Headache & Migraine

Key clinical point: Prophylactic treatment with monthly or quarterly fremanezumab demonstrated favorable efficacy and tolerability in a real-world cohort of patients with episodic migraine (EM) or chronic migraine (CM).

Major finding: After initiating fremanezumab, the monthly migraine days reduced by 6.1, 7.7, and 8.5 days at 1, 3, and 6 months, respectively, with similar reductions observed when categorized by EM or CM (all P < .001). At 6 months, ≥50%, ≥75%, and 100% response rates were achieved by 67.6%, 22.5%, and 5.4% of patients in the overall cohort, respectively, with 48.0% of patients with CM experiencing remission to EM after 1-month fremanezumab treatment. Overall, 9.5% of the patients experienced adverse reactions, which were mostly mild.

Study details: Findings are from a retrospective study that included 127 patients with migraine (EM n = 54; CM n = 73) who received monthly or quarterly fremanezumab doses over 6 months.

Disclosures: This study received no specific funding from any source. Four authors declared receiving lecture fees from various sources.

Source: Suzuki S et al. Real-world experience with monthly and quarterly dosing of fremanezumab for the treatment of patients with migraine in Japan. Front Neurol. 2023;14:1220285 (Jul 6). Doi: 10.3389/fneur.2023.1220285

Key clinical point: Prophylactic treatment with monthly or quarterly fremanezumab demonstrated favorable efficacy and tolerability in a real-world cohort of patients with episodic migraine (EM) or chronic migraine (CM).

Major finding: After initiating fremanezumab, the monthly migraine days reduced by 6.1, 7.7, and 8.5 days at 1, 3, and 6 months, respectively, with similar reductions observed when categorized by EM or CM (all P < .001). At 6 months, ≥50%, ≥75%, and 100% response rates were achieved by 67.6%, 22.5%, and 5.4% of patients in the overall cohort, respectively, with 48.0% of patients with CM experiencing remission to EM after 1-month fremanezumab treatment. Overall, 9.5% of the patients experienced adverse reactions, which were mostly mild.

Study details: Findings are from a retrospective study that included 127 patients with migraine (EM n = 54; CM n = 73) who received monthly or quarterly fremanezumab doses over 6 months.

Disclosures: This study received no specific funding from any source. Four authors declared receiving lecture fees from various sources.

Source: Suzuki S et al. Real-world experience with monthly and quarterly dosing of fremanezumab for the treatment of patients with migraine in Japan. Front Neurol. 2023;14:1220285 (Jul 6). Doi: 10.3389/fneur.2023.1220285

Key clinical point: Prophylactic treatment with monthly or quarterly fremanezumab demonstrated favorable efficacy and tolerability in a real-world cohort of patients with episodic migraine (EM) or chronic migraine (CM).

Major finding: After initiating fremanezumab, the monthly migraine days reduced by 6.1, 7.7, and 8.5 days at 1, 3, and 6 months, respectively, with similar reductions observed when categorized by EM or CM (all P < .001). At 6 months, ≥50%, ≥75%, and 100% response rates were achieved by 67.6%, 22.5%, and 5.4% of patients in the overall cohort, respectively, with 48.0% of patients with CM experiencing remission to EM after 1-month fremanezumab treatment. Overall, 9.5% of the patients experienced adverse reactions, which were mostly mild.

Study details: Findings are from a retrospective study that included 127 patients with migraine (EM n = 54; CM n = 73) who received monthly or quarterly fremanezumab doses over 6 months.

Disclosures: This study received no specific funding from any source. Four authors declared receiving lecture fees from various sources.

Source: Suzuki S et al. Real-world experience with monthly and quarterly dosing of fremanezumab for the treatment of patients with migraine in Japan. Front Neurol. 2023;14:1220285 (Jul 6). Doi: 10.3389/fneur.2023.1220285

Key clinical point: Higher intake of dietary caffeine was positively associated with a higher prevalence of severe headaches or migraines in US adults.

Major finding: Overall, the incidence of severe headaches or migraines increased by 5% with each 100 mg/day increase in dietary caffeine intake (odds ratio [OR] 1.05; P < .001), with the risk increasing by 42% with caffeine intake ≥ 400 mg/day vs ≥0 to <40 mg/day (OR 1.42; P < .001).

Study details: This cross-sectional study evaluated the association between dietary caffeine intake and severe headaches or migraines in 8993 U.S. adults age ≥ 20 years.

Disclosures: This study was funded by the Shandong Traditional Chinese Medicine Science and Technology Development Project, China. The authors declared no conflicts of interest.

Source: Zhang L et al. Association between dietary caffeine intake and severe headache or migraine in US adults. Sci Rep. 2023;13:10220 (Jun 23). Doi: 10.1038/s41598-023-36325-8

Key clinical point: Higher intake of dietary caffeine was positively associated with a higher prevalence of severe headaches or migraines in US adults.

Major finding: Overall, the incidence of severe headaches or migraines increased by 5% with each 100 mg/day increase in dietary caffeine intake (odds ratio [OR] 1.05; P < .001), with the risk increasing by 42% with caffeine intake ≥ 400 mg/day vs ≥0 to <40 mg/day (OR 1.42; P < .001).

Study details: This cross-sectional study evaluated the association between dietary caffeine intake and severe headaches or migraines in 8993 U.S. adults age ≥ 20 years.

Disclosures: This study was funded by the Shandong Traditional Chinese Medicine Science and Technology Development Project, China. The authors declared no conflicts of interest.

Source: Zhang L et al. Association between dietary caffeine intake and severe headache or migraine in US adults. Sci Rep. 2023;13:10220 (Jun 23). Doi: 10.1038/s41598-023-36325-8

Key clinical point: Higher intake of dietary caffeine was positively associated with a higher prevalence of severe headaches or migraines in US adults.

Major finding: Overall, the incidence of severe headaches or migraines increased by 5% with each 100 mg/day increase in dietary caffeine intake (odds ratio [OR] 1.05; P < .001), with the risk increasing by 42% with caffeine intake ≥ 400 mg/day vs ≥0 to <40 mg/day (OR 1.42; P < .001).

Study details: This cross-sectional study evaluated the association between dietary caffeine intake and severe headaches or migraines in 8993 U.S. adults age ≥ 20 years.

Disclosures: This study was funded by the Shandong Traditional Chinese Medicine Science and Technology Development Project, China. The authors declared no conflicts of interest.

Source: Zhang L et al. Association between dietary caffeine intake and severe headache or migraine in US adults. Sci Rep. 2023;13:10220 (Jun 23). Doi: 10.1038/s41598-023-36325-8

Key clinical point: Long-term erenumab treatment demonstrated sustained efficacy and safety in patients with chronic migraine (CM) with and without acute medication overuse (AMO), with erenumab reducing acute medication consumption and many patients moving to non-AMO status.

Major finding: Among baseline acute migraine-specific medication users at 52 weeks, the mean monthly migraine-specific medication days reduced by 7.4 (95% CI 6.4-8.3) days and 5.4 (95% CI 4.7-6.1) days in the AMO and non-AMO groups, respectively, with 66.1% of patients in the AMO group moving to the non-AMO group.

Study details: This post hoc subgroup analysis of a 52-week open-label extension study following a 12-week double-blind study included 469 patients with CM stratified by AMO status who were randomly assigned to receive placebo or erenumab (70 or 140 mg) throughout or switch from 70 to 140 mg erenumab.

Disclosures: This study was funded by Amgen Inc. Some authors declared being employees or stockholders of Amgen. The other authors declared ties with various sources, including Amgen.

Source: Tepper SJ et al. Long-term efficacy and safety of erenumab in patients with chronic migraine and acute medication overuse: A subgroup analysis. Headache. 2023;63(6):730-742 (Jun 14). Doi: 10.1111/head.14536

Key clinical point: Long-term erenumab treatment demonstrated sustained efficacy and safety in patients with chronic migraine (CM) with and without acute medication overuse (AMO), with erenumab reducing acute medication consumption and many patients moving to non-AMO status.

Major finding: Among baseline acute migraine-specific medication users at 52 weeks, the mean monthly migraine-specific medication days reduced by 7.4 (95% CI 6.4-8.3) days and 5.4 (95% CI 4.7-6.1) days in the AMO and non-AMO groups, respectively, with 66.1% of patients in the AMO group moving to the non-AMO group.

Study details: This post hoc subgroup analysis of a 52-week open-label extension study following a 12-week double-blind study included 469 patients with CM stratified by AMO status who were randomly assigned to receive placebo or erenumab (70 or 140 mg) throughout or switch from 70 to 140 mg erenumab.

Disclosures: This study was funded by Amgen Inc. Some authors declared being employees or stockholders of Amgen. The other authors declared ties with various sources, including Amgen.

Source: Tepper SJ et al. Long-term efficacy and safety of erenumab in patients with chronic migraine and acute medication overuse: A subgroup analysis. Headache. 2023;63(6):730-742 (Jun 14). Doi: 10.1111/head.14536

Key clinical point: Long-term erenumab treatment demonstrated sustained efficacy and safety in patients with chronic migraine (CM) with and without acute medication overuse (AMO), with erenumab reducing acute medication consumption and many patients moving to non-AMO status.

Major finding: Among baseline acute migraine-specific medication users at 52 weeks, the mean monthly migraine-specific medication days reduced by 7.4 (95% CI 6.4-8.3) days and 5.4 (95% CI 4.7-6.1) days in the AMO and non-AMO groups, respectively, with 66.1% of patients in the AMO group moving to the non-AMO group.

Study details: This post hoc subgroup analysis of a 52-week open-label extension study following a 12-week double-blind study included 469 patients with CM stratified by AMO status who were randomly assigned to receive placebo or erenumab (70 or 140 mg) throughout or switch from 70 to 140 mg erenumab.

Disclosures: This study was funded by Amgen Inc. Some authors declared being employees or stockholders of Amgen. The other authors declared ties with various sources, including Amgen.

Source: Tepper SJ et al. Long-term efficacy and safety of erenumab in patients with chronic migraine and acute medication overuse: A subgroup analysis. Headache. 2023;63(6):730-742 (Jun 14). Doi: 10.1111/head.14536

Key clinical point: Ultrasound-guided stellate ganglion block (SGB) appeared to be safe and effective in reducing pain intensity, headache frequency and duration, and the need for adjunctive anti-migraine medications in elderly patients with migraine.

Major finding: At 3 months after ultrasound-guided SGB treatment, the mean Numerical Rating Scale score reduced from 7.3 at baseline to 3.6 (P < .001), the mean headache frequency per month reduced from 23.1 days at baseline to 14.0 days (P = .001), and the mean headache duration decreased from 22.7 hours at baseline to 14.3 hours (P = .001), with 64% of patients experiencing ≥50% reduction in anti-migraine medication consumption. No procedure-related serious adverse events were reported.

Study details: Findings are from a retrospective observational case series study including 52 elderly patients (age ≥ 65 years) with migraine who received ultrasound-guided SGB treatment for headache management.

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

Source: Yu B et al. Ultrasound-guided stellate ganglion block for the treatment of migraine in elderly patients: A retrospective and observational study. Headache. 2023;63(6):763-770 (Jun 14). Doi: 10.1111/head.14537

Key clinical point: Ultrasound-guided stellate ganglion block (SGB) appeared to be safe and effective in reducing pain intensity, headache frequency and duration, and the need for adjunctive anti-migraine medications in elderly patients with migraine.

Major finding: At 3 months after ultrasound-guided SGB treatment, the mean Numerical Rating Scale score reduced from 7.3 at baseline to 3.6 (P < .001), the mean headache frequency per month reduced from 23.1 days at baseline to 14.0 days (P = .001), and the mean headache duration decreased from 22.7 hours at baseline to 14.3 hours (P = .001), with 64% of patients experiencing ≥50% reduction in anti-migraine medication consumption. No procedure-related serious adverse events were reported.

Study details: Findings are from a retrospective observational case series study including 52 elderly patients (age ≥ 65 years) with migraine who received ultrasound-guided SGB treatment for headache management.

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

Source: Yu B et al. Ultrasound-guided stellate ganglion block for the treatment of migraine in elderly patients: A retrospective and observational study. Headache. 2023;63(6):763-770 (Jun 14). Doi: 10.1111/head.14537

Key clinical point: Ultrasound-guided stellate ganglion block (SGB) appeared to be safe and effective in reducing pain intensity, headache frequency and duration, and the need for adjunctive anti-migraine medications in elderly patients with migraine.

Major finding: At 3 months after ultrasound-guided SGB treatment, the mean Numerical Rating Scale score reduced from 7.3 at baseline to 3.6 (P < .001), the mean headache frequency per month reduced from 23.1 days at baseline to 14.0 days (P = .001), and the mean headache duration decreased from 22.7 hours at baseline to 14.3 hours (P = .001), with 64% of patients experiencing ≥50% reduction in anti-migraine medication consumption. No procedure-related serious adverse events were reported.

Study details: Findings are from a retrospective observational case series study including 52 elderly patients (age ≥ 65 years) with migraine who received ultrasound-guided SGB treatment for headache management.

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

Source: Yu B et al. Ultrasound-guided stellate ganglion block for the treatment of migraine in elderly patients: A retrospective and observational study. Headache. 2023;63(6):763-770 (Jun 14). Doi: 10.1111/head.14537

Key clinical point: In patients with migraine, treatment with anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) reduced visual hypersensitivity, and this reduction was positively associated with a decrease in monthly migraine days (MMD).

Major finding: After 3 months of treatment with anti-CGRP mAb, the mean ictal Leiden Visual Sensitivity Scale (L-VISS) score decreased from 20.1 to 19.2 (P = .042) and the mean interictal L-VISS score decreased from 11.8 to 11.1 (P = .050), and a positive correlation was observed between the reduction in MMD and the decrease in ictal L-VISS (β 0.3; P = .001) and interictal L-VISS (β 0.2; P = .010) scores.

Study details: This prospective follow-up study included 205 patients with migraine who were treated with either erenumab (n = 105) or fremanezumab (n = 100).

Disclosures: This study did not disclose the funding source. Three authors declared receiving consultancy or industry and independent support from various sources. The other authors declared no conflicts of interest.

Source: de Vries Lentsch S et al. Visual hypersensitivity in patients treated with anti-calcitonin gene-related peptide (receptor) monoclonal antibodies. Headache. 2023;63(7):926-933 (Jun 26). Doi: 10.1111/head.14531

Key clinical point: In patients with migraine, treatment with anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) reduced visual hypersensitivity, and this reduction was positively associated with a decrease in monthly migraine days (MMD).

Major finding: After 3 months of treatment with anti-CGRP mAb, the mean ictal Leiden Visual Sensitivity Scale (L-VISS) score decreased from 20.1 to 19.2 (P = .042) and the mean interictal L-VISS score decreased from 11.8 to 11.1 (P = .050), and a positive correlation was observed between the reduction in MMD and the decrease in ictal L-VISS (β 0.3; P = .001) and interictal L-VISS (β 0.2; P = .010) scores.

Study details: This prospective follow-up study included 205 patients with migraine who were treated with either erenumab (n = 105) or fremanezumab (n = 100).

Disclosures: This study did not disclose the funding source. Three authors declared receiving consultancy or industry and independent support from various sources. The other authors declared no conflicts of interest.

Source: de Vries Lentsch S et al. Visual hypersensitivity in patients treated with anti-calcitonin gene-related peptide (receptor) monoclonal antibodies. Headache. 2023;63(7):926-933 (Jun 26). Doi: 10.1111/head.14531

Key clinical point: In patients with migraine, treatment with anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) reduced visual hypersensitivity, and this reduction was positively associated with a decrease in monthly migraine days (MMD).

Major finding: After 3 months of treatment with anti-CGRP mAb, the mean ictal Leiden Visual Sensitivity Scale (L-VISS) score decreased from 20.1 to 19.2 (P = .042) and the mean interictal L-VISS score decreased from 11.8 to 11.1 (P = .050), and a positive correlation was observed between the reduction in MMD and the decrease in ictal L-VISS (β 0.3; P = .001) and interictal L-VISS (β 0.2; P = .010) scores.

Study details: This prospective follow-up study included 205 patients with migraine who were treated with either erenumab (n = 105) or fremanezumab (n = 100).

Disclosures: This study did not disclose the funding source. Three authors declared receiving consultancy or industry and independent support from various sources. The other authors declared no conflicts of interest.

Source: de Vries Lentsch S et al. Visual hypersensitivity in patients treated with anti-calcitonin gene-related peptide (receptor) monoclonal antibodies. Headache. 2023;63(7):926-933 (Jun 26). Doi: 10.1111/head.14531

Key clinical point: Meta-analysis confirmed better therapeutic efficacy of rimegepant compared with placebo in patients with episodic migraine (EM), along with no significant difference in adverse events.

Major finding: Rimegepant was more effective than placebo in terms of achieving pain freedom and pain relief at 2 hours (odds ratio [OR] 1.84 and 1.80, respectively), 2-24 hours (OR 2.44 and 2.10, respectively), and 2-48 hours (OR 2.27 and 1.92, respectively; all P < .00001) post-dose. The occurrence of adverse events was not significantly different between the rimegepant and control arms (P = .06).

Study details: The data come from a systematic review and meta-analysis of 4 randomized controlled trials including 4230 patients with EM.

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

Source: Wang Q et al. Clinical efficacy and safety of rimegepant in the treatment of migraine: A meta-analysis of randomized controlled trials. Front Neurol. 2023;14:1205778 (Jun 20). Doi: 10.3389/fneur.2023.1205778

Key clinical point: Meta-analysis confirmed better therapeutic efficacy of rimegepant compared with placebo in patients with episodic migraine (EM), along with no significant difference in adverse events.

Major finding: Rimegepant was more effective than placebo in terms of achieving pain freedom and pain relief at 2 hours (odds ratio [OR] 1.84 and 1.80, respectively), 2-24 hours (OR 2.44 and 2.10, respectively), and 2-48 hours (OR 2.27 and 1.92, respectively; all P < .00001) post-dose. The occurrence of adverse events was not significantly different between the rimegepant and control arms (P = .06).

Study details: The data come from a systematic review and meta-analysis of 4 randomized controlled trials including 4230 patients with EM.

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

Source: Wang Q et al. Clinical efficacy and safety of rimegepant in the treatment of migraine: A meta-analysis of randomized controlled trials. Front Neurol. 2023;14:1205778 (Jun 20). Doi: 10.3389/fneur.2023.1205778

Key clinical point: Meta-analysis confirmed better therapeutic efficacy of rimegepant compared with placebo in patients with episodic migraine (EM), along with no significant difference in adverse events.

Major finding: Rimegepant was more effective than placebo in terms of achieving pain freedom and pain relief at 2 hours (odds ratio [OR] 1.84 and 1.80, respectively), 2-24 hours (OR 2.44 and 2.10, respectively), and 2-48 hours (OR 2.27 and 1.92, respectively; all P < .00001) post-dose. The occurrence of adverse events was not significantly different between the rimegepant and control arms (P = .06).

Study details: The data come from a systematic review and meta-analysis of 4 randomized controlled trials including 4230 patients with EM.

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

Source: Wang Q et al. Clinical efficacy and safety of rimegepant in the treatment of migraine: A meta-analysis of randomized controlled trials. Front Neurol. 2023;14:1205778 (Jun 20). Doi: 10.3389/fneur.2023.1205778

Key clinical point: Disability, anxiety, and comorbid mental disorders moderated the long-term effect of migraine-specific cognitive behavioral therapy (miCBT) or relaxation training (RLX) on headache days in patients with migraine, with those having higher and lower burden benefitting more from miCBT and RLX, respectively.

Major finding: Patients with higher headache-related disability (B −0.41; P = .047), anxiety (B −0.66; P = .056), and comorbid mental disorders (B −4.98; P = .053) benefited more from miCBT, whereas those with relatively lower headache-related disability and anxiety and without any comorbid mental disorder benefited more from RLX at 12 months of follow-up.

Study details: This secondary analysis of an open-label randomized controlled trial included 121 patients with migraine who were randomly assigned to the miCBT (n = 40), RLX (n = 41), or waiting-list control (n = 40) group.

Disclosures: This study received no specific funding. C Gaul and E Liesering-Latta declared receiving consulting and lecture honoraria from various sources. C Gaul declared serving as an honorary secretary of the German Migraine and Headache Society. The other authors declared no conflicts of interest.

Source: Klan T et al. Behavioral treatment for migraine prophylaxis in adults: Moderator analysis of a randomized controlled trial. Cephalalgia. 2023;43(6) (Jun 8). Doi: 10.1177/03331024231178237

Key clinical point: Disability, anxiety, and comorbid mental disorders moderated the long-term effect of migraine-specific cognitive behavioral therapy (miCBT) or relaxation training (RLX) on headache days in patients with migraine, with those having higher and lower burden benefitting more from miCBT and RLX, respectively.

Major finding: Patients with higher headache-related disability (B −0.41; P = .047), anxiety (B −0.66; P = .056), and comorbid mental disorders (B −4.98; P = .053) benefited more from miCBT, whereas those with relatively lower headache-related disability and anxiety and without any comorbid mental disorder benefited more from RLX at 12 months of follow-up.

Study details: This secondary analysis of an open-label randomized controlled trial included 121 patients with migraine who were randomly assigned to the miCBT (n = 40), RLX (n = 41), or waiting-list control (n = 40) group.

Disclosures: This study received no specific funding. C Gaul and E Liesering-Latta declared receiving consulting and lecture honoraria from various sources. C Gaul declared serving as an honorary secretary of the German Migraine and Headache Society. The other authors declared no conflicts of interest.

Source: Klan T et al. Behavioral treatment for migraine prophylaxis in adults: Moderator analysis of a randomized controlled trial. Cephalalgia. 2023;43(6) (Jun 8). Doi: 10.1177/03331024231178237

Key clinical point: Disability, anxiety, and comorbid mental disorders moderated the long-term effect of migraine-specific cognitive behavioral therapy (miCBT) or relaxation training (RLX) on headache days in patients with migraine, with those having higher and lower burden benefitting more from miCBT and RLX, respectively.

Major finding: Patients with higher headache-related disability (B −0.41; P = .047), anxiety (B −0.66; P = .056), and comorbid mental disorders (B −4.98; P = .053) benefited more from miCBT, whereas those with relatively lower headache-related disability and anxiety and without any comorbid mental disorder benefited more from RLX at 12 months of follow-up.

Study details: This secondary analysis of an open-label randomized controlled trial included 121 patients with migraine who were randomly assigned to the miCBT (n = 40), RLX (n = 41), or waiting-list control (n = 40) group.

Disclosures: This study received no specific funding. C Gaul and E Liesering-Latta declared receiving consulting and lecture honoraria from various sources. C Gaul declared serving as an honorary secretary of the German Migraine and Headache Society. The other authors declared no conflicts of interest.

Source: Klan T et al. Behavioral treatment for migraine prophylaxis in adults: Moderator analysis of a randomized controlled trial. Cephalalgia. 2023;43(6) (Jun 8). Doi: 10.1177/03331024231178237

Key clinical point: A broad category of blood pressure (BP)-lowering medication classes and drugs effectively reduced headache frequency in patients with episodic migraine.

Major finding: Compared with placebo, headache days per month reduced significantly with alpha-blockers (P = .023), angiotensin II receptor blockers (P = .024), beta-blockers (P = .035), and calcium channel blockers (P = .025). Specific BP-lowering drugs, such as clonidine (P = .026), candesartan (P = .001), atenolol (P = .010), bisoprolol (P = .000), propranolol (P = .000), timolol (P = .000), nicardipine (P = .001), and verapamil (P = .016), also effectively reduced the number of headache days per month.

Study details: Findings are from a systematic review and meta-analysis of 50 studies including 4310 participants.

Disclosures: This study received no specific funding. LR Griffiths reported receiving migraine research funding from the Australian National Health and Medical Research Council. AS Zagami declared being an associate editor for Cephalalgia. A Rodgers declared being an inventor for George Health Enterprises. The other authors declared no conflicts of interest.

Source: Carcel C, Haghdoost F, et al. The effect of blood pressure lowering medications on the prevention of episodic migraine: A systematic review and meta-analysis. Cephalalgia. 2023 (Jun 23). Doi: 10.1177/03331024231183166

Key clinical point: A broad category of blood pressure (BP)-lowering medication classes and drugs effectively reduced headache frequency in patients with episodic migraine.

Major finding: Compared with placebo, headache days per month reduced significantly with alpha-blockers (P = .023), angiotensin II receptor blockers (P = .024), beta-blockers (P = .035), and calcium channel blockers (P = .025). Specific BP-lowering drugs, such as clonidine (P = .026), candesartan (P = .001), atenolol (P = .010), bisoprolol (P = .000), propranolol (P = .000), timolol (P = .000), nicardipine (P = .001), and verapamil (P = .016), also effectively reduced the number of headache days per month.

Study details: Findings are from a systematic review and meta-analysis of 50 studies including 4310 participants.

Disclosures: This study received no specific funding. LR Griffiths reported receiving migraine research funding from the Australian National Health and Medical Research Council. AS Zagami declared being an associate editor for Cephalalgia. A Rodgers declared being an inventor for George Health Enterprises. The other authors declared no conflicts of interest.

Source: Carcel C, Haghdoost F, et al. The effect of blood pressure lowering medications on the prevention of episodic migraine: A systematic review and meta-analysis. Cephalalgia. 2023 (Jun 23). Doi: 10.1177/03331024231183166

Key clinical point: A broad category of blood pressure (BP)-lowering medication classes and drugs effectively reduced headache frequency in patients with episodic migraine.

Major finding: Compared with placebo, headache days per month reduced significantly with alpha-blockers (P = .023), angiotensin II receptor blockers (P = .024), beta-blockers (P = .035), and calcium channel blockers (P = .025). Specific BP-lowering drugs, such as clonidine (P = .026), candesartan (P = .001), atenolol (P = .010), bisoprolol (P = .000), propranolol (P = .000), timolol (P = .000), nicardipine (P = .001), and verapamil (P = .016), also effectively reduced the number of headache days per month.

Study details: Findings are from a systematic review and meta-analysis of 50 studies including 4310 participants.

Disclosures: This study received no specific funding. LR Griffiths reported receiving migraine research funding from the Australian National Health and Medical Research Council. AS Zagami declared being an associate editor for Cephalalgia. A Rodgers declared being an inventor for George Health Enterprises. The other authors declared no conflicts of interest.

Source: Carcel C, Haghdoost F, et al. The effect of blood pressure lowering medications on the prevention of episodic migraine: A systematic review and meta-analysis. Cephalalgia. 2023 (Jun 23). Doi: 10.1177/03331024231183166

Key clinical point: Migraine increased the risk for premature ischemic stroke similarly among women and men aged ≤60 years; however, the effect of migraine on the risk for premature myocardial infarction (MI) and hemorrhagic stroke was greater only in women but not in men with migraine.

Major finding: Compared with those without migraine, women (adjusted HR [aHR] 1.21) and men (aHR 1.23; both P < .001) with migraine showed a similar increase in the risk for premature ischemic stroke. However, the risk for premature MI (aHR 1.22; 95% CI 1.14-1.31; P < .001) and hemorrhagic stroke (aHR 1.13; 95% CI 1.02-1.24; P = .014) was significantly higher in women with vs without migraine but not in men.

Study details: This nationwide population-based cohort study included 179,680 women and 40,757 men with migraine.

Disclosures: This study did not receive any specific funding. CH Fuglsang declared owning stock in Novo Nordisk, and M Schmidt declared being supported by the Novo Nordisk Foundation.

Source: Fuglsang CH et al. Migraine and risk of premature myocardial infarction and stroke among men and women: A Danish population-based cohort study. PLoS Med. 2023;20(6):e1004238 (Jun 13). Doi: 10.1371/journal.pmed.1004238

Key clinical point: Migraine increased the risk for premature ischemic stroke similarly among women and men aged ≤60 years; however, the effect of migraine on the risk for premature myocardial infarction (MI) and hemorrhagic stroke was greater only in women but not in men with migraine.

Major finding: Compared with those without migraine, women (adjusted HR [aHR] 1.21) and men (aHR 1.23; both P < .001) with migraine showed a similar increase in the risk for premature ischemic stroke. However, the risk for premature MI (aHR 1.22; 95% CI 1.14-1.31; P < .001) and hemorrhagic stroke (aHR 1.13; 95% CI 1.02-1.24; P = .014) was significantly higher in women with vs without migraine but not in men.

Study details: This nationwide population-based cohort study included 179,680 women and 40,757 men with migraine.

Disclosures: This study did not receive any specific funding. CH Fuglsang declared owning stock in Novo Nordisk, and M Schmidt declared being supported by the Novo Nordisk Foundation.

Source: Fuglsang CH et al. Migraine and risk of premature myocardial infarction and stroke among men and women: A Danish population-based cohort study. PLoS Med. 2023;20(6):e1004238 (Jun 13). Doi: 10.1371/journal.pmed.1004238

Key clinical point: Migraine increased the risk for premature ischemic stroke similarly among women and men aged ≤60 years; however, the effect of migraine on the risk for premature myocardial infarction (MI) and hemorrhagic stroke was greater only in women but not in men with migraine.

Major finding: Compared with those without migraine, women (adjusted HR [aHR] 1.21) and men (aHR 1.23; both P < .001) with migraine showed a similar increase in the risk for premature ischemic stroke. However, the risk for premature MI (aHR 1.22; 95% CI 1.14-1.31; P < .001) and hemorrhagic stroke (aHR 1.13; 95% CI 1.02-1.24; P = .014) was significantly higher in women with vs without migraine but not in men.

Study details: This nationwide population-based cohort study included 179,680 women and 40,757 men with migraine.

Disclosures: This study did not receive any specific funding. CH Fuglsang declared owning stock in Novo Nordisk, and M Schmidt declared being supported by the Novo Nordisk Foundation.

Source: Fuglsang CH et al. Migraine and risk of premature myocardial infarction and stroke among men and women: A Danish population-based cohort study. PLoS Med. 2023;20(6):e1004238 (Jun 13). Doi: 10.1371/journal.pmed.1004238

Brain disorders, including mental illness, neurologic conditions, and stroke, account for more than 15% of all health loss worldwide – more than either cardiovascular disease or cancer – at huge cost to health care systems and society, an analysis of data from the most recent Global Burden of Disease (GBD) study shows.

“The burden of brain conditions will increase as populations continue to grow and age,” said study presenter Shayla Smith, MPH, an epidemiologist at the Institute for Health Metrics and Evaluation, the University of Washington, Seattle, in a press release.

“By 2050, more than 50 million people will be aged 65-79,” she explained, adding that the COVID-19 pandemic “has also influenced the prevalence of mental disorders globally, as people were forced to isolate and social networks broke down.”

Other factors related to brain disorders, she noted, include education level, obesity, and smoking.

“There’s still research to be done on what is the most effective way to maintain brain health, but some literature suggests a healthy brain can be achieved through a healthy lifestyle of managing conditions such as high blood pressure and diabetes, limiting alcohol consumption and smoking, prioritizing sleep, eating healthy, and staying physically and mentally active,” said Ms. Smith.

The findings were presented at the annual meeting of the Congress of the European Academy of Neurology.
 

An ‘ambitious exercise’

Coinvestigator Xaviera Steele, also from the IHME, told press conference attendees that the institute was established at the University of Washington in 2007 with the aim of “standardizing the measurement of health outcomes around the world and for all health conditions.”

A central part of that is the GBD study, “which is a very ambitious exercise in descriptive epidemiology in an effort to systematically quantify health loss” due to disease, injury, and risk factors over time, stratified by country, region, age, and sex. In addition, researchers are mapping and projecting trends over the next century and are estimating disease expenditure by country, by type of expense, and by condition “to derive a health care access and quality score for each health system in the world,” Ms. Steele said.

They are also estimating exposure to risk factors, how those risk factors contribute to health burden, and associated health outcomes by race and ethnicity to reflect the “disparities that we know are very prevalent in countries such as the United States.” From that work, Ms. Steele said that brain health and related conditions “do emerge as one of the more pressing challenges of the 21st century.”
 

Increase in dementia, mental health conditions

The data, which were gathered from 200,000 sources by the IHME, indicate that the number of individuals aged 65 years or older will increase by 350% by 2100. Ms. Steele underlined that “policy action will be needed to help families, who will struggle to provide high-quality care for their loved ones with dementia at a reasonable cost.”

The IHME calculates that in Europe health care spending on Alzheimer’s disease will increase by 226% between 2015 and 2040.

Turning to other conditions, Ms. Steele showed that since 1990, the number of individuals living with anxiety in the European region has increased by 14%, while the number living with depressive disorders has gone up by 13%.

Worldwide, the figures are even starker. Depression is estimated to affect 300 million people across the globe, which represents a 71% increase since 1990. The number of strokes increased by 95% over the same period.

Nevertheless, the “impact of brain conditions such as stroke has decreased since the 1990s due to improved treatments available,” Ms. Smith noted in the press release.

To estimate the toll caused by brain conditions, including neurologic disorders, mental disorders, cerebrovascular disease, brain cancer, brain injuries, and select infectious conditions, the researchers calculated disability-adjusted life years (DALYs).

This, Ms. Smith explained in her presentation, “captures the morbidity and mortality associated with brain conditions” and is adjusted for patient location, age, and sex.

The investigators found that, globally, brain conditions accounted for more than 15% of all health loss in 2021, at 406 DALYs – more than the 206 million DALYs that were associated with cancer, and the 402 million that were linked to cardiovascular disease.

This health loss is associated with a $1.22 trillion loss in income for people living with health disorders worldwide and accounts for $1.14 trillion in direct health care costs.

The burden of mental disorders, neurologic conditions, and stroke is expected to increase dramatically between now and 2050, said Ms. Smith, who noted that health loss linked to brain conditions is higher in younger patients. This will create “new challenges for health systems, employers, patients, and families,” she said in the press release.

“Our goal is to see an improved prevention and treatment landscape for other brain conditions and reverse the growing health loss that we are currently forecasting.”
 

Worrying increase in stroke

Jurgita Valaikiene, MD, PhD, center of neurology, clinic of neurology and neurosurgery, Vilnius (Lithuania) University Faculty of Medicine, who chaired the session, was taken aback by the findings, particularly by the worldwide increase in stroke cases.

“I work in stroke,” she said, and “we spend a lot of time on the diagnosis of stroke” and its prevention. “We try to be faster, to catch asymptomatic stenosis in the neck or head, and to apply the best medical treatment to avoid a stroke. But despite that, the numbers are increasing. I understand the population is getting older ... but still it’s a huge number.”

Dr. Valaikiene pointed out that stroke is not necessarily a condition of aging, insofar as increasing age “is not related directly to stenosis in the neck. “For example, we can have healthier vessels in older age and unhealthy vessels, with high-grade stenosis, in someone aged 30 or 40 years.”

“There are a lot of risk factors, such as smoking, physical activity, and so on. It depends on the individual,” she added.

The study was funded by the Institute for Health Metrics and Evaluation at the University of Washington. The authors have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Brain disorders, including mental illness, neurologic conditions, and stroke, account for more than 15% of all health loss worldwide – more than either cardiovascular disease or cancer – at huge cost to health care systems and society, an analysis of data from the most recent Global Burden of Disease (GBD) study shows.

“The burden of brain conditions will increase as populations continue to grow and age,” said study presenter Shayla Smith, MPH, an epidemiologist at the Institute for Health Metrics and Evaluation, the University of Washington, Seattle, in a press release.

“By 2050, more than 50 million people will be aged 65-79,” she explained, adding that the COVID-19 pandemic “has also influenced the prevalence of mental disorders globally, as people were forced to isolate and social networks broke down.”

Other factors related to brain disorders, she noted, include education level, obesity, and smoking.

“There’s still research to be done on what is the most effective way to maintain brain health, but some literature suggests a healthy brain can be achieved through a healthy lifestyle of managing conditions such as high blood pressure and diabetes, limiting alcohol consumption and smoking, prioritizing sleep, eating healthy, and staying physically and mentally active,” said Ms. Smith.

The findings were presented at the annual meeting of the Congress of the European Academy of Neurology.
 

An ‘ambitious exercise’

Coinvestigator Xaviera Steele, also from the IHME, told press conference attendees that the institute was established at the University of Washington in 2007 with the aim of “standardizing the measurement of health outcomes around the world and for all health conditions.”

A central part of that is the GBD study, “which is a very ambitious exercise in descriptive epidemiology in an effort to systematically quantify health loss” due to disease, injury, and risk factors over time, stratified by country, region, age, and sex. In addition, researchers are mapping and projecting trends over the next century and are estimating disease expenditure by country, by type of expense, and by condition “to derive a health care access and quality score for each health system in the world,” Ms. Steele said.

They are also estimating exposure to risk factors, how those risk factors contribute to health burden, and associated health outcomes by race and ethnicity to reflect the “disparities that we know are very prevalent in countries such as the United States.” From that work, Ms. Steele said that brain health and related conditions “do emerge as one of the more pressing challenges of the 21st century.”
 

Increase in dementia, mental health conditions

The data, which were gathered from 200,000 sources by the IHME, indicate that the number of individuals aged 65 years or older will increase by 350% by 2100. Ms. Steele underlined that “policy action will be needed to help families, who will struggle to provide high-quality care for their loved ones with dementia at a reasonable cost.”

The IHME calculates that in Europe health care spending on Alzheimer’s disease will increase by 226% between 2015 and 2040.

Turning to other conditions, Ms. Steele showed that since 1990, the number of individuals living with anxiety in the European region has increased by 14%, while the number living with depressive disorders has gone up by 13%.

Worldwide, the figures are even starker. Depression is estimated to affect 300 million people across the globe, which represents a 71% increase since 1990. The number of strokes increased by 95% over the same period.

Nevertheless, the “impact of brain conditions such as stroke has decreased since the 1990s due to improved treatments available,” Ms. Smith noted in the press release.

To estimate the toll caused by brain conditions, including neurologic disorders, mental disorders, cerebrovascular disease, brain cancer, brain injuries, and select infectious conditions, the researchers calculated disability-adjusted life years (DALYs).

This, Ms. Smith explained in her presentation, “captures the morbidity and mortality associated with brain conditions” and is adjusted for patient location, age, and sex.

The investigators found that, globally, brain conditions accounted for more than 15% of all health loss in 2021, at 406 DALYs – more than the 206 million DALYs that were associated with cancer, and the 402 million that were linked to cardiovascular disease.

This health loss is associated with a $1.22 trillion loss in income for people living with health disorders worldwide and accounts for $1.14 trillion in direct health care costs.

The burden of mental disorders, neurologic conditions, and stroke is expected to increase dramatically between now and 2050, said Ms. Smith, who noted that health loss linked to brain conditions is higher in younger patients. This will create “new challenges for health systems, employers, patients, and families,” she said in the press release.

“Our goal is to see an improved prevention and treatment landscape for other brain conditions and reverse the growing health loss that we are currently forecasting.”
 

Worrying increase in stroke

Jurgita Valaikiene, MD, PhD, center of neurology, clinic of neurology and neurosurgery, Vilnius (Lithuania) University Faculty of Medicine, who chaired the session, was taken aback by the findings, particularly by the worldwide increase in stroke cases.

“I work in stroke,” she said, and “we spend a lot of time on the diagnosis of stroke” and its prevention. “We try to be faster, to catch asymptomatic stenosis in the neck or head, and to apply the best medical treatment to avoid a stroke. But despite that, the numbers are increasing. I understand the population is getting older ... but still it’s a huge number.”

Dr. Valaikiene pointed out that stroke is not necessarily a condition of aging, insofar as increasing age “is not related directly to stenosis in the neck. “For example, we can have healthier vessels in older age and unhealthy vessels, with high-grade stenosis, in someone aged 30 or 40 years.”

“There are a lot of risk factors, such as smoking, physical activity, and so on. It depends on the individual,” she added.

The study was funded by the Institute for Health Metrics and Evaluation at the University of Washington. The authors have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Brain disorders, including mental illness, neurologic conditions, and stroke, account for more than 15% of all health loss worldwide – more than either cardiovascular disease or cancer – at huge cost to health care systems and society, an analysis of data from the most recent Global Burden of Disease (GBD) study shows.

“The burden of brain conditions will increase as populations continue to grow and age,” said study presenter Shayla Smith, MPH, an epidemiologist at the Institute for Health Metrics and Evaluation, the University of Washington, Seattle, in a press release.

“By 2050, more than 50 million people will be aged 65-79,” she explained, adding that the COVID-19 pandemic “has also influenced the prevalence of mental disorders globally, as people were forced to isolate and social networks broke down.”

Other factors related to brain disorders, she noted, include education level, obesity, and smoking.

“There’s still research to be done on what is the most effective way to maintain brain health, but some literature suggests a healthy brain can be achieved through a healthy lifestyle of managing conditions such as high blood pressure and diabetes, limiting alcohol consumption and smoking, prioritizing sleep, eating healthy, and staying physically and mentally active,” said Ms. Smith.

The findings were presented at the annual meeting of the Congress of the European Academy of Neurology.
 

An ‘ambitious exercise’

Coinvestigator Xaviera Steele, also from the IHME, told press conference attendees that the institute was established at the University of Washington in 2007 with the aim of “standardizing the measurement of health outcomes around the world and for all health conditions.”

A central part of that is the GBD study, “which is a very ambitious exercise in descriptive epidemiology in an effort to systematically quantify health loss” due to disease, injury, and risk factors over time, stratified by country, region, age, and sex. In addition, researchers are mapping and projecting trends over the next century and are estimating disease expenditure by country, by type of expense, and by condition “to derive a health care access and quality score for each health system in the world,” Ms. Steele said.

They are also estimating exposure to risk factors, how those risk factors contribute to health burden, and associated health outcomes by race and ethnicity to reflect the “disparities that we know are very prevalent in countries such as the United States.” From that work, Ms. Steele said that brain health and related conditions “do emerge as one of the more pressing challenges of the 21st century.”
 

Increase in dementia, mental health conditions

The data, which were gathered from 200,000 sources by the IHME, indicate that the number of individuals aged 65 years or older will increase by 350% by 2100. Ms. Steele underlined that “policy action will be needed to help families, who will struggle to provide high-quality care for their loved ones with dementia at a reasonable cost.”

The IHME calculates that in Europe health care spending on Alzheimer’s disease will increase by 226% between 2015 and 2040.

Turning to other conditions, Ms. Steele showed that since 1990, the number of individuals living with anxiety in the European region has increased by 14%, while the number living with depressive disorders has gone up by 13%.

Worldwide, the figures are even starker. Depression is estimated to affect 300 million people across the globe, which represents a 71% increase since 1990. The number of strokes increased by 95% over the same period.

Nevertheless, the “impact of brain conditions such as stroke has decreased since the 1990s due to improved treatments available,” Ms. Smith noted in the press release.

To estimate the toll caused by brain conditions, including neurologic disorders, mental disorders, cerebrovascular disease, brain cancer, brain injuries, and select infectious conditions, the researchers calculated disability-adjusted life years (DALYs).

This, Ms. Smith explained in her presentation, “captures the morbidity and mortality associated with brain conditions” and is adjusted for patient location, age, and sex.

The investigators found that, globally, brain conditions accounted for more than 15% of all health loss in 2021, at 406 DALYs – more than the 206 million DALYs that were associated with cancer, and the 402 million that were linked to cardiovascular disease.

This health loss is associated with a $1.22 trillion loss in income for people living with health disorders worldwide and accounts for $1.14 trillion in direct health care costs.

The burden of mental disorders, neurologic conditions, and stroke is expected to increase dramatically between now and 2050, said Ms. Smith, who noted that health loss linked to brain conditions is higher in younger patients. This will create “new challenges for health systems, employers, patients, and families,” she said in the press release.

“Our goal is to see an improved prevention and treatment landscape for other brain conditions and reverse the growing health loss that we are currently forecasting.”
 

Worrying increase in stroke

Jurgita Valaikiene, MD, PhD, center of neurology, clinic of neurology and neurosurgery, Vilnius (Lithuania) University Faculty of Medicine, who chaired the session, was taken aback by the findings, particularly by the worldwide increase in stroke cases.

“I work in stroke,” she said, and “we spend a lot of time on the diagnosis of stroke” and its prevention. “We try to be faster, to catch asymptomatic stenosis in the neck or head, and to apply the best medical treatment to avoid a stroke. But despite that, the numbers are increasing. I understand the population is getting older ... but still it’s a huge number.”

Dr. Valaikiene pointed out that stroke is not necessarily a condition of aging, insofar as increasing age “is not related directly to stenosis in the neck. “For example, we can have healthier vessels in older age and unhealthy vessels, with high-grade stenosis, in someone aged 30 or 40 years.”

“There are a lot of risk factors, such as smoking, physical activity, and so on. It depends on the individual,” she added.

The study was funded by the Institute for Health Metrics and Evaluation at the University of Washington. The authors have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.