be an effective bridge therapy to ease withdrawal symptoms and improve reversal for patients with migraine whose headaches persist despite them taking an abundance of acute headache medications, a condition known as medication-overuse headache (MOH), an observational study out of South Korea has found.

The study, a post-hoc analysis of the RELEASE multicenter observational cohort study of MOH patients in South Korea, found that patients who took prednisolone as a bridge therapy in the early phase of withdrawal from headache medications, or detoxification, had statistically significant higher rates of MOH reversal at 3 months after enrollment than those who did not, 73.8% versus 57.8% (P = .034)  

Seoul National Univeristy College of Medicine

The reversal trend also was noted at 1 month after treatment, the study authors, led by Mi Ji Lee, MD, PhD, an assistant professor at Seoul National University Hospital, Seoul, South Korea, wrote. “Although an observational study cannot draw a definitive conclusion, our study supports the use of prednisolone for the treatment of MOH in a real-world setting,” Dr. Lee and colleagues wrote.
 

Study methods

The study was a post hoc analysis of the RELEASE study, which stands for Registry for Load and Management of Medication Overuse Headache. RELEASE is a multicenter observational cohort study that has been ongoing in South Korea since April 2020. The post hoc analysis included 309 patients, 59 of whom received prednisolone at a varying dose of 10-40 mg a day, with a varying course of 5-14 days. About 74% of patients (228 of 309) completed the 3-month follow-up period, including 41 in the prednisolone group.

The study used three different forms of medication withdrawal before the patients started prednisolone therapy: abrupt discontinuation; gradual discontinuation concurrent with starting prednisolone; and no withdrawal.

Because of the observational nature of the RELEASE study, participating physicians prescribed prednisolone at their own discretion. The study authors noted prednisolone use was neither randomized nor controlled, which they acknowledged as a limitation.

Dr. Lee and colleagues also acknowledged that newer calcitonin gene–related peptide (CGRP) receptor antagonists may not require detoxification to reverse MOH, but that those therapies are not always available for a variety of reasons, such as reimbursement restrictions, regional distribution issues, and financial issues.

The study also evaluated a number of secondary outcomes. For example, 72% of prednisolone patients achieved MOH reversal 1 month after starting treatment versus 54.9% of the nonprednisolone patients. (P = .33). Prednisolone users also had greater reductions in acute medication days (AMD) at 1 month and scores on headache impact test-6 (HIT-6) at 6 months.

Dr. Lee and colleagues noted that the concept of detoxification, or discontinuing medication overuse, as a treatment for MOH has been controversial due to a lack of high-quality evidence to support the approach. “Nevertheless,” they wrote, “several experts still put withdrawal of medication overuse as an important step of MOH treatment in clinical practice despite limited evidence.”
 

Commentary

Alan Rapoport, MD, a clinical professor of neurology at the David Geffen School of Medicine at University of California, Los Angeles, noted a number of limitations with the study. “It wasn’t a unified population of patients,” he said, “which makes it a little harder to say this medicine worked — worked on whom?” The lack of a treatment regimen — the varied dosing and treatment durations, along with the different withdrawal approaches — are further limitations, Dr. Rapoport said.

Nonetheless, the study is an important addition to the evidence on how to manage medication withdrawal in MOH, said Dr. Rapoport, a past president of the International Headache Society and founder and director emeritus of the New England Center for Headache in Stamford, Connecticut, who has a keen interest in MOH research.

“I think this shows to some extent, although it doesn’t prove it because it’s a whole mixture of patients who were all treated differently by different doctors, but when you put them all together the patients who took steroids did better than the patients who did not,” he said. “The study authors did the best they could with the information they had.”

He termed the study “well-done by well-known authors in South Korea.” As medications such as CGRP receptor antagonists and monoclonal antibodies that target CGRP and its receptors become more available, MOH patients “may not need actual detoxification or steroids in their treatment,” Dr. Rapoport said.

Dr. Lee and co-authors have no disclosures. Dr. Rapoport is editor-in-chief of Neurology Reviews. He disclosed relationships with AbbVie, Biohaven, Cala Health, Dr. Reddy’s, Pfizer, Satsuma, Teva Pharmaceutical Industries, and Theranica.

Prednisolone may be an effective bridge therapy to ease withdrawal symptoms and improve reversal for patients with migraine whose headaches persist despite them taking an abundance of acute headache medications, a condition known as medication-overuse headache (MOH), an observational study out of South Korea has found.

The study, a post-hoc analysis of the RELEASE multicenter observational cohort study of MOH patients in South Korea, found that patients who took prednisolone as a bridge therapy in the early phase of withdrawal from headache medications, or detoxification, had statistically significant higher rates of MOH reversal at 3 months after enrollment than those who did not, 73.8% versus 57.8% (P = .034)  

Seoul National Univeristy College of Medicine

The reversal trend also was noted at 1 month after treatment, the study authors, led by Mi Ji Lee, MD, PhD, an assistant professor at Seoul National University Hospital, Seoul, South Korea, wrote. “Although an observational study cannot draw a definitive conclusion, our study supports the use of prednisolone for the treatment of MOH in a real-world setting,” Dr. Lee and colleagues wrote.
 

Study methods

The study was a post hoc analysis of the RELEASE study, which stands for Registry for Load and Management of Medication Overuse Headache. RELEASE is a multicenter observational cohort study that has been ongoing in South Korea since April 2020. The post hoc analysis included 309 patients, 59 of whom received prednisolone at a varying dose of 10-40 mg a day, with a varying course of 5-14 days. About 74% of patients (228 of 309) completed the 3-month follow-up period, including 41 in the prednisolone group.

The study used three different forms of medication withdrawal before the patients started prednisolone therapy: abrupt discontinuation; gradual discontinuation concurrent with starting prednisolone; and no withdrawal.

Because of the observational nature of the RELEASE study, participating physicians prescribed prednisolone at their own discretion. The study authors noted prednisolone use was neither randomized nor controlled, which they acknowledged as a limitation.

Dr. Lee and colleagues also acknowledged that newer calcitonin gene–related peptide (CGRP) receptor antagonists may not require detoxification to reverse MOH, but that those therapies are not always available for a variety of reasons, such as reimbursement restrictions, regional distribution issues, and financial issues.

The study also evaluated a number of secondary outcomes. For example, 72% of prednisolone patients achieved MOH reversal 1 month after starting treatment versus 54.9% of the nonprednisolone patients. (P = .33). Prednisolone users also had greater reductions in acute medication days (AMD) at 1 month and scores on headache impact test-6 (HIT-6) at 6 months.

Dr. Lee and colleagues noted that the concept of detoxification, or discontinuing medication overuse, as a treatment for MOH has been controversial due to a lack of high-quality evidence to support the approach. “Nevertheless,” they wrote, “several experts still put withdrawal of medication overuse as an important step of MOH treatment in clinical practice despite limited evidence.”
 

Commentary

Alan Rapoport, MD, a clinical professor of neurology at the David Geffen School of Medicine at University of California, Los Angeles, noted a number of limitations with the study. “It wasn’t a unified population of patients,” he said, “which makes it a little harder to say this medicine worked — worked on whom?” The lack of a treatment regimen — the varied dosing and treatment durations, along with the different withdrawal approaches — are further limitations, Dr. Rapoport said.

Nonetheless, the study is an important addition to the evidence on how to manage medication withdrawal in MOH, said Dr. Rapoport, a past president of the International Headache Society and founder and director emeritus of the New England Center for Headache in Stamford, Connecticut, who has a keen interest in MOH research.

“I think this shows to some extent, although it doesn’t prove it because it’s a whole mixture of patients who were all treated differently by different doctors, but when you put them all together the patients who took steroids did better than the patients who did not,” he said. “The study authors did the best they could with the information they had.”

He termed the study “well-done by well-known authors in South Korea.” As medications such as CGRP receptor antagonists and monoclonal antibodies that target CGRP and its receptors become more available, MOH patients “may not need actual detoxification or steroids in their treatment,” Dr. Rapoport said.

Dr. Lee and co-authors have no disclosures. Dr. Rapoport is editor-in-chief of Neurology Reviews. He disclosed relationships with AbbVie, Biohaven, Cala Health, Dr. Reddy’s, Pfizer, Satsuma, Teva Pharmaceutical Industries, and Theranica.

Key clinical point: Higher dietary intakes of vitamin B₆ and folate were significantly associated with a lower risk for severe headaches or migraines, with a synergistic interaction observed between vitamin B₆ and folate intake and reduced migraine risk.

Major finding: Compared with the lowest quintile of dietary vitamin B₆ (≤1.13 mg/day) and folate (≤240 μg/day) intake, the risk for severe headache or migraine was lower in the highest quintile of vitamin B₆ (≥2.39 mg/day; adjusted odds ratio [aOR] 0.66; P = .01) and folate (≥502.01 μg/day; aOR 0.57; P = .002) intake. A synergistic interaction was observed between the high mass of vitamin B₆ and folate intake and a lower risk for severe headache or migraine (synergy index 0.58; 95% CI 0.40-0.83).

Study details: This cross-sectional study included 7017 adult participants (age ≥ 20 years), of whom 1350 (19.23%) had migraine.

Disclosures: This study was supported by the National Natural Science Foundation of China, Natural Science Foundation of Jiangxi Province, and others. No conflicts of interests were declared.

Source: Tian S et al. Vitamin B₆ and folate intake are associated with lower risk of severe headache or migraine in adults: An analysis based on NHANES 1999-2004. Nutr Res. 2023;121:51-60 (Nov 15). doi: 10.1016/j.nutres.2023.11.008

Key clinical point: Higher dietary intakes of vitamin B₆ and folate were significantly associated with a lower risk for severe headaches or migraines, with a synergistic interaction observed between vitamin B₆ and folate intake and reduced migraine risk.

Major finding: Compared with the lowest quintile of dietary vitamin B₆ (≤1.13 mg/day) and folate (≤240 μg/day) intake, the risk for severe headache or migraine was lower in the highest quintile of vitamin B₆ (≥2.39 mg/day; adjusted odds ratio [aOR] 0.66; P = .01) and folate (≥502.01 μg/day; aOR 0.57; P = .002) intake. A synergistic interaction was observed between the high mass of vitamin B₆ and folate intake and a lower risk for severe headache or migraine (synergy index 0.58; 95% CI 0.40-0.83).

Study details: This cross-sectional study included 7017 adult participants (age ≥ 20 years), of whom 1350 (19.23%) had migraine.

Disclosures: This study was supported by the National Natural Science Foundation of China, Natural Science Foundation of Jiangxi Province, and others. No conflicts of interests were declared.

Source: Tian S et al. Vitamin B₆ and folate intake are associated with lower risk of severe headache or migraine in adults: An analysis based on NHANES 1999-2004. Nutr Res. 2023;121:51-60 (Nov 15). doi: 10.1016/j.nutres.2023.11.008

Key clinical point: Higher dietary intakes of vitamin B₆ and folate were significantly associated with a lower risk for severe headaches or migraines, with a synergistic interaction observed between vitamin B₆ and folate intake and reduced migraine risk.

Major finding: Compared with the lowest quintile of dietary vitamin B₆ (≤1.13 mg/day) and folate (≤240 μg/day) intake, the risk for severe headache or migraine was lower in the highest quintile of vitamin B₆ (≥2.39 mg/day; adjusted odds ratio [aOR] 0.66; P = .01) and folate (≥502.01 μg/day; aOR 0.57; P = .002) intake. A synergistic interaction was observed between the high mass of vitamin B₆ and folate intake and a lower risk for severe headache or migraine (synergy index 0.58; 95% CI 0.40-0.83).

Study details: This cross-sectional study included 7017 adult participants (age ≥ 20 years), of whom 1350 (19.23%) had migraine.

Disclosures: This study was supported by the National Natural Science Foundation of China, Natural Science Foundation of Jiangxi Province, and others. No conflicts of interests were declared.

Source: Tian S et al. Vitamin B₆ and folate intake are associated with lower risk of severe headache or migraine in adults: An analysis based on NHANES 1999-2004. Nutr Res. 2023;121:51-60 (Nov 15). doi: 10.1016/j.nutres.2023.11.008

The authors of a study published in the December 2023 issue of the Scandinavian Journal of Gastroenterology analyzed data to examine the potential link between gut microbiota and migraine. According to the statistical analysis, the researchers found that "a greater abundance of genus Lactobacillus was associated with a higher risk of migraine and a higher abundance of family Prevotellaceae was related to a decreased risk of migraine." Furthermore, they noted that these gut microbial patterns could be due to a genetic predisposition. The authors suggested that stool sampling could potentially be helpful in the diagnosis of migraine, and that measures to modify gut microbiota in the context of migraine therapy could be identified with future research.

While it is not clear whether migraine is a cause or effect of these alterations, or whether there is another confounding variable, the idea of using diet as a means of reducing migraine risk would be appealing for many patients. This offers hope, but it also leaves a window open for exaggeration and excessive reliance on certain foods or supplements before reliable links are established.

Further examining the genetic factors that might play a role in migraine, a large Korean data analysis published in the December 2023 issue of Epidemiology and Health described a link between migraine and Parkinson's disease. The researchers included 214,193 patients with migraine and 5,879,711 individuals without migraine. According to the statistical analysis, the patients who had migraine with aura showed a 1.35-fold higher risk for Parkinson's disease than individuals without migraine. However, the researchers did not note a statistically significant difference between the risk for Parkinson's disease among patients who had migraine without aura and individuals without migraine.

They also examined other factors, and noted that among individuals with migraine, those who had preexisting dyslipidemia had a higher risk for Parkinson's disease than those who did not have dyslipidemia. Other factors that were not correlated with an association between migraine and Parkinson's disease included cardiovascular risk factors, hypertension, diabetes, smoking status, and high body mass index.

The study authors noted that factors associated with the activity of calcitonin gene-related peptide (CGRP), which is known to play a significant role in the pathophysiology of migraine, could play a role in the link between migraine and Parkinson's disease. They pointed to previous studies that found evidence of elevated CGRP levels in the cerebrospinal fluid of patients with Parkinson's disease as possible evidence of a pathophysiologic link.

An earlier commentary, published in the April 2020 issue of Headache, suggested an implication of CGRP antagonists in the development of neurodegenerative disorders such as Parkinson's disease. The commentary authors noted that previous research correlated midlife migraine to late-life parkinsonism, suggesting a conceivable common pathology, which could include a genetic or environmental predisposition.^[1] They also noted that studies suggest a possible link between CGRP and multiple system atrophy, a parkinsonian disorder.^[1] They considered the possibility that one of the ways that CGRP could contribute to these disorders is through its role in the recruitment of inflammatory mediators, which can alter the function of nicotinic receptors in the dopaminergic system in Parkinson's disease pathogenesis.^[2]

Recent research published in the December 2023 issue of Headache suggests that CGRP responsiveness in migraine therapy could be mediated by genetics. The study included 198 patients who had been typed for genes involved in CGRP signaling or pharmacologic response and were given genetic and polygenic risk scores. Responders were defined as patients who experienced ≥ 50% reduction in migraine days per month at 5.7-month follow-up.

The analysis revealed an association between nonresponder status and rs12615320-G in RAMP1, a gene that encodes a component of high-affinity CGRP receptors, which increased the risk for nonresponder status. The researchers also identified an association between nonresponder status and rs4680-A in COMT, a gene that has been associated with lower COMT enzymatic activity, chronic pain/fibromyalgia, and a "worrier" phenotype. Nonresponders also had a lower mean genetic risk score than responders. These genetic associations could help identify which patients would be most likely to benefit from anti-CGRP therapies.

Given that CGRP responsiveness may have a genetic component, it is possible that one of the contributors to the link between migraine and Parkinson's disease could lie in patients' genetic predisposition to CGRP activity. Yet, the association between these two common conditions is not thoroughly established, and the role of CGRP in the pathogenesis of Parkinson's disease is not fully validated. Nevertheless, the new developments in treatments that modify CGRP activity could have implications beyond migraine.

Additional References

1. Alexoudi A, Deftereos S. CGRP antagonists: side effects and potential Parkinson's disease development. Headache. 2020;60:789-790. doi: 10.1111/head.13770 Source

2. Blumenfeld A, Durham PL, Feoktistov A, et al. Hypervigilance, allostatic load, and migraine prevention: Antibodies to CGRP or receptor. Neurol Ther. 2021;10:469-497. doi:10.1007/s40120-021-00250-7 Source

The authors of a study published in the December 2023 issue of the Scandinavian Journal of Gastroenterology analyzed data to examine the potential link between gut microbiota and migraine. According to the statistical analysis, the researchers found that "a greater abundance of genus Lactobacillus was associated with a higher risk of migraine and a higher abundance of family Prevotellaceae was related to a decreased risk of migraine." Furthermore, they noted that these gut microbial patterns could be due to a genetic predisposition. The authors suggested that stool sampling could potentially be helpful in the diagnosis of migraine, and that measures to modify gut microbiota in the context of migraine therapy could be identified with future research.

While it is not clear whether migraine is a cause or effect of these alterations, or whether there is another confounding variable, the idea of using diet as a means of reducing migraine risk would be appealing for many patients. This offers hope, but it also leaves a window open for exaggeration and excessive reliance on certain foods or supplements before reliable links are established.

Further examining the genetic factors that might play a role in migraine, a large Korean data analysis published in the December 2023 issue of Epidemiology and Health described a link between migraine and Parkinson's disease. The researchers included 214,193 patients with migraine and 5,879,711 individuals without migraine. According to the statistical analysis, the patients who had migraine with aura showed a 1.35-fold higher risk for Parkinson's disease than individuals without migraine. However, the researchers did not note a statistically significant difference between the risk for Parkinson's disease among patients who had migraine without aura and individuals without migraine.

They also examined other factors, and noted that among individuals with migraine, those who had preexisting dyslipidemia had a higher risk for Parkinson's disease than those who did not have dyslipidemia. Other factors that were not correlated with an association between migraine and Parkinson's disease included cardiovascular risk factors, hypertension, diabetes, smoking status, and high body mass index.

The study authors noted that factors associated with the activity of calcitonin gene-related peptide (CGRP), which is known to play a significant role in the pathophysiology of migraine, could play a role in the link between migraine and Parkinson's disease. They pointed to previous studies that found evidence of elevated CGRP levels in the cerebrospinal fluid of patients with Parkinson's disease as possible evidence of a pathophysiologic link.

An earlier commentary, published in the April 2020 issue of Headache, suggested an implication of CGRP antagonists in the development of neurodegenerative disorders such as Parkinson's disease. The commentary authors noted that previous research correlated midlife migraine to late-life parkinsonism, suggesting a conceivable common pathology, which could include a genetic or environmental predisposition.^[1] They also noted that studies suggest a possible link between CGRP and multiple system atrophy, a parkinsonian disorder.^[1] They considered the possibility that one of the ways that CGRP could contribute to these disorders is through its role in the recruitment of inflammatory mediators, which can alter the function of nicotinic receptors in the dopaminergic system in Parkinson's disease pathogenesis.^[2]

Recent research published in the December 2023 issue of Headache suggests that CGRP responsiveness in migraine therapy could be mediated by genetics. The study included 198 patients who had been typed for genes involved in CGRP signaling or pharmacologic response and were given genetic and polygenic risk scores. Responders were defined as patients who experienced ≥ 50% reduction in migraine days per month at 5.7-month follow-up.

The analysis revealed an association between nonresponder status and rs12615320-G in RAMP1, a gene that encodes a component of high-affinity CGRP receptors, which increased the risk for nonresponder status. The researchers also identified an association between nonresponder status and rs4680-A in COMT, a gene that has been associated with lower COMT enzymatic activity, chronic pain/fibromyalgia, and a "worrier" phenotype. Nonresponders also had a lower mean genetic risk score than responders. These genetic associations could help identify which patients would be most likely to benefit from anti-CGRP therapies.

Given that CGRP responsiveness may have a genetic component, it is possible that one of the contributors to the link between migraine and Parkinson's disease could lie in patients' genetic predisposition to CGRP activity. Yet, the association between these two common conditions is not thoroughly established, and the role of CGRP in the pathogenesis of Parkinson's disease is not fully validated. Nevertheless, the new developments in treatments that modify CGRP activity could have implications beyond migraine.

Additional References

1. Alexoudi A, Deftereos S. CGRP antagonists: side effects and potential Parkinson's disease development. Headache. 2020;60:789-790. doi: 10.1111/head.13770 Source

2. Blumenfeld A, Durham PL, Feoktistov A, et al. Hypervigilance, allostatic load, and migraine prevention: Antibodies to CGRP or receptor. Neurol Ther. 2021;10:469-497. doi:10.1007/s40120-021-00250-7 Source

The authors of a study published in the December 2023 issue of the Scandinavian Journal of Gastroenterology analyzed data to examine the potential link between gut microbiota and migraine. According to the statistical analysis, the researchers found that "a greater abundance of genus Lactobacillus was associated with a higher risk of migraine and a higher abundance of family Prevotellaceae was related to a decreased risk of migraine." Furthermore, they noted that these gut microbial patterns could be due to a genetic predisposition. The authors suggested that stool sampling could potentially be helpful in the diagnosis of migraine, and that measures to modify gut microbiota in the context of migraine therapy could be identified with future research.

While it is not clear whether migraine is a cause or effect of these alterations, or whether there is another confounding variable, the idea of using diet as a means of reducing migraine risk would be appealing for many patients. This offers hope, but it also leaves a window open for exaggeration and excessive reliance on certain foods or supplements before reliable links are established.

Further examining the genetic factors that might play a role in migraine, a large Korean data analysis published in the December 2023 issue of Epidemiology and Health described a link between migraine and Parkinson's disease. The researchers included 214,193 patients with migraine and 5,879,711 individuals without migraine. According to the statistical analysis, the patients who had migraine with aura showed a 1.35-fold higher risk for Parkinson's disease than individuals without migraine. However, the researchers did not note a statistically significant difference between the risk for Parkinson's disease among patients who had migraine without aura and individuals without migraine.

They also examined other factors, and noted that among individuals with migraine, those who had preexisting dyslipidemia had a higher risk for Parkinson's disease than those who did not have dyslipidemia. Other factors that were not correlated with an association between migraine and Parkinson's disease included cardiovascular risk factors, hypertension, diabetes, smoking status, and high body mass index.

The study authors noted that factors associated with the activity of calcitonin gene-related peptide (CGRP), which is known to play a significant role in the pathophysiology of migraine, could play a role in the link between migraine and Parkinson's disease. They pointed to previous studies that found evidence of elevated CGRP levels in the cerebrospinal fluid of patients with Parkinson's disease as possible evidence of a pathophysiologic link.

An earlier commentary, published in the April 2020 issue of Headache, suggested an implication of CGRP antagonists in the development of neurodegenerative disorders such as Parkinson's disease. The commentary authors noted that previous research correlated midlife migraine to late-life parkinsonism, suggesting a conceivable common pathology, which could include a genetic or environmental predisposition.^[1] They also noted that studies suggest a possible link between CGRP and multiple system atrophy, a parkinsonian disorder.^[1] They considered the possibility that one of the ways that CGRP could contribute to these disorders is through its role in the recruitment of inflammatory mediators, which can alter the function of nicotinic receptors in the dopaminergic system in Parkinson's disease pathogenesis.^[2]

Recent research published in the December 2023 issue of Headache suggests that CGRP responsiveness in migraine therapy could be mediated by genetics. The study included 198 patients who had been typed for genes involved in CGRP signaling or pharmacologic response and were given genetic and polygenic risk scores. Responders were defined as patients who experienced ≥ 50% reduction in migraine days per month at 5.7-month follow-up.

The analysis revealed an association between nonresponder status and rs12615320-G in RAMP1, a gene that encodes a component of high-affinity CGRP receptors, which increased the risk for nonresponder status. The researchers also identified an association between nonresponder status and rs4680-A in COMT, a gene that has been associated with lower COMT enzymatic activity, chronic pain/fibromyalgia, and a "worrier" phenotype. Nonresponders also had a lower mean genetic risk score than responders. These genetic associations could help identify which patients would be most likely to benefit from anti-CGRP therapies.

Given that CGRP responsiveness may have a genetic component, it is possible that one of the contributors to the link between migraine and Parkinson's disease could lie in patients' genetic predisposition to CGRP activity. Yet, the association between these two common conditions is not thoroughly established, and the role of CGRP in the pathogenesis of Parkinson's disease is not fully validated. Nevertheless, the new developments in treatments that modify CGRP activity could have implications beyond migraine.

Additional References

1. Alexoudi A, Deftereos S. CGRP antagonists: side effects and potential Parkinson's disease development. Headache. 2020;60:789-790. doi: 10.1111/head.13770 Source

2. Blumenfeld A, Durham PL, Feoktistov A, et al. Hypervigilance, allostatic load, and migraine prevention: Antibodies to CGRP or receptor. Neurol Ther. 2021;10:469-497. doi:10.1007/s40120-021-00250-7 Source

TOPLINE:

Migraine is associated with a significantly increased risk of developing inflammatory bowel disease (IBD), including both Crohn’s disease (CD) and ulcerative colitis (UC), a new nationwide, population-based cohort study showed.

METHODOLOGY:

• Investigators analyzed data from South Korea’s National Health Insurance Service (NHIS) database, which houses data for the nationwide obligatory health system for South Korean citizens.
• Individuals aged ≥ 20 years who had at least one national health screening in 2009 were enrolled in the study and followed until December 2019.
• Investigators searched the data for International Classification of Diseases (10th Revision) codes corresponding to migraine and IBD. IBD diagnoses were also based on clinical manifestation, endoscopic findings, and pathologic findings.

TAKEAWAY:

• More than 10 million people were enrolled in the study (55% male; mean age, 47 years), and of these, 2.8% were diagnosed with migraine during the study period.
• During a median follow-up of 10 years, the incidence of IBD was significantly higher in patients with migraine (adjusted hazard ratio [aHR], 1.31; P < .001), CD (aHR, 1.58; P < .001) and UC (aHR, 1.26; P < .001) than in those without migraine.
• in men vs women (aHR, 1.43 vs 1.12; P = .042).
• Investigators could only speculate about the mechanisms underlying the association between migraine and IBD but suggest pathological processes underlying both migraine and IBD, including proinflammatory cytokines and tumor necrosis factor alpha, may be involved.

IN PRACTICE:

“Clinicians should be aware of the potential risk of IBD in patients diagnosed with migraine especially in men for the development of UC and in migraineurs with a long disease duration for a further risk of CD,” the authors wrote.

SOURCE:

Hyunjung Lee, MD, of Seoul National University College of Medicine, Seoul, South Korea, led the study, which was published online on January 12, 2024, in Scientific Reports.

LIMITATIONS:

Disease severity of migraine and IBD was not available. In addition, certain medications taken to relieve migraine, such as nonsteroidal anti-inflammatory drugs like ibuprofen, could cause intestinal inflammation, but there was no medication information available.

DISCLOSURES:

There was no information about study funding nor disclosures from study authors.
 

A version of this article appeared on Medscape.com.

TOPLINE:

Migraine is associated with a significantly increased risk of developing inflammatory bowel disease (IBD), including both Crohn’s disease (CD) and ulcerative colitis (UC), a new nationwide, population-based cohort study showed.

METHODOLOGY:

• Investigators analyzed data from South Korea’s National Health Insurance Service (NHIS) database, which houses data for the nationwide obligatory health system for South Korean citizens.
• Individuals aged ≥ 20 years who had at least one national health screening in 2009 were enrolled in the study and followed until December 2019.
• Investigators searched the data for International Classification of Diseases (10th Revision) codes corresponding to migraine and IBD. IBD diagnoses were also based on clinical manifestation, endoscopic findings, and pathologic findings.

TAKEAWAY:

• More than 10 million people were enrolled in the study (55% male; mean age, 47 years), and of these, 2.8% were diagnosed with migraine during the study period.
• During a median follow-up of 10 years, the incidence of IBD was significantly higher in patients with migraine (adjusted hazard ratio [aHR], 1.31; P < .001), CD (aHR, 1.58; P < .001) and UC (aHR, 1.26; P < .001) than in those without migraine.
• in men vs women (aHR, 1.43 vs 1.12; P = .042).
• Investigators could only speculate about the mechanisms underlying the association between migraine and IBD but suggest pathological processes underlying both migraine and IBD, including proinflammatory cytokines and tumor necrosis factor alpha, may be involved.

IN PRACTICE:

“Clinicians should be aware of the potential risk of IBD in patients diagnosed with migraine especially in men for the development of UC and in migraineurs with a long disease duration for a further risk of CD,” the authors wrote.

SOURCE:

Hyunjung Lee, MD, of Seoul National University College of Medicine, Seoul, South Korea, led the study, which was published online on January 12, 2024, in Scientific Reports.

LIMITATIONS:

Disease severity of migraine and IBD was not available. In addition, certain medications taken to relieve migraine, such as nonsteroidal anti-inflammatory drugs like ibuprofen, could cause intestinal inflammation, but there was no medication information available.

DISCLOSURES:

There was no information about study funding nor disclosures from study authors.
 

A version of this article appeared on Medscape.com.

TOPLINE:

Migraine is associated with a significantly increased risk of developing inflammatory bowel disease (IBD), including both Crohn’s disease (CD) and ulcerative colitis (UC), a new nationwide, population-based cohort study showed.

METHODOLOGY:

• Investigators analyzed data from South Korea’s National Health Insurance Service (NHIS) database, which houses data for the nationwide obligatory health system for South Korean citizens.
• Individuals aged ≥ 20 years who had at least one national health screening in 2009 were enrolled in the study and followed until December 2019.
• Investigators searched the data for International Classification of Diseases (10th Revision) codes corresponding to migraine and IBD. IBD diagnoses were also based on clinical manifestation, endoscopic findings, and pathologic findings.

TAKEAWAY:

• More than 10 million people were enrolled in the study (55% male; mean age, 47 years), and of these, 2.8% were diagnosed with migraine during the study period.
• During a median follow-up of 10 years, the incidence of IBD was significantly higher in patients with migraine (adjusted hazard ratio [aHR], 1.31; P < .001), CD (aHR, 1.58; P < .001) and UC (aHR, 1.26; P < .001) than in those without migraine.
• in men vs women (aHR, 1.43 vs 1.12; P = .042).
• Investigators could only speculate about the mechanisms underlying the association between migraine and IBD but suggest pathological processes underlying both migraine and IBD, including proinflammatory cytokines and tumor necrosis factor alpha, may be involved.

IN PRACTICE:

“Clinicians should be aware of the potential risk of IBD in patients diagnosed with migraine especially in men for the development of UC and in migraineurs with a long disease duration for a further risk of CD,” the authors wrote.

SOURCE:

Hyunjung Lee, MD, of Seoul National University College of Medicine, Seoul, South Korea, led the study, which was published online on January 12, 2024, in Scientific Reports.

LIMITATIONS:

Disease severity of migraine and IBD was not available. In addition, certain medications taken to relieve migraine, such as nonsteroidal anti-inflammatory drugs like ibuprofen, could cause intestinal inflammation, but there was no medication information available.

DISCLOSURES:

There was no information about study funding nor disclosures from study authors.
 

A version of this article appeared on Medscape.com.

Key clinical point: Patients with migraine initiating calcitonin gene-related peptide (CGRP) monoclonal antibody treatment with galcanezumab showed higher treatment persistence, lower treatment discontinuation, and similar adherence compared with those initiating fremanezumab or erenumab.

Major finding: Compared with fremanezumab, galcanezumab initiators showed higher rates of treatment persistence (P = .001) and lower treatment discontinuation (P = .005). Compared with erenumab, galcanezumab initiators had lower treatment discontinuation (P = .040). Patient adherence was similar among those who initiated galcanezumab vs fremanezumab or erenumab.

Study details: This retrospective real-world study included patients with migraine initiating galcanezumab treatment who were matched with those initiating fremanezumab (n = 2674) or erenumab (n = 3503) treatment using propensity score matching.

Disclosures: This study was funded by Eli Lilly and Company. The authors declared no conflicts of interest.

Source: Varnado OJ et al. Comparison of treatment patterns in patients with migraine initiating calcitonin gene-related peptide monoclonal antibodies: A Retrospective Real-World US Study. Patient Preference and Adherence. 2024;18:69-88 (Jan 9). doi: 10.2147/PPA.S437396

Key clinical point: Patients with migraine initiating calcitonin gene-related peptide (CGRP) monoclonal antibody treatment with galcanezumab showed higher treatment persistence, lower treatment discontinuation, and similar adherence compared with those initiating fremanezumab or erenumab.

Major finding: Compared with fremanezumab, galcanezumab initiators showed higher rates of treatment persistence (P = .001) and lower treatment discontinuation (P = .005). Compared with erenumab, galcanezumab initiators had lower treatment discontinuation (P = .040). Patient adherence was similar among those who initiated galcanezumab vs fremanezumab or erenumab.

Study details: This retrospective real-world study included patients with migraine initiating galcanezumab treatment who were matched with those initiating fremanezumab (n = 2674) or erenumab (n = 3503) treatment using propensity score matching.

Disclosures: This study was funded by Eli Lilly and Company. The authors declared no conflicts of interest.

Source: Varnado OJ et al. Comparison of treatment patterns in patients with migraine initiating calcitonin gene-related peptide monoclonal antibodies: A Retrospective Real-World US Study. Patient Preference and Adherence. 2024;18:69-88 (Jan 9). doi: 10.2147/PPA.S437396

Key clinical point: Patients with migraine initiating calcitonin gene-related peptide (CGRP) monoclonal antibody treatment with galcanezumab showed higher treatment persistence, lower treatment discontinuation, and similar adherence compared with those initiating fremanezumab or erenumab.

Major finding: Compared with fremanezumab, galcanezumab initiators showed higher rates of treatment persistence (P = .001) and lower treatment discontinuation (P = .005). Compared with erenumab, galcanezumab initiators had lower treatment discontinuation (P = .040). Patient adherence was similar among those who initiated galcanezumab vs fremanezumab or erenumab.

Study details: This retrospective real-world study included patients with migraine initiating galcanezumab treatment who were matched with those initiating fremanezumab (n = 2674) or erenumab (n = 3503) treatment using propensity score matching.

Disclosures: This study was funded by Eli Lilly and Company. The authors declared no conflicts of interest.

Source: Varnado OJ et al. Comparison of treatment patterns in patients with migraine initiating calcitonin gene-related peptide monoclonal antibodies: A Retrospective Real-World US Study. Patient Preference and Adherence. 2024;18:69-88 (Jan 9). doi: 10.2147/PPA.S437396

Key clinical point: Patients with episodic migraine without aura (EMoA) presented a higher delayed discounting rate, which was positively associated with the migraine history.

Major finding: Patients with EMoA vs control individuals showed a significantly higher subjective discount rate (F = 4.74; P = .032), which was positively correlated with migraine history (r = 0.742; P < .001). The resting-state functional connectivity between the left ventral striatum and middle occipital gyrus was significantly associated with migraine history (r′ = 0.294; P = .036) and subjective discount rate (r′ = 0.380; P = .006).

Study details: This study included 51 patients with EMoA and 45 control individuals who underwent task-based and multi-model magnetic resonance imaging.

Disclosures: This study was supported by the National Natural Science Foundation of China, Foundation for the Cultivation of Doctoral Research Talents, and the 2021 Youth Foundation Training Program of the First Affiliated Hospital of Anhui Medical University. The authors declared no conflicts of interest.

Source: Wang L et al. Patients with episodic migraine without aura have an increased rate of delayed discounting. Brain Behav. 2024;14(1):e3367 (Jan 2). doi: 10.1002/brb3.3367

Key clinical point: Patients with episodic migraine without aura (EMoA) presented a higher delayed discounting rate, which was positively associated with the migraine history.

Major finding: Patients with EMoA vs control individuals showed a significantly higher subjective discount rate (F = 4.74; P = .032), which was positively correlated with migraine history (r = 0.742; P < .001). The resting-state functional connectivity between the left ventral striatum and middle occipital gyrus was significantly associated with migraine history (r′ = 0.294; P = .036) and subjective discount rate (r′ = 0.380; P = .006).

Study details: This study included 51 patients with EMoA and 45 control individuals who underwent task-based and multi-model magnetic resonance imaging.

Disclosures: This study was supported by the National Natural Science Foundation of China, Foundation for the Cultivation of Doctoral Research Talents, and the 2021 Youth Foundation Training Program of the First Affiliated Hospital of Anhui Medical University. The authors declared no conflicts of interest.

Source: Wang L et al. Patients with episodic migraine without aura have an increased rate of delayed discounting. Brain Behav. 2024;14(1):e3367 (Jan 2). doi: 10.1002/brb3.3367

Key clinical point: Patients with episodic migraine without aura (EMoA) presented a higher delayed discounting rate, which was positively associated with the migraine history.

Major finding: Patients with EMoA vs control individuals showed a significantly higher subjective discount rate (F = 4.74; P = .032), which was positively correlated with migraine history (r = 0.742; P < .001). The resting-state functional connectivity between the left ventral striatum and middle occipital gyrus was significantly associated with migraine history (r′ = 0.294; P = .036) and subjective discount rate (r′ = 0.380; P = .006).

Study details: This study included 51 patients with EMoA and 45 control individuals who underwent task-based and multi-model magnetic resonance imaging.

Disclosures: This study was supported by the National Natural Science Foundation of China, Foundation for the Cultivation of Doctoral Research Talents, and the 2021 Youth Foundation Training Program of the First Affiliated Hospital of Anhui Medical University. The authors declared no conflicts of interest.

Source: Wang L et al. Patients with episodic migraine without aura have an increased rate of delayed discounting. Brain Behav. 2024;14(1):e3367 (Jan 2). doi: 10.1002/brb3.3367

Key clinical point: Patients with migraine have increased risk for incident Parkinson's disease (PD), with younger age and underlying dyslipidemia aggravating the risk for PD among women and men with migraine, respectively.

Major finding: The risk of incident PD was 1.35-fold (adjusted hazard ratio 1.35; 95% CI 1.29-1.41) higher in patients with vs without migraine, with the risk of PD being significantly higher among younger vs older women (age < 65 years vs ≥ 65 years; P = .038) and men with vs without dyslipidemia (P = .012).

Study details: This retrospective, nationwide, population-based cohort study included 214,193 individuals with migraine and 5,879,711 individuals without migraine, of whom 1973 (0.92%) and 30,664 (0.52%) individuals with and without migraine, respectively, were diagnosed with PD.

Disclosures: This research was supported by a grant from the National Research Foundation, Technology Development Program, and Technology Innovation Program. Korea. The authors declared no conflicts of interest.

Source: Ha WS et al. The association between migraine and Parkinson's disease: A nationwide cohort study. Epidemiol Health. 2023 (Dec 18). doi: 10.4178/epih.e2024010

Key clinical point: Patients with migraine have increased risk for incident Parkinson's disease (PD), with younger age and underlying dyslipidemia aggravating the risk for PD among women and men with migraine, respectively.

Major finding: The risk of incident PD was 1.35-fold (adjusted hazard ratio 1.35; 95% CI 1.29-1.41) higher in patients with vs without migraine, with the risk of PD being significantly higher among younger vs older women (age < 65 years vs ≥ 65 years; P = .038) and men with vs without dyslipidemia (P = .012).

Study details: This retrospective, nationwide, population-based cohort study included 214,193 individuals with migraine and 5,879,711 individuals without migraine, of whom 1973 (0.92%) and 30,664 (0.52%) individuals with and without migraine, respectively, were diagnosed with PD.

Disclosures: This research was supported by a grant from the National Research Foundation, Technology Development Program, and Technology Innovation Program. Korea. The authors declared no conflicts of interest.

Source: Ha WS et al. The association between migraine and Parkinson's disease: A nationwide cohort study. Epidemiol Health. 2023 (Dec 18). doi: 10.4178/epih.e2024010

Key clinical point: Patients with migraine have increased risk for incident Parkinson's disease (PD), with younger age and underlying dyslipidemia aggravating the risk for PD among women and men with migraine, respectively.

Major finding: The risk of incident PD was 1.35-fold (adjusted hazard ratio 1.35; 95% CI 1.29-1.41) higher in patients with vs without migraine, with the risk of PD being significantly higher among younger vs older women (age < 65 years vs ≥ 65 years; P = .038) and men with vs without dyslipidemia (P = .012).

Study details: This retrospective, nationwide, population-based cohort study included 214,193 individuals with migraine and 5,879,711 individuals without migraine, of whom 1973 (0.92%) and 30,664 (0.52%) individuals with and without migraine, respectively, were diagnosed with PD.

Disclosures: This research was supported by a grant from the National Research Foundation, Technology Development Program, and Technology Innovation Program. Korea. The authors declared no conflicts of interest.

Source: Ha WS et al. The association between migraine and Parkinson's disease: A nationwide cohort study. Epidemiol Health. 2023 (Dec 18). doi: 10.4178/epih.e2024010

Key clinical point: In this meta-analysis, migraine was more frequent among patients with vs without epilepsy and epilepsy was more frequent among patients with vs without migraine, highlighting a co-morbid association between migraine and epilepsy.

Major finding: The lifetime prevalence of migraine was 80% higher in patients with epilepsy compared with those without epilepsy (odds ratio [OR]/relative risk [RR] 1.80; P < .001). Similarly, the lifetime prevalence of epilepsy was 80% higher in patients with migraine compared with those without migraine (OR/RR 1.80; P < .001).

Study details: The data come from a meta-analysis of 13 studies that evaluated the association between migraine and epilepsy.

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

Source: Wu X and Zhuang J. Association between migraine and epilepsy: A meta-analysis. Front Neurol. 2024;14:1276663 (Jan 5). doi: 10.3389/fneur.2023.1276663

Key clinical point: In this meta-analysis, migraine was more frequent among patients with vs without epilepsy and epilepsy was more frequent among patients with vs without migraine, highlighting a co-morbid association between migraine and epilepsy.

Major finding: The lifetime prevalence of migraine was 80% higher in patients with epilepsy compared with those without epilepsy (odds ratio [OR]/relative risk [RR] 1.80; P < .001). Similarly, the lifetime prevalence of epilepsy was 80% higher in patients with migraine compared with those without migraine (OR/RR 1.80; P < .001).

Study details: The data come from a meta-analysis of 13 studies that evaluated the association between migraine and epilepsy.

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

Source: Wu X and Zhuang J. Association between migraine and epilepsy: A meta-analysis. Front Neurol. 2024;14:1276663 (Jan 5). doi: 10.3389/fneur.2023.1276663

Key clinical point: In this meta-analysis, migraine was more frequent among patients with vs without epilepsy and epilepsy was more frequent among patients with vs without migraine, highlighting a co-morbid association between migraine and epilepsy.

Major finding: The lifetime prevalence of migraine was 80% higher in patients with epilepsy compared with those without epilepsy (odds ratio [OR]/relative risk [RR] 1.80; P < .001). Similarly, the lifetime prevalence of epilepsy was 80% higher in patients with migraine compared with those without migraine (OR/RR 1.80; P < .001).

Study details: The data come from a meta-analysis of 13 studies that evaluated the association between migraine and epilepsy.

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

Source: Wu X and Zhuang J. Association between migraine and epilepsy: A meta-analysis. Front Neurol. 2024;14:1276663 (Jan 5). doi: 10.3389/fneur.2023.1276663

Key clinical point: Erenumab demonstrated a more favorable efficacy profile than rimegepant for the prevention of episodic and chronic migraine.

Major finding: Compared with 75 mg rimegepant, 70 mg erenumab significantly reduced monthly migraine days (MMD) by 0.90 days at 3 months (P = .042) and 140 mg erenumab significantly reduced MMD by 0.94 (P = .014) and 1.28 (P = .005) days at 1 month and 3 months, respectively. Erenumab showed advantages over rimegepant in improving Migraine-Specific Quality-of-life role function-restrictive domain and Migraine Disability Assessment scores (MIDAS) at 3 months.

Study details: This study performed anchored matching-adjusted indirect comparison of the relative efficacy of two erenumab regimens (70 mg and 140 mg) with rimegepant (75 mg) for migraine prevention using data from two phase 2/3 trials for erenumab (295 and STRIVE) and a phase 2/3 trial for rimegepant.

Disclosures: This study was funded by Novartis Healthcare Pvt. Ltd. Several authors declared being employees of and holding stocks or stock options in Novartis.

Source: Mahon R et al. Comparative effectiveness of erenumab versus rimegepant for migraine prevention using matching-adjusted indirect comparison. J Comp Eff Res. 2024 (Jan 4). doi: 10.57264/cer-2023-0122

Key clinical point: Erenumab demonstrated a more favorable efficacy profile than rimegepant for the prevention of episodic and chronic migraine.

Major finding: Compared with 75 mg rimegepant, 70 mg erenumab significantly reduced monthly migraine days (MMD) by 0.90 days at 3 months (P = .042) and 140 mg erenumab significantly reduced MMD by 0.94 (P = .014) and 1.28 (P = .005) days at 1 month and 3 months, respectively. Erenumab showed advantages over rimegepant in improving Migraine-Specific Quality-of-life role function-restrictive domain and Migraine Disability Assessment scores (MIDAS) at 3 months.

Study details: This study performed anchored matching-adjusted indirect comparison of the relative efficacy of two erenumab regimens (70 mg and 140 mg) with rimegepant (75 mg) for migraine prevention using data from two phase 2/3 trials for erenumab (295 and STRIVE) and a phase 2/3 trial for rimegepant.

Disclosures: This study was funded by Novartis Healthcare Pvt. Ltd. Several authors declared being employees of and holding stocks or stock options in Novartis.

Source: Mahon R et al. Comparative effectiveness of erenumab versus rimegepant for migraine prevention using matching-adjusted indirect comparison. J Comp Eff Res. 2024 (Jan 4). doi: 10.57264/cer-2023-0122

Key clinical point: Erenumab demonstrated a more favorable efficacy profile than rimegepant for the prevention of episodic and chronic migraine.

Major finding: Compared with 75 mg rimegepant, 70 mg erenumab significantly reduced monthly migraine days (MMD) by 0.90 days at 3 months (P = .042) and 140 mg erenumab significantly reduced MMD by 0.94 (P = .014) and 1.28 (P = .005) days at 1 month and 3 months, respectively. Erenumab showed advantages over rimegepant in improving Migraine-Specific Quality-of-life role function-restrictive domain and Migraine Disability Assessment scores (MIDAS) at 3 months.

Study details: This study performed anchored matching-adjusted indirect comparison of the relative efficacy of two erenumab regimens (70 mg and 140 mg) with rimegepant (75 mg) for migraine prevention using data from two phase 2/3 trials for erenumab (295 and STRIVE) and a phase 2/3 trial for rimegepant.

Disclosures: This study was funded by Novartis Healthcare Pvt. Ltd. Several authors declared being employees of and holding stocks or stock options in Novartis.

Source: Mahon R et al. Comparative effectiveness of erenumab versus rimegepant for migraine prevention using matching-adjusted indirect comparison. J Comp Eff Res. 2024 (Jan 4). doi: 10.57264/cer-2023-0122

Key clinical point: Monoclonal antibodies targeting the anti-calcitonin gene-related peptide (CGRP) showed persistent and comparable outcomes within a real-world cohort of patients with migraine leading to a reduction in migraine days per month (MDM) among responders with large effect sizes; however, the response was influenced by genetic factors.

Major finding: Patients responding to anti-CGRP monoclonal antibodies demonstrated persistent reduction in MDM (usually ≥50% reduction from baseline) at first (η² = 0.26) and second (η² = 0.22) follow-up, with all treatments showing similar effects and large effect sizes. Non-responders vs responders had a lower mean genetic risk score (P = .041) without any difference in polygenic risk score.

Study details: This retrospective clinical and genetic study included 481 patients with migraine who were prescribed preventive erenumab (n = 166), galcanezumab (n = 164), or fremanezumab (n = 151).

Disclosures: This study was funded by the US Agency for Healthcare Research and Quality. S Meyers declared serving on the speakers’ bureau for Biohaven Pharmaceuticals and Allergan.

Source: Chase BA et al. Characteristics associated with response to subcutaneously administered anti-CGRP monoclonal antibody medications in a real-world community cohort of persons living with migraine: A retrospective clinical and genetic study. Headache. 2023 (Dec 10). doi:

Key clinical point: Monoclonal antibodies targeting the anti-calcitonin gene-related peptide (CGRP) showed persistent and comparable outcomes within a real-world cohort of patients with migraine leading to a reduction in migraine days per month (MDM) among responders with large effect sizes; however, the response was influenced by genetic factors.

Major finding: Patients responding to anti-CGRP monoclonal antibodies demonstrated persistent reduction in MDM (usually ≥50% reduction from baseline) at first (η² = 0.26) and second (η² = 0.22) follow-up, with all treatments showing similar effects and large effect sizes. Non-responders vs responders had a lower mean genetic risk score (P = .041) without any difference in polygenic risk score.

Study details: This retrospective clinical and genetic study included 481 patients with migraine who were prescribed preventive erenumab (n = 166), galcanezumab (n = 164), or fremanezumab (n = 151).

Disclosures: This study was funded by the US Agency for Healthcare Research and Quality. S Meyers declared serving on the speakers’ bureau for Biohaven Pharmaceuticals and Allergan.

Source: Chase BA et al. Characteristics associated with response to subcutaneously administered anti-CGRP monoclonal antibody medications in a real-world community cohort of persons living with migraine: A retrospective clinical and genetic study. Headache. 2023 (Dec 10). doi:

Key clinical point: Monoclonal antibodies targeting the anti-calcitonin gene-related peptide (CGRP) showed persistent and comparable outcomes within a real-world cohort of patients with migraine leading to a reduction in migraine days per month (MDM) among responders with large effect sizes; however, the response was influenced by genetic factors.

Major finding: Patients responding to anti-CGRP monoclonal antibodies demonstrated persistent reduction in MDM (usually ≥50% reduction from baseline) at first (η² = 0.26) and second (η² = 0.22) follow-up, with all treatments showing similar effects and large effect sizes. Non-responders vs responders had a lower mean genetic risk score (P = .041) without any difference in polygenic risk score.

Study details: This retrospective clinical and genetic study included 481 patients with migraine who were prescribed preventive erenumab (n = 166), galcanezumab (n = 164), or fremanezumab (n = 151).

Disclosures: This study was funded by the US Agency for Healthcare Research and Quality. S Meyers declared serving on the speakers’ bureau for Biohaven Pharmaceuticals and Allergan.

Source: Chase BA et al. Characteristics associated with response to subcutaneously administered anti-CGRP monoclonal antibody medications in a real-world community cohort of persons living with migraine: A retrospective clinical and genetic study. Headache. 2023 (Dec 10). doi: