Headache & Migraine

Key clinical point: Galcanezumab was safe and effective in a patient population severely impaired by chronic migraine (CM) and medication overuse headache (MOH).

Major finding: Galcanezumab led to a significant reduction in migraine days per month, painkillers per month, number of days on medication, numeric rating scale scores, 6-item Headache Impact Test scores, and Migraine Disability Assessment questionnaire scores (all P < .001), with improvements being the greatest during the first 3 months of treatment. Adverse events were mostly mild, with only one case of treatment discontinuation because of severe low back pain.

Study details: The data come from a single-center, prospective study including 78 patients with CM and MOH who received galcanezumab.

Disclosures: This study did not report the funding source. S Guerzoni and C Baraldi declared receiving honoraria from various sources. L Pani declared serving as the Chief Scientific Officer of EDRA-LSWR Publishing Company and Inpeco SA Total Lab Automation Company and had ties to other sources. Other authors declared no conflicts of interest.

Source: Guerzoni S et al. Galcanezumab for the treatment of chronic migraine and medication overuse headache: Real-world clinical evidence in a severely impaired patient population. Brain Behav. 2023;13:e2799 (May 19). doi: 10.1002/brb3.2799

Key clinical point: Galcanezumab was safe and effective in a patient population severely impaired by chronic migraine (CM) and medication overuse headache (MOH).

Major finding: Galcanezumab led to a significant reduction in migraine days per month, painkillers per month, number of days on medication, numeric rating scale scores, 6-item Headache Impact Test scores, and Migraine Disability Assessment questionnaire scores (all P < .001), with improvements being the greatest during the first 3 months of treatment. Adverse events were mostly mild, with only one case of treatment discontinuation because of severe low back pain.

Study details: The data come from a single-center, prospective study including 78 patients with CM and MOH who received galcanezumab.

Disclosures: This study did not report the funding source. S Guerzoni and C Baraldi declared receiving honoraria from various sources. L Pani declared serving as the Chief Scientific Officer of EDRA-LSWR Publishing Company and Inpeco SA Total Lab Automation Company and had ties to other sources. Other authors declared no conflicts of interest.

Source: Guerzoni S et al. Galcanezumab for the treatment of chronic migraine and medication overuse headache: Real-world clinical evidence in a severely impaired patient population. Brain Behav. 2023;13:e2799 (May 19). doi: 10.1002/brb3.2799

Key clinical point: Galcanezumab was safe and effective in a patient population severely impaired by chronic migraine (CM) and medication overuse headache (MOH).

Major finding: Galcanezumab led to a significant reduction in migraine days per month, painkillers per month, number of days on medication, numeric rating scale scores, 6-item Headache Impact Test scores, and Migraine Disability Assessment questionnaire scores (all P < .001), with improvements being the greatest during the first 3 months of treatment. Adverse events were mostly mild, with only one case of treatment discontinuation because of severe low back pain.

Study details: The data come from a single-center, prospective study including 78 patients with CM and MOH who received galcanezumab.

Disclosures: This study did not report the funding source. S Guerzoni and C Baraldi declared receiving honoraria from various sources. L Pani declared serving as the Chief Scientific Officer of EDRA-LSWR Publishing Company and Inpeco SA Total Lab Automation Company and had ties to other sources. Other authors declared no conflicts of interest.

Source: Guerzoni S et al. Galcanezumab for the treatment of chronic migraine and medication overuse headache: Real-world clinical evidence in a severely impaired patient population. Brain Behav. 2023;13:e2799 (May 19). doi: 10.1002/brb3.2799

Key clinical point: Ketogenic diet (KD) significantly improved sleep complaints in patients with migraine, irrespective of migraine improvements and anthropometric modifications.

Major finding: Migraine intensity, headache frequency, and the severity of headache-related disability improved significantly after 3 months of KD therapy (all P < .001) along with a significant decrease in the rate of insomnia (before vs after treatment: 60% vs 40%; P < .001) and number of patients experiencing poor sleep (reduced to half at follow-up; P < .001). The modifications in sleep features showed no correlation with migraine improvements and anthropometric changes.

Study details: This study included 70 patients with migraine who received KD as a preventive therapy for migraine.

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

Source: Merlino G et al. Sleep of migraine patients is ameliorated by ketogenic diet, independently of pain control. Sleep Med. 2023;107:196-201 (May 9). doi: 10.1016/j.sleep.2023.05.006

Key clinical point: Ketogenic diet (KD) significantly improved sleep complaints in patients with migraine, irrespective of migraine improvements and anthropometric modifications.

Major finding: Migraine intensity, headache frequency, and the severity of headache-related disability improved significantly after 3 months of KD therapy (all P < .001) along with a significant decrease in the rate of insomnia (before vs after treatment: 60% vs 40%; P < .001) and number of patients experiencing poor sleep (reduced to half at follow-up; P < .001). The modifications in sleep features showed no correlation with migraine improvements and anthropometric changes.

Study details: This study included 70 patients with migraine who received KD as a preventive therapy for migraine.

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

Source: Merlino G et al. Sleep of migraine patients is ameliorated by ketogenic diet, independently of pain control. Sleep Med. 2023;107:196-201 (May 9). doi: 10.1016/j.sleep.2023.05.006

Key clinical point: Ketogenic diet (KD) significantly improved sleep complaints in patients with migraine, irrespective of migraine improvements and anthropometric modifications.

Major finding: Migraine intensity, headache frequency, and the severity of headache-related disability improved significantly after 3 months of KD therapy (all P < .001) along with a significant decrease in the rate of insomnia (before vs after treatment: 60% vs 40%; P < .001) and number of patients experiencing poor sleep (reduced to half at follow-up; P < .001). The modifications in sleep features showed no correlation with migraine improvements and anthropometric changes.

Study details: This study included 70 patients with migraine who received KD as a preventive therapy for migraine.

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

Source: Merlino G et al. Sleep of migraine patients is ameliorated by ketogenic diet, independently of pain control. Sleep Med. 2023;107:196-201 (May 9). doi: 10.1016/j.sleep.2023.05.006

Key clinical point: The risk of developing Alzheimer’s disease (AD) dementia is significantly higher in individuals with vs without migraine, with younger age, obesity, and chronic migraine being significant risk factors for AD dementia among individuals with migraine.

Major finding: A prior history of migraine is a significant risk factor for AD dementia (hazard ratio [HR] 1.32; 95% CI 1.30-1.35). The risk was prominently higher among individuals with vs without migraine who were younger (HR 1.58; 95% CI 1.52-1.64) and had obesity (HR 1.39; 95% CI 1.35-1.43) and among those with chronic vs episodic migraine (CM HR 1.48, 95% CI 1.44-1.52; vs EM HR 1.26, 95% CI 1.27-1.29).

Study details: This retrospective, nationwide cohort study included individuals without (n = 5,863,348) and with (n = 212,836) migraine.

Disclosures: This study was supported by grants from the National Research Foundation funded by the Ministry of Education, the Technology Development Program funded by the Ministry of SMEs and Startups (Korea), and others. The authors declared no conflicts of interest.

Source: Kim J et al. Association between migraine and Alzheimer’s disease: A nationwide cohort study. Front Aging Neurosci. 2023;15:1196185 (May 25). doi: 10.3389/fnagi.2023.1196185

Key clinical point: The risk of developing Alzheimer’s disease (AD) dementia is significantly higher in individuals with vs without migraine, with younger age, obesity, and chronic migraine being significant risk factors for AD dementia among individuals with migraine.

Major finding: A prior history of migraine is a significant risk factor for AD dementia (hazard ratio [HR] 1.32; 95% CI 1.30-1.35). The risk was prominently higher among individuals with vs without migraine who were younger (HR 1.58; 95% CI 1.52-1.64) and had obesity (HR 1.39; 95% CI 1.35-1.43) and among those with chronic vs episodic migraine (CM HR 1.48, 95% CI 1.44-1.52; vs EM HR 1.26, 95% CI 1.27-1.29).

Study details: This retrospective, nationwide cohort study included individuals without (n = 5,863,348) and with (n = 212,836) migraine.

Disclosures: This study was supported by grants from the National Research Foundation funded by the Ministry of Education, the Technology Development Program funded by the Ministry of SMEs and Startups (Korea), and others. The authors declared no conflicts of interest.

Source: Kim J et al. Association between migraine and Alzheimer’s disease: A nationwide cohort study. Front Aging Neurosci. 2023;15:1196185 (May 25). doi: 10.3389/fnagi.2023.1196185

Key clinical point: The risk of developing Alzheimer’s disease (AD) dementia is significantly higher in individuals with vs without migraine, with younger age, obesity, and chronic migraine being significant risk factors for AD dementia among individuals with migraine.

Major finding: A prior history of migraine is a significant risk factor for AD dementia (hazard ratio [HR] 1.32; 95% CI 1.30-1.35). The risk was prominently higher among individuals with vs without migraine who were younger (HR 1.58; 95% CI 1.52-1.64) and had obesity (HR 1.39; 95% CI 1.35-1.43) and among those with chronic vs episodic migraine (CM HR 1.48, 95% CI 1.44-1.52; vs EM HR 1.26, 95% CI 1.27-1.29).

Study details: This retrospective, nationwide cohort study included individuals without (n = 5,863,348) and with (n = 212,836) migraine.

Disclosures: This study was supported by grants from the National Research Foundation funded by the Ministry of Education, the Technology Development Program funded by the Ministry of SMEs and Startups (Korea), and others. The authors declared no conflicts of interest.

Source: Kim J et al. Association between migraine and Alzheimer’s disease: A nationwide cohort study. Front Aging Neurosci. 2023;15:1196185 (May 25). doi: 10.3389/fnagi.2023.1196185

Key clinical point: Use of opioids is still prevalent among patients with migraine, thus indicating non-adherence to evidence-based international guidelines; moreover, the opioid use is more frequent and prolonged among patients with chronic migraine (CM) than among those with episodic migraine (EM).

Major finding: Overall, 13.4% of patients reported ever using an opioid for headache, with 46.3% using opioids occasionally, whereas 27.0% and 11.3% reported using them for >1 month and >1 year, respectively. Additionally, 2.4% of participants used opioids without a prescription. Patients with CM vs EM reported more frequent (21.6% vs 11.7%; P < .001) and prolonged (>1 month: 33.6% vs 24.4%; P < .003; >1 year: 17.7% vs 8.7%; P < .001) opioid use.

Study details: Findings are from a cross-sectional questionnaire-based study including 3712 patients with migraine (CM n = 629; EM n = 3,083).

Disclosures: This study did not receive any funding. GM Terwindt declared receiving consultancy support and independent support from various sources. No other conflicts of interest were declared.

Source: van Welie RF, van Welie FC, et al. Characterizing opioid use in a Dutch cohort with migraine. Cephalalgia. 2023;43(5) (May 11). doi: 10.1177/03331024231174160

Key clinical point: Use of opioids is still prevalent among patients with migraine, thus indicating non-adherence to evidence-based international guidelines; moreover, the opioid use is more frequent and prolonged among patients with chronic migraine (CM) than among those with episodic migraine (EM).

Major finding: Overall, 13.4% of patients reported ever using an opioid for headache, with 46.3% using opioids occasionally, whereas 27.0% and 11.3% reported using them for >1 month and >1 year, respectively. Additionally, 2.4% of participants used opioids without a prescription. Patients with CM vs EM reported more frequent (21.6% vs 11.7%; P < .001) and prolonged (>1 month: 33.6% vs 24.4%; P < .003; >1 year: 17.7% vs 8.7%; P < .001) opioid use.

Study details: Findings are from a cross-sectional questionnaire-based study including 3712 patients with migraine (CM n = 629; EM n = 3,083).

Disclosures: This study did not receive any funding. GM Terwindt declared receiving consultancy support and independent support from various sources. No other conflicts of interest were declared.

Source: van Welie RF, van Welie FC, et al. Characterizing opioid use in a Dutch cohort with migraine. Cephalalgia. 2023;43(5) (May 11). doi: 10.1177/03331024231174160

Key clinical point: Use of opioids is still prevalent among patients with migraine, thus indicating non-adherence to evidence-based international guidelines; moreover, the opioid use is more frequent and prolonged among patients with chronic migraine (CM) than among those with episodic migraine (EM).

Major finding: Overall, 13.4% of patients reported ever using an opioid for headache, with 46.3% using opioids occasionally, whereas 27.0% and 11.3% reported using them for >1 month and >1 year, respectively. Additionally, 2.4% of participants used opioids without a prescription. Patients with CM vs EM reported more frequent (21.6% vs 11.7%; P < .001) and prolonged (>1 month: 33.6% vs 24.4%; P < .003; >1 year: 17.7% vs 8.7%; P < .001) opioid use.

Study details: Findings are from a cross-sectional questionnaire-based study including 3712 patients with migraine (CM n = 629; EM n = 3,083).

Disclosures: This study did not receive any funding. GM Terwindt declared receiving consultancy support and independent support from various sources. No other conflicts of interest were declared.

Source: van Welie RF, van Welie FC, et al. Characterizing opioid use in a Dutch cohort with migraine. Cephalalgia. 2023;43(5) (May 11). doi: 10.1177/03331024231174160

Key clinical point: Switching to fremanezumab may provide clinical benefits in patients with difficult-to-treat episodic or chronic migraine who have not responded to prior monoclonal antibody (mAb) therapy targeting the calcitonin gene-related peptide (anti-CGRP) pathway.

Major finding: Overall, 42.8% of patients achieved a 50% reduction in the monthly migraine days (MMD) after switching to fremanezumab. The MMD decreased from 13.6 to 7.2 (P < .0001), Migraine Disability Assessment scores were reduced from 73.3 to 50.3 (P = .0014), and acute migraine medication use decreased from 9.7 to 4.9 days/month (P < .0001) after 3 months of fremanezumab therapy.

Study details: This subgroup analysis of the real-world, non-interventional Finesse study included 153 patients with episodic or chronic migraine who switched to fremanezumab from other anti-CGRP mAb treatments.

Disclosures: This study was funded by TEVA GmbH. Two authors declared being employees of TEVA GmbH. Several authors, including the lead author, declared serving as consultants or on advisory or speaker boards or receiving research grants from various sources, including TEVA GmbH.

Source: Straube A et al. Real-world effectiveness of fremanezumab in patients with migraine switching from another mAb targeting the CGRP pathway: A subgroup analysis of the Finesse Study. J Headache Pain. 2023;24:59 (May 23). doi: 10.1186/s10194-023-01593-2

Key clinical point: Switching to fremanezumab may provide clinical benefits in patients with difficult-to-treat episodic or chronic migraine who have not responded to prior monoclonal antibody (mAb) therapy targeting the calcitonin gene-related peptide (anti-CGRP) pathway.

Major finding: Overall, 42.8% of patients achieved a 50% reduction in the monthly migraine days (MMD) after switching to fremanezumab. The MMD decreased from 13.6 to 7.2 (P < .0001), Migraine Disability Assessment scores were reduced from 73.3 to 50.3 (P = .0014), and acute migraine medication use decreased from 9.7 to 4.9 days/month (P < .0001) after 3 months of fremanezumab therapy.

Study details: This subgroup analysis of the real-world, non-interventional Finesse study included 153 patients with episodic or chronic migraine who switched to fremanezumab from other anti-CGRP mAb treatments.

Disclosures: This study was funded by TEVA GmbH. Two authors declared being employees of TEVA GmbH. Several authors, including the lead author, declared serving as consultants or on advisory or speaker boards or receiving research grants from various sources, including TEVA GmbH.

Source: Straube A et al. Real-world effectiveness of fremanezumab in patients with migraine switching from another mAb targeting the CGRP pathway: A subgroup analysis of the Finesse Study. J Headache Pain. 2023;24:59 (May 23). doi: 10.1186/s10194-023-01593-2

Key clinical point: Switching to fremanezumab may provide clinical benefits in patients with difficult-to-treat episodic or chronic migraine who have not responded to prior monoclonal antibody (mAb) therapy targeting the calcitonin gene-related peptide (anti-CGRP) pathway.

Major finding: Overall, 42.8% of patients achieved a 50% reduction in the monthly migraine days (MMD) after switching to fremanezumab. The MMD decreased from 13.6 to 7.2 (P < .0001), Migraine Disability Assessment scores were reduced from 73.3 to 50.3 (P = .0014), and acute migraine medication use decreased from 9.7 to 4.9 days/month (P < .0001) after 3 months of fremanezumab therapy.

Study details: This subgroup analysis of the real-world, non-interventional Finesse study included 153 patients with episodic or chronic migraine who switched to fremanezumab from other anti-CGRP mAb treatments.

Disclosures: This study was funded by TEVA GmbH. Two authors declared being employees of TEVA GmbH. Several authors, including the lead author, declared serving as consultants or on advisory or speaker boards or receiving research grants from various sources, including TEVA GmbH.

Source: Straube A et al. Real-world effectiveness of fremanezumab in patients with migraine switching from another mAb targeting the CGRP pathway: A subgroup analysis of the Finesse Study. J Headache Pain. 2023;24:59 (May 23). doi: 10.1186/s10194-023-01593-2

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) are a safe and effective treatment option for patients age > 65 years with migraine and who did not respond to ≥3 prior migraine preventive medications.

Major finding: At 6 months, monthly migraine days, monthly headache days, and monthly acute medication intake days reduced by 10.1 days (P = .0001), 10.5 days (P < .001), and 9.4 days (P < .001), respectively. Nearly 25.3% of the patients experienced adverse effects at some point during follow-up, which were mostly mild in severity.

Study details: The data come from an observational retrospective study including 162 patients age > 65 years with migraine who did not respond to ≥3 migraine preventive medications and were treated with any one of the three anti-CGRP mAb (erenumab, galcanezumab, or fremanezumab).

Disclosures: This study did not receive any specific grant. Several authors, including the lead author, reported receiving honoraria for consulting, speaking, or advisory board participation; research funding; or travel funding from various sources.

Source: Muñoz-Vendrell A et al. Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years: A real-life multicentre analysis of 162 patients. J Headache Pain. 2023;24:63 (Jun 2). doi: 10.1186/s10194-023-01585-2

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) are a safe and effective treatment option for patients age > 65 years with migraine and who did not respond to ≥3 prior migraine preventive medications.

Major finding: At 6 months, monthly migraine days, monthly headache days, and monthly acute medication intake days reduced by 10.1 days (P = .0001), 10.5 days (P < .001), and 9.4 days (P < .001), respectively. Nearly 25.3% of the patients experienced adverse effects at some point during follow-up, which were mostly mild in severity.

Study details: The data come from an observational retrospective study including 162 patients age > 65 years with migraine who did not respond to ≥3 migraine preventive medications and were treated with any one of the three anti-CGRP mAb (erenumab, galcanezumab, or fremanezumab).

Disclosures: This study did not receive any specific grant. Several authors, including the lead author, reported receiving honoraria for consulting, speaking, or advisory board participation; research funding; or travel funding from various sources.

Source: Muñoz-Vendrell A et al. Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years: A real-life multicentre analysis of 162 patients. J Headache Pain. 2023;24:63 (Jun 2). doi: 10.1186/s10194-023-01585-2

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) are a safe and effective treatment option for patients age > 65 years with migraine and who did not respond to ≥3 prior migraine preventive medications.

Major finding: At 6 months, monthly migraine days, monthly headache days, and monthly acute medication intake days reduced by 10.1 days (P = .0001), 10.5 days (P < .001), and 9.4 days (P < .001), respectively. Nearly 25.3% of the patients experienced adverse effects at some point during follow-up, which were mostly mild in severity.

Study details: The data come from an observational retrospective study including 162 patients age > 65 years with migraine who did not respond to ≥3 migraine preventive medications and were treated with any one of the three anti-CGRP mAb (erenumab, galcanezumab, or fremanezumab).

Disclosures: This study did not receive any specific grant. Several authors, including the lead author, reported receiving honoraria for consulting, speaking, or advisory board participation; research funding; or travel funding from various sources.

Source: Muñoz-Vendrell A et al. Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years: A real-life multicentre analysis of 162 patients. J Headache Pain. 2023;24:63 (Jun 2). doi: 10.1186/s10194-023-01585-2

Key clinical point: The perimenstrual period was associated with an increased susceptibility to migraine without aura exclusively in both women who experienced migraine with and without aura; hence, the study recommended that only attacks without aura should be considered for a perimenstrual migraine diagnosis.

Major finding: A significant interaction was observed between the perimenstrual window and migraine subtype for migraine attack occurrence (P = .022), with the effect of the perimenstrual window being greater among women with migraine without aura (odds ratio [OR] 1.57; 95% CI 1.45-1.69) vs with aura (OR 1.36; 95% CI 1.24-1.49). Women with migraine with vs without aura showed similar increase in migraine attacks without aura during the perimenstrual window (P = .224).

Study details: This longitudinal electronic diary study included 526 premenopausal women diagnosed with migraine with or without aura.

Disclosures: This study was supported by ZonMw and the Dutch Brain Foundation. Five authors, including the lead author, declared receiving independent support from the study funders. Some authors declared receiving consultancy and independent support from various sources.

Source: Verhagen IE et al. Migraine with and without aura in relation to the menstrual cycle and other hormonal milestones: A prospective cohort study. Cephalalgia. 2023;43(6) (May 31). doi: 10.1177/03331024231164322

Key clinical point: The perimenstrual period was associated with an increased susceptibility to migraine without aura exclusively in both women who experienced migraine with and without aura; hence, the study recommended that only attacks without aura should be considered for a perimenstrual migraine diagnosis.

Major finding: A significant interaction was observed between the perimenstrual window and migraine subtype for migraine attack occurrence (P = .022), with the effect of the perimenstrual window being greater among women with migraine without aura (odds ratio [OR] 1.57; 95% CI 1.45-1.69) vs with aura (OR 1.36; 95% CI 1.24-1.49). Women with migraine with vs without aura showed similar increase in migraine attacks without aura during the perimenstrual window (P = .224).

Study details: This longitudinal electronic diary study included 526 premenopausal women diagnosed with migraine with or without aura.

Disclosures: This study was supported by ZonMw and the Dutch Brain Foundation. Five authors, including the lead author, declared receiving independent support from the study funders. Some authors declared receiving consultancy and independent support from various sources.

Source: Verhagen IE et al. Migraine with and without aura in relation to the menstrual cycle and other hormonal milestones: A prospective cohort study. Cephalalgia. 2023;43(6) (May 31). doi: 10.1177/03331024231164322

Key clinical point: The perimenstrual period was associated with an increased susceptibility to migraine without aura exclusively in both women who experienced migraine with and without aura; hence, the study recommended that only attacks without aura should be considered for a perimenstrual migraine diagnosis.

Major finding: A significant interaction was observed between the perimenstrual window and migraine subtype for migraine attack occurrence (P = .022), with the effect of the perimenstrual window being greater among women with migraine without aura (odds ratio [OR] 1.57; 95% CI 1.45-1.69) vs with aura (OR 1.36; 95% CI 1.24-1.49). Women with migraine with vs without aura showed similar increase in migraine attacks without aura during the perimenstrual window (P = .224).

Study details: This longitudinal electronic diary study included 526 premenopausal women diagnosed with migraine with or without aura.

Disclosures: This study was supported by ZonMw and the Dutch Brain Foundation. Five authors, including the lead author, declared receiving independent support from the study funders. Some authors declared receiving consultancy and independent support from various sources.

Source: Verhagen IE et al. Migraine with and without aura in relation to the menstrual cycle and other hormonal milestones: A prospective cohort study. Cephalalgia. 2023;43(6) (May 31). doi: 10.1177/03331024231164322

Key clinical point: Galcanezumab showed significant efficacy after the first week of treatment, and the treatment efficacy after the first week was a significant predictor of the response rate at 3 months.

Major finding: The mean changes in weekly response rates (RR) at 1, 2, 3, and 4 weeks after galcanezumab initiation were 44.6%, 31.4%, 26.0%, and 32.6%, respectively, with the improvement being greatest at 1 week (P < .001) and the RR at 1 week being the only predictive factor for ≥50% RR at 3 months (adjusted odds ratio 1.029; P = .002). Adverse events were mostly mild.

Study details: This retrospective, observational study included 55 patients with high-frequency episodic migraine or chronic migraine who received galcanezumab treatment (an initial loading dose of 240 mg followed by a dose of 120 mg monthly for at least 2 months).

Disclosures: This study did not receive any funding. Four authors declared receiving lecture fees from various sources. No other conflicts of interest were declared.

Source: Suzuki K et al. Could efficacy at 1 week after galcanezumab administration for patients with migraine predict responders at 3 months? A real world study. J Neurol. 2023 (May 23). doi: 10.1007/s00415-023-11788-x

Key clinical point: Galcanezumab showed significant efficacy after the first week of treatment, and the treatment efficacy after the first week was a significant predictor of the response rate at 3 months.

Major finding: The mean changes in weekly response rates (RR) at 1, 2, 3, and 4 weeks after galcanezumab initiation were 44.6%, 31.4%, 26.0%, and 32.6%, respectively, with the improvement being greatest at 1 week (P < .001) and the RR at 1 week being the only predictive factor for ≥50% RR at 3 months (adjusted odds ratio 1.029; P = .002). Adverse events were mostly mild.

Study details: This retrospective, observational study included 55 patients with high-frequency episodic migraine or chronic migraine who received galcanezumab treatment (an initial loading dose of 240 mg followed by a dose of 120 mg monthly for at least 2 months).

Disclosures: This study did not receive any funding. Four authors declared receiving lecture fees from various sources. No other conflicts of interest were declared.

Source: Suzuki K et al. Could efficacy at 1 week after galcanezumab administration for patients with migraine predict responders at 3 months? A real world study. J Neurol. 2023 (May 23). doi: 10.1007/s00415-023-11788-x

Key clinical point: Galcanezumab showed significant efficacy after the first week of treatment, and the treatment efficacy after the first week was a significant predictor of the response rate at 3 months.

Major finding: The mean changes in weekly response rates (RR) at 1, 2, 3, and 4 weeks after galcanezumab initiation were 44.6%, 31.4%, 26.0%, and 32.6%, respectively, with the improvement being greatest at 1 week (P < .001) and the RR at 1 week being the only predictive factor for ≥50% RR at 3 months (adjusted odds ratio 1.029; P = .002). Adverse events were mostly mild.

Study details: This retrospective, observational study included 55 patients with high-frequency episodic migraine or chronic migraine who received galcanezumab treatment (an initial loading dose of 240 mg followed by a dose of 120 mg monthly for at least 2 months).

Disclosures: This study did not receive any funding. Four authors declared receiving lecture fees from various sources. No other conflicts of interest were declared.

Source: Suzuki K et al. Could efficacy at 1 week after galcanezumab administration for patients with migraine predict responders at 3 months? A real world study. J Neurol. 2023 (May 23). doi: 10.1007/s00415-023-11788-x

Key clinical point: Among patients with chronic migraine, the use of concomitant oral treatments (CT) with onabotulinumtoxinA (BoNTA) was not associated with any unexpected tolerability concerns; however, BoNTA plus CT specifically for migraine vs BoNTA alone led to lesser reduction in monthly headache days (MHD).

Major finding: The reduction in MHD after 2-4 cycles of BoNTA treatment was significantly lower among patients receiving BoNTA plus CT for migraine vs BoNTA alone (P < .05). Side effects occurred in 20.3% of patients receiving BoNTA plus CT for migraine, with only 4.1% experiencing significant interference with functioning.

Study details: This retrospective study included 178 patients with chronic migraine who received prophylactic BoNTA with or without CT with a potential effect on migraine.

Disclosures: This study received only the open access funding enabled by Projekt DEAL. Several authors declared receiving honoraria and research funding, serving on advisory boards, or having other ties with various sources. Three authors, including the lead author, declared no conflicts of interest.

Source: Overeem LH et al. A retrospective real-life multicenter study on concurrent oral preventive treatments in patients with chronic migraine treated with onabotulinumtoxinA. CNS Drugs. 2023;37:453-465 (May 22). doi: 10.1007/s40263-023-01001-y

Key clinical point: Among patients with chronic migraine, the use of concomitant oral treatments (CT) with onabotulinumtoxinA (BoNTA) was not associated with any unexpected tolerability concerns; however, BoNTA plus CT specifically for migraine vs BoNTA alone led to lesser reduction in monthly headache days (MHD).

Major finding: The reduction in MHD after 2-4 cycles of BoNTA treatment was significantly lower among patients receiving BoNTA plus CT for migraine vs BoNTA alone (P < .05). Side effects occurred in 20.3% of patients receiving BoNTA plus CT for migraine, with only 4.1% experiencing significant interference with functioning.

Study details: This retrospective study included 178 patients with chronic migraine who received prophylactic BoNTA with or without CT with a potential effect on migraine.

Disclosures: This study received only the open access funding enabled by Projekt DEAL. Several authors declared receiving honoraria and research funding, serving on advisory boards, or having other ties with various sources. Three authors, including the lead author, declared no conflicts of interest.

Source: Overeem LH et al. A retrospective real-life multicenter study on concurrent oral preventive treatments in patients with chronic migraine treated with onabotulinumtoxinA. CNS Drugs. 2023;37:453-465 (May 22). doi: 10.1007/s40263-023-01001-y

Key clinical point: Among patients with chronic migraine, the use of concomitant oral treatments (CT) with onabotulinumtoxinA (BoNTA) was not associated with any unexpected tolerability concerns; however, BoNTA plus CT specifically for migraine vs BoNTA alone led to lesser reduction in monthly headache days (MHD).

Major finding: The reduction in MHD after 2-4 cycles of BoNTA treatment was significantly lower among patients receiving BoNTA plus CT for migraine vs BoNTA alone (P < .05). Side effects occurred in 20.3% of patients receiving BoNTA plus CT for migraine, with only 4.1% experiencing significant interference with functioning.

Study details: This retrospective study included 178 patients with chronic migraine who received prophylactic BoNTA with or without CT with a potential effect on migraine.

Disclosures: This study received only the open access funding enabled by Projekt DEAL. Several authors declared receiving honoraria and research funding, serving on advisory boards, or having other ties with various sources. Three authors, including the lead author, declared no conflicts of interest.

Source: Overeem LH et al. A retrospective real-life multicenter study on concurrent oral preventive treatments in patients with chronic migraine treated with onabotulinumtoxinA. CNS Drugs. 2023;37:453-465 (May 22). doi: 10.1007/s40263-023-01001-y

Key clinical point: The clinical characteristics of menstrual migraine (MM) quantitatively differ from those of non-MM, with its symptoms being more severe and inadequately captured by the current diagnostic criteria, necessitating formulation of new criteria for MM diagnosis.

Major finding: The prevalence rates of MM and non-MM were 16.6% and 45.9%, respectively. The MM vs non-MM group was more likely to have more frequent (odds ratio [OR] 7.21), longer duration (OR 2.32), and more severe (OR 1.17) migraine attacks; less frequent nonmigraine headaches (OR 0.31); better treatment outcomes with triptans (OR 1.66); better improvement in migraine attacks during late pregnancy (OR 5.10); and a faster reappearance of migraine attacks postpartum (OR 3.19; all P < .001).

Study details: This case-control study included 12,618 patients with migraine (3434 men and 9184 women).

Disclosures: This study was funded by the Candys Foundation and others. S Brunak and OB Pedersen declared receiving grants, research funds, personal fees, or compensation as a managing board member from or holding stocks in various organizations. The other authors disclosed no conflicts of interest.

Source: Chalmer MA et al. Population-based characterization of menstrual migraine and proposed diagnostic criteria. JAMA Netw Open. 2023;6:e2313235 (May 15). doi: 10.1001/jamanetworkopen.2023.13235

Key clinical point: The clinical characteristics of menstrual migraine (MM) quantitatively differ from those of non-MM, with its symptoms being more severe and inadequately captured by the current diagnostic criteria, necessitating formulation of new criteria for MM diagnosis.

Major finding: The prevalence rates of MM and non-MM were 16.6% and 45.9%, respectively. The MM vs non-MM group was more likely to have more frequent (odds ratio [OR] 7.21), longer duration (OR 2.32), and more severe (OR 1.17) migraine attacks; less frequent nonmigraine headaches (OR 0.31); better treatment outcomes with triptans (OR 1.66); better improvement in migraine attacks during late pregnancy (OR 5.10); and a faster reappearance of migraine attacks postpartum (OR 3.19; all P < .001).

Study details: This case-control study included 12,618 patients with migraine (3434 men and 9184 women).

Disclosures: This study was funded by the Candys Foundation and others. S Brunak and OB Pedersen declared receiving grants, research funds, personal fees, or compensation as a managing board member from or holding stocks in various organizations. The other authors disclosed no conflicts of interest.

Source: Chalmer MA et al. Population-based characterization of menstrual migraine and proposed diagnostic criteria. JAMA Netw Open. 2023;6:e2313235 (May 15). doi: 10.1001/jamanetworkopen.2023.13235

Key clinical point: The clinical characteristics of menstrual migraine (MM) quantitatively differ from those of non-MM, with its symptoms being more severe and inadequately captured by the current diagnostic criteria, necessitating formulation of new criteria for MM diagnosis.

Major finding: The prevalence rates of MM and non-MM were 16.6% and 45.9%, respectively. The MM vs non-MM group was more likely to have more frequent (odds ratio [OR] 7.21), longer duration (OR 2.32), and more severe (OR 1.17) migraine attacks; less frequent nonmigraine headaches (OR 0.31); better treatment outcomes with triptans (OR 1.66); better improvement in migraine attacks during late pregnancy (OR 5.10); and a faster reappearance of migraine attacks postpartum (OR 3.19; all P < .001).

Study details: This case-control study included 12,618 patients with migraine (3434 men and 9184 women).

Disclosures: This study was funded by the Candys Foundation and others. S Brunak and OB Pedersen declared receiving grants, research funds, personal fees, or compensation as a managing board member from or holding stocks in various organizations. The other authors disclosed no conflicts of interest.

Source: Chalmer MA et al. Population-based characterization of menstrual migraine and proposed diagnostic criteria. JAMA Netw Open. 2023;6:e2313235 (May 15). doi: 10.1001/jamanetworkopen.2023.13235