Headache & Migraine

Key clinical point: A history of migraine was significantly associated with an increased risk for cervical artery dissection (CeAD), with the risk being predominantly driven by migraine without aura.

Major finding: The risk for CeAD was 1.74-fold higher in patients with vs without migraine (adjusted odds ratio [aOR] 1.74; 95% CI 1.38-2.19), with the risk being pronounced in migraine without aura (aOR 1.86; 95% CI 1.55-2.24) but not in migraine with aura (aOR 1.15; 95% CI 0.71-1.88).

Study details: This meta-analysis included 11 case-control studies with 2188 CeAD cases and 7669 control participants.

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

Source: Sun Z et al. Migraine and the risk of cervical artery dissection: A systematic review and meta-analysis. Eur Stroke J. 2023 (Aug 9). doi: 10.1177/23969873231191860

Key clinical point: A history of migraine was significantly associated with an increased risk for cervical artery dissection (CeAD), with the risk being predominantly driven by migraine without aura.

Major finding: The risk for CeAD was 1.74-fold higher in patients with vs without migraine (adjusted odds ratio [aOR] 1.74; 95% CI 1.38-2.19), with the risk being pronounced in migraine without aura (aOR 1.86; 95% CI 1.55-2.24) but not in migraine with aura (aOR 1.15; 95% CI 0.71-1.88).

Study details: This meta-analysis included 11 case-control studies with 2188 CeAD cases and 7669 control participants.

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

Source: Sun Z et al. Migraine and the risk of cervical artery dissection: A systematic review and meta-analysis. Eur Stroke J. 2023 (Aug 9). doi: 10.1177/23969873231191860

Key clinical point: A history of migraine was significantly associated with an increased risk for cervical artery dissection (CeAD), with the risk being predominantly driven by migraine without aura.

Major finding: The risk for CeAD was 1.74-fold higher in patients with vs without migraine (adjusted odds ratio [aOR] 1.74; 95% CI 1.38-2.19), with the risk being pronounced in migraine without aura (aOR 1.86; 95% CI 1.55-2.24) but not in migraine with aura (aOR 1.15; 95% CI 0.71-1.88).

Study details: This meta-analysis included 11 case-control studies with 2188 CeAD cases and 7669 control participants.

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

Source: Sun Z et al. Migraine and the risk of cervical artery dissection: A systematic review and meta-analysis. Eur Stroke J. 2023 (Aug 9). doi: 10.1177/23969873231191860

Key clinical point: Early wearing-off effect (WOE) is common in patients with chronic migraine (CM) receiving onabotulinumtoxinA (OnabotA) and more frequent after the first cycle of OnabotA, with depression and anxiety disorders being clinical predictors of the WOE.

Major finding: Early WOE was reported more frequently after the first vs second treatment cycle of OnabotA (35.6% vs 23.8% of patients), with depression and anxiety disorders being significant clinical predictors of WOE (odds ratio 3.4; 95% CI 1.22-10.84; P = .028).

Study details: Findings are from a prospective real-life study including 59 patients with CM and insufficient response, absence of tolerability, or contraindications to previous migraine therapies who initiated prophylactic treatment with OnabotA, 40.6% of whom reported a WOE.

Disclosures: This study received no external funding. The authors declared no conflicts of interest.

Source: Rodríguez-Montolio J et al. Early wearing-off effect of OnabotulinumtoxinA in chronic migraine: A prospective real-life study. J Clin Med. 2023;12(16):5360 (Aug 17). doi: 10.3390/jcm12165360

Key clinical point: Early wearing-off effect (WOE) is common in patients with chronic migraine (CM) receiving onabotulinumtoxinA (OnabotA) and more frequent after the first cycle of OnabotA, with depression and anxiety disorders being clinical predictors of the WOE.

Major finding: Early WOE was reported more frequently after the first vs second treatment cycle of OnabotA (35.6% vs 23.8% of patients), with depression and anxiety disorders being significant clinical predictors of WOE (odds ratio 3.4; 95% CI 1.22-10.84; P = .028).

Study details: Findings are from a prospective real-life study including 59 patients with CM and insufficient response, absence of tolerability, or contraindications to previous migraine therapies who initiated prophylactic treatment with OnabotA, 40.6% of whom reported a WOE.

Disclosures: This study received no external funding. The authors declared no conflicts of interest.

Source: Rodríguez-Montolio J et al. Early wearing-off effect of OnabotulinumtoxinA in chronic migraine: A prospective real-life study. J Clin Med. 2023;12(16):5360 (Aug 17). doi: 10.3390/jcm12165360

Key clinical point: Early wearing-off effect (WOE) is common in patients with chronic migraine (CM) receiving onabotulinumtoxinA (OnabotA) and more frequent after the first cycle of OnabotA, with depression and anxiety disorders being clinical predictors of the WOE.

Major finding: Early WOE was reported more frequently after the first vs second treatment cycle of OnabotA (35.6% vs 23.8% of patients), with depression and anxiety disorders being significant clinical predictors of WOE (odds ratio 3.4; 95% CI 1.22-10.84; P = .028).

Study details: Findings are from a prospective real-life study including 59 patients with CM and insufficient response, absence of tolerability, or contraindications to previous migraine therapies who initiated prophylactic treatment with OnabotA, 40.6% of whom reported a WOE.

Disclosures: This study received no external funding. The authors declared no conflicts of interest.

Source: Rodríguez-Montolio J et al. Early wearing-off effect of OnabotulinumtoxinA in chronic migraine: A prospective real-life study. J Clin Med. 2023;12(16):5360 (Aug 17). doi: 10.3390/jcm12165360

Key clinical point: Ubrogepant shows similar efficacy and no new safety concerns for the treatment of perimenstrual migraine (pmM) and non-pmM attacks.

Major finding: At 2 hours post dose, pain freedom (P = .054) and pain relief (P = .683) were similar between pmM and non-pmM attacks treated with 50 mg ubrogepant. Absence of migraine-associated symptoms (photophobia and phonophobia) and functional disability was not significantly different between pmM and non-pmM attacks treated with 50 mg ubrogepant, with similar findings observed for 100 mg ubrogepant. Nausea and dizziness were reported in < 6% of participants overall in both the 50 mg and 100 mg ubrogepant groups.

Study details: This post hoc analysis of a long-term safety extension trial included 734 women with migraine, of whom 278 and 716 were treated with ubrogepant (50 mg or 100 mg) for ≥ 1 pmM and non-pmM attacks, respectively.

Disclosures: This study was funded by Allergan (prior to its acquisition by AbbVie). Four authors declared being employees of or holding stocks in AbbVie, and the other authors declared ties with various sources, including AbbVie.

Source: MacGregor EA et al. Safety and efficacy of ubrogepant for the acute treatment of perimenstrual migraine attacks: A post hoc analysis. Headache. 2023 (Sep 1). doi: 10.1111/head.14619

Key clinical point: Ubrogepant shows similar efficacy and no new safety concerns for the treatment of perimenstrual migraine (pmM) and non-pmM attacks.

Major finding: At 2 hours post dose, pain freedom (P = .054) and pain relief (P = .683) were similar between pmM and non-pmM attacks treated with 50 mg ubrogepant. Absence of migraine-associated symptoms (photophobia and phonophobia) and functional disability was not significantly different between pmM and non-pmM attacks treated with 50 mg ubrogepant, with similar findings observed for 100 mg ubrogepant. Nausea and dizziness were reported in < 6% of participants overall in both the 50 mg and 100 mg ubrogepant groups.

Study details: This post hoc analysis of a long-term safety extension trial included 734 women with migraine, of whom 278 and 716 were treated with ubrogepant (50 mg or 100 mg) for ≥ 1 pmM and non-pmM attacks, respectively.

Disclosures: This study was funded by Allergan (prior to its acquisition by AbbVie). Four authors declared being employees of or holding stocks in AbbVie, and the other authors declared ties with various sources, including AbbVie.

Source: MacGregor EA et al. Safety and efficacy of ubrogepant for the acute treatment of perimenstrual migraine attacks: A post hoc analysis. Headache. 2023 (Sep 1). doi: 10.1111/head.14619

Key clinical point: Ubrogepant shows similar efficacy and no new safety concerns for the treatment of perimenstrual migraine (pmM) and non-pmM attacks.

Major finding: At 2 hours post dose, pain freedom (P = .054) and pain relief (P = .683) were similar between pmM and non-pmM attacks treated with 50 mg ubrogepant. Absence of migraine-associated symptoms (photophobia and phonophobia) and functional disability was not significantly different between pmM and non-pmM attacks treated with 50 mg ubrogepant, with similar findings observed for 100 mg ubrogepant. Nausea and dizziness were reported in < 6% of participants overall in both the 50 mg and 100 mg ubrogepant groups.

Study details: This post hoc analysis of a long-term safety extension trial included 734 women with migraine, of whom 278 and 716 were treated with ubrogepant (50 mg or 100 mg) for ≥ 1 pmM and non-pmM attacks, respectively.

Disclosures: This study was funded by Allergan (prior to its acquisition by AbbVie). Four authors declared being employees of or holding stocks in AbbVie, and the other authors declared ties with various sources, including AbbVie.

Source: MacGregor EA et al. Safety and efficacy of ubrogepant for the acute treatment of perimenstrual migraine attacks: A post hoc analysis. Headache. 2023 (Sep 1). doi: 10.1111/head.14619

Key clinical point: In patients with migraine, COVID-19 vaccination worsened the overall migraine symptoms in the first month post-vaccination; however, COVID-19 infection solely increased the number of acute medication intake days in the first month following infection.

Major finding: COVID-19 vaccination led to a significant increase in the number of monthly migraine days (MMD), monthly headache days (MHD), and monthly acute medication days (MAMD) by 1.06, 1.52, and 0.72, respectively (all P < .001) in the first month post-vaccination. COVID-19 infection solely increased MAMD by 1.11 (P = .027) in the first month following infection, with no significant effects on MMD and MHD.

Study details: This longitudinal cohort study identified 547 patients with migraine, of whom 147 were included in the vaccine analysis and 59 in the infection analysis.

Disclosures: This study did not receive any funding. BWH van der Arend and GM Terwindt declared receiving independent support and consultancy or industry support from various sources. The other authors declared no conflicts of interest.

Source: van der Arend BWH et al. Effect of COVID vaccination on monthly migraine days: A longitudinal cohort study. Cephalalgia. 2023;43(9) (Sep 8). doi: 10.1177/03331024231198792

Key clinical point: In patients with migraine, COVID-19 vaccination worsened the overall migraine symptoms in the first month post-vaccination; however, COVID-19 infection solely increased the number of acute medication intake days in the first month following infection.

Major finding: COVID-19 vaccination led to a significant increase in the number of monthly migraine days (MMD), monthly headache days (MHD), and monthly acute medication days (MAMD) by 1.06, 1.52, and 0.72, respectively (all P < .001) in the first month post-vaccination. COVID-19 infection solely increased MAMD by 1.11 (P = .027) in the first month following infection, with no significant effects on MMD and MHD.

Study details: This longitudinal cohort study identified 547 patients with migraine, of whom 147 were included in the vaccine analysis and 59 in the infection analysis.

Disclosures: This study did not receive any funding. BWH van der Arend and GM Terwindt declared receiving independent support and consultancy or industry support from various sources. The other authors declared no conflicts of interest.

Source: van der Arend BWH et al. Effect of COVID vaccination on monthly migraine days: A longitudinal cohort study. Cephalalgia. 2023;43(9) (Sep 8). doi: 10.1177/03331024231198792

Key clinical point: In patients with migraine, COVID-19 vaccination worsened the overall migraine symptoms in the first month post-vaccination; however, COVID-19 infection solely increased the number of acute medication intake days in the first month following infection.

Major finding: COVID-19 vaccination led to a significant increase in the number of monthly migraine days (MMD), monthly headache days (MHD), and monthly acute medication days (MAMD) by 1.06, 1.52, and 0.72, respectively (all P < .001) in the first month post-vaccination. COVID-19 infection solely increased MAMD by 1.11 (P = .027) in the first month following infection, with no significant effects on MMD and MHD.

Study details: This longitudinal cohort study identified 547 patients with migraine, of whom 147 were included in the vaccine analysis and 59 in the infection analysis.

Disclosures: This study did not receive any funding. BWH van der Arend and GM Terwindt declared receiving independent support and consultancy or industry support from various sources. The other authors declared no conflicts of interest.

Source: van der Arend BWH et al. Effect of COVID vaccination on monthly migraine days: A longitudinal cohort study. Cephalalgia. 2023;43(9) (Sep 8). doi: 10.1177/03331024231198792

Key clinical point: Pain in the lower limbs of children and adolescents, often referred to as ‘growing pain’ (GP) by pediatricians and orthopedists, can be a precursor of or a comorbidity linked to migraine.

Major finding: Overall, 76% vs 22% of children and adolescents with vs without GP experienced a primary headache disorder fulfilling the International Classification of Headache Disorders-3 diagnostic criteria for migraine (P < .001). GP persisted in 14% of patients who initially had GP and appeared in 39% of patients who were previously asymptomatic (P = .026).

Study details: This cross-sectional, prospective study included 78 children and adolescents without any headache complaints who were aged between 5 and 10 years and were born to mothers with migraine, of whom 42 experienced GP and 36 patients did not experience GP.

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

Source: Silva-Néto RP et al. “Growing pains” in children and adolescents as an early symptom of migraine: A prospective study. Headache. 2023 (Sep 6). doi: 10.1111/head.14608

Key clinical point: Pain in the lower limbs of children and adolescents, often referred to as ‘growing pain’ (GP) by pediatricians and orthopedists, can be a precursor of or a comorbidity linked to migraine.

Major finding: Overall, 76% vs 22% of children and adolescents with vs without GP experienced a primary headache disorder fulfilling the International Classification of Headache Disorders-3 diagnostic criteria for migraine (P < .001). GP persisted in 14% of patients who initially had GP and appeared in 39% of patients who were previously asymptomatic (P = .026).

Study details: This cross-sectional, prospective study included 78 children and adolescents without any headache complaints who were aged between 5 and 10 years and were born to mothers with migraine, of whom 42 experienced GP and 36 patients did not experience GP.

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

Source: Silva-Néto RP et al. “Growing pains” in children and adolescents as an early symptom of migraine: A prospective study. Headache. 2023 (Sep 6). doi: 10.1111/head.14608

Key clinical point: Pain in the lower limbs of children and adolescents, often referred to as ‘growing pain’ (GP) by pediatricians and orthopedists, can be a precursor of or a comorbidity linked to migraine.

Major finding: Overall, 76% vs 22% of children and adolescents with vs without GP experienced a primary headache disorder fulfilling the International Classification of Headache Disorders-3 diagnostic criteria for migraine (P < .001). GP persisted in 14% of patients who initially had GP and appeared in 39% of patients who were previously asymptomatic (P = .026).

Study details: This cross-sectional, prospective study included 78 children and adolescents without any headache complaints who were aged between 5 and 10 years and were born to mothers with migraine, of whom 42 experienced GP and 36 patients did not experience GP.

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

Source: Silva-Néto RP et al. “Growing pains” in children and adolescents as an early symptom of migraine: A prospective study. Headache. 2023 (Sep 6). doi: 10.1111/head.14608

The calcitonin gene-related peptide (CGRP) antagonist class of medications has changed the face of migraine treatment — and there are now both acute and preventive options that are available in oral and injectable formulations. The gepant subclass of CGRP antagonists are small-molecule medications, in contrast to the CGRP monoclonal antibodies. Atogepant was developed as the first oral migraine-specific preventive medication, and the initial trials allowed for an initial approval by the US Food and Drug Administration for episodic migraine alone. The study by Pozo-Rosich and colleagues extended the patient population to patients with chronic migraine.

This was an international, multicenter, randomized controlled study of two dosages of atogepant (30 mg twice daily and 60 mg daily) compared with placebo over 12 weeks. The primary endpoint was change in mean monthly migraine days. There was a safety population as well that received a single dose of medication. Nearly 800 participants were enrolled equally into these three groups, and the authors used a modified intention-to-treat format that included all participants with at least 1 month of e-diary data and took at least one dose of the study medication.

The baseline number of mean monthly migraine days in this chronic migraine population was 18.6 days per month. After 12 weeks, the three groups showed decreases of 7.5, 6.1, and 5.1 days per month, which was statistically significant for the two intervention groups. The most common side effects were constipation and nausea, with up to 10% of the study population experiencing some gastrointestinal symptoms. Weight loss of 7% of body weight was also noticed in the two intervention groups.

This study describes the benefit of atogepant extending beyond the indication of episodic migraine. This chronic migraine population showed significant benefit in the decrease of mean monthly migraine days per month after 12 weeks. One additional benefit is weight loss even after 12 weeks. Compared with the monoclonal antibody class of CGRP antagonist, this medication appears to be approximately equally effective, with the additional benefit of weight loss. Because many preventive medications for migraine may be associated with weight gain — particularly the antidepressant and potentially the antihypertensive classes of medications — this can be a differentiating factor when choosing an appropriate preventive medication for your patients with chronic migraine.

CGRP is a known inflammatory modulator that also plays a significant role in the propagation of migraine. CGRP blockade has been associated, in some studies, with upper respiratory tract infection symptoms, raising the question of whether blocking CGRP chronically may increase the risk for infection. A prior study revealed that CGRP levels were decreased in patients with severe COVID-19, and another study did not find significant differences in COVID-19 disease, progression, or severity among migraine patients on CGRP antagonists. Wang and colleagues specifically sought to determine any potential association or risk between the use of CGRP antagonist medications and COVID.

This retrospective cohort study was performed in the US Veterans Affairs (VA) hospital system. It analyzed the electronic medical records of veterans diagnosed with migraine between January and May 2022. The participants' exposure to CGRP medications and the 30-day odds of hospitalization, as well as use of mechanical ventilation, were calculated. CGRP prescriptions were identified using outpatient pharmacy records for erenumab, fremanezumab (225 mg/1.5 mL), and galcanezumab (120 mg/mL), which were the only CGRP medications available at that point in the VA system. The primary outcome was cumulative incidence of SARS-CoV-2 infection; occurrences of SARS-CoV-2 infection were obtained from the VA COVID-19 Shared Data Resource. Secondary analysis of the clinical outcomes was performed among patients with a positive SARS-CoV-2 test result.

This analysis revealed that CGRP monoclonal antibody use was not associated with risk for COVID-19, and among participants who tested positive for COVID-19, there were no significant differences in hospitalization, oxygen supplementation, mechanical ventilation, or COVID-19–related death between those who were receiving CGRP medications and those who were not. Although another prior study implied that CGRP blockade may decrease the risk for severe disease related to a cytokine storm, those results were only in vitro, and no results from human or animal trials have replicated these data. There is, therefore, no contraindication to using CGRP antagonist medications in people at high risk for development of COVID-19.

Many patients with migraine are recommended specific treatments for the prevention of migraine attacks and for the acute treatment of their attacks. Very few studies have investigated specific combinations of acute and preventive treatments. Although logically, there should be no contraindication to most treatment combinations, there may be some additional synergistic benefit to the combination of specific classes of medications. We have previously discussed a synergy between the CGRP antagonist class and onabotulinumtoxinA (Botox) for the prevention of chronic migraine; Manack Adams and colleagues sought to quantify the efficacy of ubrogepant when the patients were also administered botulinum toxin.

The joint American Academy of Neurology/American Headache Society consensus statement recommends starting preventive medication for anyone with migraine who experiences > 4-5 days of headache per month. It also recommends a migraine-specific acute treatment for anyone who experiences migraine attacks. Botulinum toxin is approved by the US Food and Drug Administration for the prevention of chronic migraine at a dose of 155 units injected every 3 months; ubrogepant is a CGRP oral small-molecule antagonist that is approved for the acute treatment of migraine.

This study investigated the effectiveness of ubrogepant, with a primary endpoint of meaningful pain relief and return to normal function 2 and 4 hours after an initial dose of 50 or 100 mg. Meaningful pain relief was defined as answering "yes" to a question about whether the patient experienced meaningful pain relief. This has been a pre-reported endpoint in other acute migraine treatment trials. Return to normal function was defined as the time point where the patient could perform their daily activities on the basis of a functional disability scale. Achieving normal function was classified as either remaining free of disability or by reporting functional disability before taking ubrogepant and then indicating a return to normal function at 2 and 4 hours post-dose.

A total of 134 patients were enrolled, taking both ubrogepant and botulinum toxin; patients were included if they were treated with ubrogepant at least once. Meaningful pain relief was achieved in 53.3% of patients at 2 hours and in 76.2% of patients at 4 hours post-dose. Return to normal function was achieved by 30.1% of patients at 2 hours and by 52.1% of patients at 4 hours post-dose. Both meaningful pain relief and return to normal function were seen to be statistically significant and stable across up to 10 attacks per person.

Headache treatment providers typically need to consider different classes of medications for prevention and acute treatment. A growing body of evidence describes a synergy between the CGRP class of medications and botulinum toxin. This appears to be true both when CGRP antagonists are used preventively and, in this case, when they are used for acute events. This certainly would be a safe and effective choice in many instances for many patients.

The calcitonin gene-related peptide (CGRP) antagonist class of medications has changed the face of migraine treatment — and there are now both acute and preventive options that are available in oral and injectable formulations. The gepant subclass of CGRP antagonists are small-molecule medications, in contrast to the CGRP monoclonal antibodies. Atogepant was developed as the first oral migraine-specific preventive medication, and the initial trials allowed for an initial approval by the US Food and Drug Administration for episodic migraine alone. The study by Pozo-Rosich and colleagues extended the patient population to patients with chronic migraine.

This was an international, multicenter, randomized controlled study of two dosages of atogepant (30 mg twice daily and 60 mg daily) compared with placebo over 12 weeks. The primary endpoint was change in mean monthly migraine days. There was a safety population as well that received a single dose of medication. Nearly 800 participants were enrolled equally into these three groups, and the authors used a modified intention-to-treat format that included all participants with at least 1 month of e-diary data and took at least one dose of the study medication.

The baseline number of mean monthly migraine days in this chronic migraine population was 18.6 days per month. After 12 weeks, the three groups showed decreases of 7.5, 6.1, and 5.1 days per month, which was statistically significant for the two intervention groups. The most common side effects were constipation and nausea, with up to 10% of the study population experiencing some gastrointestinal symptoms. Weight loss of 7% of body weight was also noticed in the two intervention groups.

This study describes the benefit of atogepant extending beyond the indication of episodic migraine. This chronic migraine population showed significant benefit in the decrease of mean monthly migraine days per month after 12 weeks. One additional benefit is weight loss even after 12 weeks. Compared with the monoclonal antibody class of CGRP antagonist, this medication appears to be approximately equally effective, with the additional benefit of weight loss. Because many preventive medications for migraine may be associated with weight gain — particularly the antidepressant and potentially the antihypertensive classes of medications — this can be a differentiating factor when choosing an appropriate preventive medication for your patients with chronic migraine.

CGRP is a known inflammatory modulator that also plays a significant role in the propagation of migraine. CGRP blockade has been associated, in some studies, with upper respiratory tract infection symptoms, raising the question of whether blocking CGRP chronically may increase the risk for infection. A prior study revealed that CGRP levels were decreased in patients with severe COVID-19, and another study did not find significant differences in COVID-19 disease, progression, or severity among migraine patients on CGRP antagonists. Wang and colleagues specifically sought to determine any potential association or risk between the use of CGRP antagonist medications and COVID.

This retrospective cohort study was performed in the US Veterans Affairs (VA) hospital system. It analyzed the electronic medical records of veterans diagnosed with migraine between January and May 2022. The participants' exposure to CGRP medications and the 30-day odds of hospitalization, as well as use of mechanical ventilation, were calculated. CGRP prescriptions were identified using outpatient pharmacy records for erenumab, fremanezumab (225 mg/1.5 mL), and galcanezumab (120 mg/mL), which were the only CGRP medications available at that point in the VA system. The primary outcome was cumulative incidence of SARS-CoV-2 infection; occurrences of SARS-CoV-2 infection were obtained from the VA COVID-19 Shared Data Resource. Secondary analysis of the clinical outcomes was performed among patients with a positive SARS-CoV-2 test result.

This analysis revealed that CGRP monoclonal antibody use was not associated with risk for COVID-19, and among participants who tested positive for COVID-19, there were no significant differences in hospitalization, oxygen supplementation, mechanical ventilation, or COVID-19–related death between those who were receiving CGRP medications and those who were not. Although another prior study implied that CGRP blockade may decrease the risk for severe disease related to a cytokine storm, those results were only in vitro, and no results from human or animal trials have replicated these data. There is, therefore, no contraindication to using CGRP antagonist medications in people at high risk for development of COVID-19.

Many patients with migraine are recommended specific treatments for the prevention of migraine attacks and for the acute treatment of their attacks. Very few studies have investigated specific combinations of acute and preventive treatments. Although logically, there should be no contraindication to most treatment combinations, there may be some additional synergistic benefit to the combination of specific classes of medications. We have previously discussed a synergy between the CGRP antagonist class and onabotulinumtoxinA (Botox) for the prevention of chronic migraine; Manack Adams and colleagues sought to quantify the efficacy of ubrogepant when the patients were also administered botulinum toxin.

The joint American Academy of Neurology/American Headache Society consensus statement recommends starting preventive medication for anyone with migraine who experiences > 4-5 days of headache per month. It also recommends a migraine-specific acute treatment for anyone who experiences migraine attacks. Botulinum toxin is approved by the US Food and Drug Administration for the prevention of chronic migraine at a dose of 155 units injected every 3 months; ubrogepant is a CGRP oral small-molecule antagonist that is approved for the acute treatment of migraine.

This study investigated the effectiveness of ubrogepant, with a primary endpoint of meaningful pain relief and return to normal function 2 and 4 hours after an initial dose of 50 or 100 mg. Meaningful pain relief was defined as answering "yes" to a question about whether the patient experienced meaningful pain relief. This has been a pre-reported endpoint in other acute migraine treatment trials. Return to normal function was defined as the time point where the patient could perform their daily activities on the basis of a functional disability scale. Achieving normal function was classified as either remaining free of disability or by reporting functional disability before taking ubrogepant and then indicating a return to normal function at 2 and 4 hours post-dose.

A total of 134 patients were enrolled, taking both ubrogepant and botulinum toxin; patients were included if they were treated with ubrogepant at least once. Meaningful pain relief was achieved in 53.3% of patients at 2 hours and in 76.2% of patients at 4 hours post-dose. Return to normal function was achieved by 30.1% of patients at 2 hours and by 52.1% of patients at 4 hours post-dose. Both meaningful pain relief and return to normal function were seen to be statistically significant and stable across up to 10 attacks per person.

Headache treatment providers typically need to consider different classes of medications for prevention and acute treatment. A growing body of evidence describes a synergy between the CGRP class of medications and botulinum toxin. This appears to be true both when CGRP antagonists are used preventively and, in this case, when they are used for acute events. This certainly would be a safe and effective choice in many instances for many patients.

The calcitonin gene-related peptide (CGRP) antagonist class of medications has changed the face of migraine treatment — and there are now both acute and preventive options that are available in oral and injectable formulations. The gepant subclass of CGRP antagonists are small-molecule medications, in contrast to the CGRP monoclonal antibodies. Atogepant was developed as the first oral migraine-specific preventive medication, and the initial trials allowed for an initial approval by the US Food and Drug Administration for episodic migraine alone. The study by Pozo-Rosich and colleagues extended the patient population to patients with chronic migraine.

This was an international, multicenter, randomized controlled study of two dosages of atogepant (30 mg twice daily and 60 mg daily) compared with placebo over 12 weeks. The primary endpoint was change in mean monthly migraine days. There was a safety population as well that received a single dose of medication. Nearly 800 participants were enrolled equally into these three groups, and the authors used a modified intention-to-treat format that included all participants with at least 1 month of e-diary data and took at least one dose of the study medication.

The baseline number of mean monthly migraine days in this chronic migraine population was 18.6 days per month. After 12 weeks, the three groups showed decreases of 7.5, 6.1, and 5.1 days per month, which was statistically significant for the two intervention groups. The most common side effects were constipation and nausea, with up to 10% of the study population experiencing some gastrointestinal symptoms. Weight loss of 7% of body weight was also noticed in the two intervention groups.

This study describes the benefit of atogepant extending beyond the indication of episodic migraine. This chronic migraine population showed significant benefit in the decrease of mean monthly migraine days per month after 12 weeks. One additional benefit is weight loss even after 12 weeks. Compared with the monoclonal antibody class of CGRP antagonist, this medication appears to be approximately equally effective, with the additional benefit of weight loss. Because many preventive medications for migraine may be associated with weight gain — particularly the antidepressant and potentially the antihypertensive classes of medications — this can be a differentiating factor when choosing an appropriate preventive medication for your patients with chronic migraine.

CGRP is a known inflammatory modulator that also plays a significant role in the propagation of migraine. CGRP blockade has been associated, in some studies, with upper respiratory tract infection symptoms, raising the question of whether blocking CGRP chronically may increase the risk for infection. A prior study revealed that CGRP levels were decreased in patients with severe COVID-19, and another study did not find significant differences in COVID-19 disease, progression, or severity among migraine patients on CGRP antagonists. Wang and colleagues specifically sought to determine any potential association or risk between the use of CGRP antagonist medications and COVID.

This retrospective cohort study was performed in the US Veterans Affairs (VA) hospital system. It analyzed the electronic medical records of veterans diagnosed with migraine between January and May 2022. The participants' exposure to CGRP medications and the 30-day odds of hospitalization, as well as use of mechanical ventilation, were calculated. CGRP prescriptions were identified using outpatient pharmacy records for erenumab, fremanezumab (225 mg/1.5 mL), and galcanezumab (120 mg/mL), which were the only CGRP medications available at that point in the VA system. The primary outcome was cumulative incidence of SARS-CoV-2 infection; occurrences of SARS-CoV-2 infection were obtained from the VA COVID-19 Shared Data Resource. Secondary analysis of the clinical outcomes was performed among patients with a positive SARS-CoV-2 test result.

This analysis revealed that CGRP monoclonal antibody use was not associated with risk for COVID-19, and among participants who tested positive for COVID-19, there were no significant differences in hospitalization, oxygen supplementation, mechanical ventilation, or COVID-19–related death between those who were receiving CGRP medications and those who were not. Although another prior study implied that CGRP blockade may decrease the risk for severe disease related to a cytokine storm, those results were only in vitro, and no results from human or animal trials have replicated these data. There is, therefore, no contraindication to using CGRP antagonist medications in people at high risk for development of COVID-19.

Many patients with migraine are recommended specific treatments for the prevention of migraine attacks and for the acute treatment of their attacks. Very few studies have investigated specific combinations of acute and preventive treatments. Although logically, there should be no contraindication to most treatment combinations, there may be some additional synergistic benefit to the combination of specific classes of medications. We have previously discussed a synergy between the CGRP antagonist class and onabotulinumtoxinA (Botox) for the prevention of chronic migraine; Manack Adams and colleagues sought to quantify the efficacy of ubrogepant when the patients were also administered botulinum toxin.

The joint American Academy of Neurology/American Headache Society consensus statement recommends starting preventive medication for anyone with migraine who experiences > 4-5 days of headache per month. It also recommends a migraine-specific acute treatment for anyone who experiences migraine attacks. Botulinum toxin is approved by the US Food and Drug Administration for the prevention of chronic migraine at a dose of 155 units injected every 3 months; ubrogepant is a CGRP oral small-molecule antagonist that is approved for the acute treatment of migraine.

This study investigated the effectiveness of ubrogepant, with a primary endpoint of meaningful pain relief and return to normal function 2 and 4 hours after an initial dose of 50 or 100 mg. Meaningful pain relief was defined as answering "yes" to a question about whether the patient experienced meaningful pain relief. This has been a pre-reported endpoint in other acute migraine treatment trials. Return to normal function was defined as the time point where the patient could perform their daily activities on the basis of a functional disability scale. Achieving normal function was classified as either remaining free of disability or by reporting functional disability before taking ubrogepant and then indicating a return to normal function at 2 and 4 hours post-dose.

A total of 134 patients were enrolled, taking both ubrogepant and botulinum toxin; patients were included if they were treated with ubrogepant at least once. Meaningful pain relief was achieved in 53.3% of patients at 2 hours and in 76.2% of patients at 4 hours post-dose. Return to normal function was achieved by 30.1% of patients at 2 hours and by 52.1% of patients at 4 hours post-dose. Both meaningful pain relief and return to normal function were seen to be statistically significant and stable across up to 10 attacks per person.

Headache treatment providers typically need to consider different classes of medications for prevention and acute treatment. A growing body of evidence describes a synergy between the CGRP class of medications and botulinum toxin. This appears to be true both when CGRP antagonists are used preventively and, in this case, when they are used for acute events. This certainly would be a safe and effective choice in many instances for many patients.

Intense throbbing, sensitivity to light and sound, nausea: These were the symptoms Nathan Solomon experienced during his first-ever migraine about a month after receiving a diagnosis of long COVID.

“I’ve also noticed visual disturbances, like flickering lights or blurred vision, which I later learned are called auras,” the 30-year-old medical billing specialist in Seattle told this news organization.

Mr. Solomon isn’t alone. It’s estimated that 1 out of 8 people with COVID develop long COVID. Of those persons, 44% also experience headaches. Research has found that many of those headaches are migraines – and many patients who are afflicted say they had never had a migraine before. These migraines tend to persist for at least 5 or 6 months, according to data from the American Headache Society.

What’s more, other patients may suddenly have more frequent or intense versions of headaches they’ve not noticed before.

The mechanism as to how long COVID could manifest migraines is not yet fully understood, but many doctors believe that inflammation caused by the virus plays a key role.

“To understand why some patients have migraine in long COVID, we have to go back to understand the role of inflammation in COVID-19 itself,” says Emad Estemalik, MD, clinical assistant professor of neurology at Cleveland Clinic Lerner College of Medicine and section head of headache medicine at Cleveland Clinic.

In COVID-19, inflammation occurs because of a cytokine storm. Cytokines, which are proteins essential for a strong immune system, can be overproduced in a patient with COVID, which causes too much inflammation in any organ in the body, including the brain. This can result in new daily headache for some patients.

A new study from Italian researchers found that many patients who develop migraines for the first time while ill with long COVID are middle-aged women (traditionally a late point in life for a first migraine) who have a family history of migraine. Potential causes could have to do with the immune system remaining persistently activated from inflammation during long COVID, as well as the activation of the trigeminovascular system in the brain, which contains neurons that can trigger a migraine.

What treatments can work for migraines related to long COVID?

Long COVID usually causes a constellation of other symptoms at the same time as migraine.

“It’s so important for patients to take an interdisciplinary approach,” Dr. Estemalik stresses. “Patients should make sure their doctors are addressing all of their symptoms.”

When it comes to specifically targeting migraines, standard treatments can be effective.

“In terms of treating migraine in long COVID patients, we don’t do anything different or special,” says Matthew E. Fink, MD, chair of neurology at Weill Cornell Medical College and chief of the Division of Stroke and Critical Care Neurology at New York–Presbyterian Hospital/Weill Cornell Medical Center. “We treat these patients with standard migraine medications.”

Mr. Solomon is following this course of action.

“My doctor prescribed triptans, which have been somewhat effective in reducing the severity and duration of the migraines,” he says. A daily supplement of magnesium and a daily dose of aspirin can also work for some patients, according to Dr. Fink.

Lifestyle modification is also a great idea.

“Patients should keep regular sleep hours, getting up and going to bed at the same time every day,” Dr. Fink continues. “Daily exercise is also recommended.”

Mr. Solomon suggests tracking migraine triggers and patterns in a journal.

“Try to identify lifestyle changes that help, like managing stress and staying hydrated,” Mr. Solomon advises. “Seeking support from health care professionals and support groups can make a significant difference.”

The best news of all: for patients that are diligent in following these strategies, they’ve been proven to work.

“We doctors are very optimistic when it comes to good outcomes for patients with long COVID and migraine,” Dr. Fink says. “I reassure my patients by telling them, ‘You will get better long-term.’ ”

A version of this article appeared on Medscape.com.

Intense throbbing, sensitivity to light and sound, nausea: These were the symptoms Nathan Solomon experienced during his first-ever migraine about a month after receiving a diagnosis of long COVID.

“I’ve also noticed visual disturbances, like flickering lights or blurred vision, which I later learned are called auras,” the 30-year-old medical billing specialist in Seattle told this news organization.

Mr. Solomon isn’t alone. It’s estimated that 1 out of 8 people with COVID develop long COVID. Of those persons, 44% also experience headaches. Research has found that many of those headaches are migraines – and many patients who are afflicted say they had never had a migraine before. These migraines tend to persist for at least 5 or 6 months, according to data from the American Headache Society.

What’s more, other patients may suddenly have more frequent or intense versions of headaches they’ve not noticed before.

The mechanism as to how long COVID could manifest migraines is not yet fully understood, but many doctors believe that inflammation caused by the virus plays a key role.

“To understand why some patients have migraine in long COVID, we have to go back to understand the role of inflammation in COVID-19 itself,” says Emad Estemalik, MD, clinical assistant professor of neurology at Cleveland Clinic Lerner College of Medicine and section head of headache medicine at Cleveland Clinic.

In COVID-19, inflammation occurs because of a cytokine storm. Cytokines, which are proteins essential for a strong immune system, can be overproduced in a patient with COVID, which causes too much inflammation in any organ in the body, including the brain. This can result in new daily headache for some patients.

A new study from Italian researchers found that many patients who develop migraines for the first time while ill with long COVID are middle-aged women (traditionally a late point in life for a first migraine) who have a family history of migraine. Potential causes could have to do with the immune system remaining persistently activated from inflammation during long COVID, as well as the activation of the trigeminovascular system in the brain, which contains neurons that can trigger a migraine.

What treatments can work for migraines related to long COVID?

Long COVID usually causes a constellation of other symptoms at the same time as migraine.

“It’s so important for patients to take an interdisciplinary approach,” Dr. Estemalik stresses. “Patients should make sure their doctors are addressing all of their symptoms.”

When it comes to specifically targeting migraines, standard treatments can be effective.

“In terms of treating migraine in long COVID patients, we don’t do anything different or special,” says Matthew E. Fink, MD, chair of neurology at Weill Cornell Medical College and chief of the Division of Stroke and Critical Care Neurology at New York–Presbyterian Hospital/Weill Cornell Medical Center. “We treat these patients with standard migraine medications.”

Mr. Solomon is following this course of action.

“My doctor prescribed triptans, which have been somewhat effective in reducing the severity and duration of the migraines,” he says. A daily supplement of magnesium and a daily dose of aspirin can also work for some patients, according to Dr. Fink.

Lifestyle modification is also a great idea.

“Patients should keep regular sleep hours, getting up and going to bed at the same time every day,” Dr. Fink continues. “Daily exercise is also recommended.”

Mr. Solomon suggests tracking migraine triggers and patterns in a journal.

“Try to identify lifestyle changes that help, like managing stress and staying hydrated,” Mr. Solomon advises. “Seeking support from health care professionals and support groups can make a significant difference.”

The best news of all: for patients that are diligent in following these strategies, they’ve been proven to work.

“We doctors are very optimistic when it comes to good outcomes for patients with long COVID and migraine,” Dr. Fink says. “I reassure my patients by telling them, ‘You will get better long-term.’ ”

A version of this article appeared on Medscape.com.

Intense throbbing, sensitivity to light and sound, nausea: These were the symptoms Nathan Solomon experienced during his first-ever migraine about a month after receiving a diagnosis of long COVID.

“I’ve also noticed visual disturbances, like flickering lights or blurred vision, which I later learned are called auras,” the 30-year-old medical billing specialist in Seattle told this news organization.

Mr. Solomon isn’t alone. It’s estimated that 1 out of 8 people with COVID develop long COVID. Of those persons, 44% also experience headaches. Research has found that many of those headaches are migraines – and many patients who are afflicted say they had never had a migraine before. These migraines tend to persist for at least 5 or 6 months, according to data from the American Headache Society.

What’s more, other patients may suddenly have more frequent or intense versions of headaches they’ve not noticed before.

The mechanism as to how long COVID could manifest migraines is not yet fully understood, but many doctors believe that inflammation caused by the virus plays a key role.

“To understand why some patients have migraine in long COVID, we have to go back to understand the role of inflammation in COVID-19 itself,” says Emad Estemalik, MD, clinical assistant professor of neurology at Cleveland Clinic Lerner College of Medicine and section head of headache medicine at Cleveland Clinic.

In COVID-19, inflammation occurs because of a cytokine storm. Cytokines, which are proteins essential for a strong immune system, can be overproduced in a patient with COVID, which causes too much inflammation in any organ in the body, including the brain. This can result in new daily headache for some patients.

A new study from Italian researchers found that many patients who develop migraines for the first time while ill with long COVID are middle-aged women (traditionally a late point in life for a first migraine) who have a family history of migraine. Potential causes could have to do with the immune system remaining persistently activated from inflammation during long COVID, as well as the activation of the trigeminovascular system in the brain, which contains neurons that can trigger a migraine.

What treatments can work for migraines related to long COVID?

Long COVID usually causes a constellation of other symptoms at the same time as migraine.

“It’s so important for patients to take an interdisciplinary approach,” Dr. Estemalik stresses. “Patients should make sure their doctors are addressing all of their symptoms.”

When it comes to specifically targeting migraines, standard treatments can be effective.

“In terms of treating migraine in long COVID patients, we don’t do anything different or special,” says Matthew E. Fink, MD, chair of neurology at Weill Cornell Medical College and chief of the Division of Stroke and Critical Care Neurology at New York–Presbyterian Hospital/Weill Cornell Medical Center. “We treat these patients with standard migraine medications.”

Mr. Solomon is following this course of action.

“My doctor prescribed triptans, which have been somewhat effective in reducing the severity and duration of the migraines,” he says. A daily supplement of magnesium and a daily dose of aspirin can also work for some patients, according to Dr. Fink.

Lifestyle modification is also a great idea.

“Patients should keep regular sleep hours, getting up and going to bed at the same time every day,” Dr. Fink continues. “Daily exercise is also recommended.”

Mr. Solomon suggests tracking migraine triggers and patterns in a journal.

“Try to identify lifestyle changes that help, like managing stress and staying hydrated,” Mr. Solomon advises. “Seeking support from health care professionals and support groups can make a significant difference.”

The best news of all: for patients that are diligent in following these strategies, they’ve been proven to work.

“We doctors are very optimistic when it comes to good outcomes for patients with long COVID and migraine,” Dr. Fink says. “I reassure my patients by telling them, ‘You will get better long-term.’ ”

A version of this article appeared on Medscape.com.

Key clinical point: Severe obesity (body mass index [BMI] > 40 kg/m²) and postmenopausal status were associated with a significantly higher migraine frequency, with severe obesity also being associated with higher migraine severity.

Major finding: Migraine headache index scores (165.5 vs 105.5; P  =  .01) and the number of migraine headaches per month (P  =  .007) were significantly higher in patients with severe obesity vs those with healthy weight (BMI 18.5-24.9 kg/m²), with the number of migraine headaches per month being significantly higher among postmenopausal vs premenopausal women (mean 23 vs 19 days; P  =  .02).

Study details: Findings are from a retrospective cohort study including 223 patients with refractory migraine.

Disclosures: This study did not receive any specific funding. The authors declared no competing interests.

Source: Saffari TM et al. Severe obesity is associated with increased migraine severity and frequency: A retrospective cohort study. J Clin Neurosci. 2023;115:8-13 (Jul 14). doi: 10.1016/j.jocn.2023.07.007

Key clinical point: Severe obesity (body mass index [BMI] > 40 kg/m²) and postmenopausal status were associated with a significantly higher migraine frequency, with severe obesity also being associated with higher migraine severity.

Major finding: Migraine headache index scores (165.5 vs 105.5; P  =  .01) and the number of migraine headaches per month (P  =  .007) were significantly higher in patients with severe obesity vs those with healthy weight (BMI 18.5-24.9 kg/m²), with the number of migraine headaches per month being significantly higher among postmenopausal vs premenopausal women (mean 23 vs 19 days; P  =  .02).

Study details: Findings are from a retrospective cohort study including 223 patients with refractory migraine.

Disclosures: This study did not receive any specific funding. The authors declared no competing interests.

Source: Saffari TM et al. Severe obesity is associated with increased migraine severity and frequency: A retrospective cohort study. J Clin Neurosci. 2023;115:8-13 (Jul 14). doi: 10.1016/j.jocn.2023.07.007

Key clinical point: Severe obesity (body mass index [BMI] > 40 kg/m²) and postmenopausal status were associated with a significantly higher migraine frequency, with severe obesity also being associated with higher migraine severity.

Major finding: Migraine headache index scores (165.5 vs 105.5; P  =  .01) and the number of migraine headaches per month (P  =  .007) were significantly higher in patients with severe obesity vs those with healthy weight (BMI 18.5-24.9 kg/m²), with the number of migraine headaches per month being significantly higher among postmenopausal vs premenopausal women (mean 23 vs 19 days; P  =  .02).

Study details: Findings are from a retrospective cohort study including 223 patients with refractory migraine.

Disclosures: This study did not receive any specific funding. The authors declared no competing interests.

Source: Saffari TM et al. Severe obesity is associated with increased migraine severity and frequency: A retrospective cohort study. J Clin Neurosci. 2023;115:8-13 (Jul 14). doi: 10.1016/j.jocn.2023.07.007

Key clinical point: Higher dietary intake of zinc was negatively associated with the risk for migraine in adults, with the association being more prominent among those age 20-50 years.

Major finding: Compared with participants in the lowest quintile of dietary zinc consumption (≤ 5.93 mg/day), the risk for migraine was lower among those in the higher quintiles of dietary zinc consumption (5.94-8.38 mg/day: adjusted odds ratio [aOR] 0.73; P  =  .004; 8.39-11.26 mg/day: aOR 0.72; P  =  .02; and 11.27-15.75 mg/day: aOR 0.76; P  =  .04), with a non-linear association observed between zinc intake and migraine in the age 20-50 years group (P < .001).

Study details: This cross-sectional study included 9849 adult participants (age ≥ 20 years), of whom 1963 (19.93%) had migraine.

Disclosures: This study was supported by the National Natural Science Foundation of China, Natural Science Foundation of Jiangxi Province, and Jiangxi Provincial Department of Education Science and Technology Program Project. No potential conflicts of interest were declared.

Source: Zheng H et al. Dietary zinc intake in relation to migraine among adults: A cross sectional study of NHANES 1999-2004. Nutr Neurosci. 2023 (Aug 4). doi: 10.1080/1028415X.2023.2243678

Key clinical point: Higher dietary intake of zinc was negatively associated with the risk for migraine in adults, with the association being more prominent among those age 20-50 years.

Major finding: Compared with participants in the lowest quintile of dietary zinc consumption (≤ 5.93 mg/day), the risk for migraine was lower among those in the higher quintiles of dietary zinc consumption (5.94-8.38 mg/day: adjusted odds ratio [aOR] 0.73; P  =  .004; 8.39-11.26 mg/day: aOR 0.72; P  =  .02; and 11.27-15.75 mg/day: aOR 0.76; P  =  .04), with a non-linear association observed between zinc intake and migraine in the age 20-50 years group (P < .001).

Study details: This cross-sectional study included 9849 adult participants (age ≥ 20 years), of whom 1963 (19.93%) had migraine.

Disclosures: This study was supported by the National Natural Science Foundation of China, Natural Science Foundation of Jiangxi Province, and Jiangxi Provincial Department of Education Science and Technology Program Project. No potential conflicts of interest were declared.

Source: Zheng H et al. Dietary zinc intake in relation to migraine among adults: A cross sectional study of NHANES 1999-2004. Nutr Neurosci. 2023 (Aug 4). doi: 10.1080/1028415X.2023.2243678

Key clinical point: Higher dietary intake of zinc was negatively associated with the risk for migraine in adults, with the association being more prominent among those age 20-50 years.

Major finding: Compared with participants in the lowest quintile of dietary zinc consumption (≤ 5.93 mg/day), the risk for migraine was lower among those in the higher quintiles of dietary zinc consumption (5.94-8.38 mg/day: adjusted odds ratio [aOR] 0.73; P  =  .004; 8.39-11.26 mg/day: aOR 0.72; P  =  .02; and 11.27-15.75 mg/day: aOR 0.76; P  =  .04), with a non-linear association observed between zinc intake and migraine in the age 20-50 years group (P < .001).

Study details: This cross-sectional study included 9849 adult participants (age ≥ 20 years), of whom 1963 (19.93%) had migraine.

Disclosures: This study was supported by the National Natural Science Foundation of China, Natural Science Foundation of Jiangxi Province, and Jiangxi Provincial Department of Education Science and Technology Program Project. No potential conflicts of interest were declared.

Source: Zheng H et al. Dietary zinc intake in relation to migraine among adults: A cross sectional study of NHANES 1999-2004. Nutr Neurosci. 2023 (Aug 4). doi: 10.1080/1028415X.2023.2243678

Key clinical point: Patients with migraine are at a greater risk of experiencing rheumatoid arthritis (RA) attacks, with the risk being prominently higher among those having migraine without aura.

Major finding: The risk for RA was 1.94 times higher in patients with migraine vs control individuals (adjusted odds ratio [aOR] 1.94; 95% CI 1.74-2.17), with the risk being prominent in those with migraine without aura (aOR 1.49; 95% CI 1.35-1.64).

Study details: The data come from a meta-analysis of five studies including 321,877 participants.

Disclosures: This study did not disclose the funding source. The authors declared no competing interests.

Source: Tian D et al. Migraine and risk of rheumatoid arthritis: A systematic review and meta-analysis of observational studies. Heliyon. 2023;9(8):e18430 (Jul 18). doi: 10.1016/j.heliyon.2023.e18430

Key clinical point: Patients with migraine are at a greater risk of experiencing rheumatoid arthritis (RA) attacks, with the risk being prominently higher among those having migraine without aura.

Major finding: The risk for RA was 1.94 times higher in patients with migraine vs control individuals (adjusted odds ratio [aOR] 1.94; 95% CI 1.74-2.17), with the risk being prominent in those with migraine without aura (aOR 1.49; 95% CI 1.35-1.64).

Study details: The data come from a meta-analysis of five studies including 321,877 participants.

Disclosures: This study did not disclose the funding source. The authors declared no competing interests.

Source: Tian D et al. Migraine and risk of rheumatoid arthritis: A systematic review and meta-analysis of observational studies. Heliyon. 2023;9(8):e18430 (Jul 18). doi: 10.1016/j.heliyon.2023.e18430

Key clinical point: Patients with migraine are at a greater risk of experiencing rheumatoid arthritis (RA) attacks, with the risk being prominently higher among those having migraine without aura.

Major finding: The risk for RA was 1.94 times higher in patients with migraine vs control individuals (adjusted odds ratio [aOR] 1.94; 95% CI 1.74-2.17), with the risk being prominent in those with migraine without aura (aOR 1.49; 95% CI 1.35-1.64).

Study details: The data come from a meta-analysis of five studies including 321,877 participants.

Disclosures: This study did not disclose the funding source. The authors declared no competing interests.

Source: Tian D et al. Migraine and risk of rheumatoid arthritis: A systematic review and meta-analysis of observational studies. Heliyon. 2023;9(8):e18430 (Jul 18). doi: 10.1016/j.heliyon.2023.e18430