Headache & Migraine

Key clinical point: Lasmiditan, rimegepant, and ubrogepant demonstrated superior efficacy over placebo for the acute treatment of migraine attacks, with lasmiditan being the most effective at high doses but with higher odds of adverse events.

Major finding: Compared with placebo, 200 mg lasmiditan (odds ratio [OR] 2.88; 95% CI 2.22-3.73), followed by 100 mg lasmiditan (OR 2.28; 95% CI 1.75-2.96), rimegepant (OR 2.0; 95% CI 1.45-2.75), and 100 mg ubrogepant (OR 1.97; 95% CI 1.27-3.07) were more efficacious for achieving pain freedom at 2 hours post-dose before the use of any rescue medication. However, the odds of dizziness, nausea, and somnolence were greater with all doses of lasmiditan.

Study details: This network meta-analysis of seven phase 3 randomized controlled trials included 12,859 patients with migraine

Disclosures: This study did not report the funding source. PJ Goadsby and C Tassorelli declared receiving grants or personal fees or participating in advisory boards or lecturing at symposia for various sources.

Source: Puledda F et al. Efficacy, safety and indirect comparisons of lasmiditan, rimegepant, and ubrogepant for the acute treatment of migraine: A systematic review and network meta-analysis of the literature. Cephalalgia. 2023;43(3): 03331024231151419 (Feb 14). Doi: 10.1177/03331024231151419

Key clinical point: Lasmiditan, rimegepant, and ubrogepant demonstrated superior efficacy over placebo for the acute treatment of migraine attacks, with lasmiditan being the most effective at high doses but with higher odds of adverse events.

Major finding: Compared with placebo, 200 mg lasmiditan (odds ratio [OR] 2.88; 95% CI 2.22-3.73), followed by 100 mg lasmiditan (OR 2.28; 95% CI 1.75-2.96), rimegepant (OR 2.0; 95% CI 1.45-2.75), and 100 mg ubrogepant (OR 1.97; 95% CI 1.27-3.07) were more efficacious for achieving pain freedom at 2 hours post-dose before the use of any rescue medication. However, the odds of dizziness, nausea, and somnolence were greater with all doses of lasmiditan.

Study details: This network meta-analysis of seven phase 3 randomized controlled trials included 12,859 patients with migraine

Disclosures: This study did not report the funding source. PJ Goadsby and C Tassorelli declared receiving grants or personal fees or participating in advisory boards or lecturing at symposia for various sources.

Source: Puledda F et al. Efficacy, safety and indirect comparisons of lasmiditan, rimegepant, and ubrogepant for the acute treatment of migraine: A systematic review and network meta-analysis of the literature. Cephalalgia. 2023;43(3): 03331024231151419 (Feb 14). Doi: 10.1177/03331024231151419

Key clinical point: Lasmiditan, rimegepant, and ubrogepant demonstrated superior efficacy over placebo for the acute treatment of migraine attacks, with lasmiditan being the most effective at high doses but with higher odds of adverse events.

Major finding: Compared with placebo, 200 mg lasmiditan (odds ratio [OR] 2.88; 95% CI 2.22-3.73), followed by 100 mg lasmiditan (OR 2.28; 95% CI 1.75-2.96), rimegepant (OR 2.0; 95% CI 1.45-2.75), and 100 mg ubrogepant (OR 1.97; 95% CI 1.27-3.07) were more efficacious for achieving pain freedom at 2 hours post-dose before the use of any rescue medication. However, the odds of dizziness, nausea, and somnolence were greater with all doses of lasmiditan.

Study details: This network meta-analysis of seven phase 3 randomized controlled trials included 12,859 patients with migraine

Disclosures: This study did not report the funding source. PJ Goadsby and C Tassorelli declared receiving grants or personal fees or participating in advisory boards or lecturing at symposia for various sources.

Source: Puledda F et al. Efficacy, safety and indirect comparisons of lasmiditan, rimegepant, and ubrogepant for the acute treatment of migraine: A systematic review and network meta-analysis of the literature. Cephalalgia. 2023;43(3): 03331024231151419 (Feb 14). Doi: 10.1177/03331024231151419

Key clinical point: Both types of anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb), those against CGRP ligand (anti-CGRP) and those against CGRP receptor (anti-CGRP-R), showed benefits as preventive treatments for migraine; however, the proportion of anti-CGRP super responders was higher.

Major finding: Patients receiving anti-CGRP vs anti-CGRP-R had a significantly lower Migraine Disability Assessment scale score at 1 (P = .040) and 3 (P = .048) months and mean migraine days at 3 months (P = .01). The proportion of super responders were significantly higher in the anti-CGRP vs anti-CGRP-R group at 3-month (P = .041) and 6-month (P = .047) follow-ups.

Study details: This retrospective observational study included 152 patients with high-frequency episodic migraine or chronic migraine, of whom 68 were treated with anti-CGRP mAbs and 84 were treated with anti-CGRP-R mAbs.

Disclosures: This study did not receive any specific funding. Three authors declared serving as consultants and on scientific advisory boards or receiving speaker honoraria from various sources.

Source: Schiano di Cola F et al. An observational study on monoclonal antibodies against CGRP and its receptor. Eur J Neurol. 2023 (Mar 1). Doi: 10.1111/ene.15761

Key clinical point: Both types of anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb), those against CGRP ligand (anti-CGRP) and those against CGRP receptor (anti-CGRP-R), showed benefits as preventive treatments for migraine; however, the proportion of anti-CGRP super responders was higher.

Major finding: Patients receiving anti-CGRP vs anti-CGRP-R had a significantly lower Migraine Disability Assessment scale score at 1 (P = .040) and 3 (P = .048) months and mean migraine days at 3 months (P = .01). The proportion of super responders were significantly higher in the anti-CGRP vs anti-CGRP-R group at 3-month (P = .041) and 6-month (P = .047) follow-ups.

Study details: This retrospective observational study included 152 patients with high-frequency episodic migraine or chronic migraine, of whom 68 were treated with anti-CGRP mAbs and 84 were treated with anti-CGRP-R mAbs.

Disclosures: This study did not receive any specific funding. Three authors declared serving as consultants and on scientific advisory boards or receiving speaker honoraria from various sources.

Source: Schiano di Cola F et al. An observational study on monoclonal antibodies against CGRP and its receptor. Eur J Neurol. 2023 (Mar 1). Doi: 10.1111/ene.15761

Key clinical point: Both types of anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb), those against CGRP ligand (anti-CGRP) and those against CGRP receptor (anti-CGRP-R), showed benefits as preventive treatments for migraine; however, the proportion of anti-CGRP super responders was higher.

Major finding: Patients receiving anti-CGRP vs anti-CGRP-R had a significantly lower Migraine Disability Assessment scale score at 1 (P = .040) and 3 (P = .048) months and mean migraine days at 3 months (P = .01). The proportion of super responders were significantly higher in the anti-CGRP vs anti-CGRP-R group at 3-month (P = .041) and 6-month (P = .047) follow-ups.

Study details: This retrospective observational study included 152 patients with high-frequency episodic migraine or chronic migraine, of whom 68 were treated with anti-CGRP mAbs and 84 were treated with anti-CGRP-R mAbs.

Disclosures: This study did not receive any specific funding. Three authors declared serving as consultants and on scientific advisory boards or receiving speaker honoraria from various sources.

Source: Schiano di Cola F et al. An observational study on monoclonal antibodies against CGRP and its receptor. Eur J Neurol. 2023 (Mar 1). Doi: 10.1111/ene.15761

Key clinical point: Real-world data support fremanezumab as an effective, safe, and well-tolerated treatment option in patients with difficult-to-treat migraine and multiple preventive treatment failures.

Major finding: Overall, 83.5% and 62.6% of patients with high-frequency episodic migraine (HFEM) and chronic migraine (CM) receiving fremanezumab achieved ≥50% reduction in monthly headache days (MHD), respectively, along with a significant improvement in mean MHD, MHD with peak headache intensity of ≤5, intake of any abortive medications, migraine-related disability, and quality of life (all P < .001). Only 36 cases of mild adverse events were reported.

Study details: This open-label, single-arm, prospective, multicenter, clinical study included 204 patients with HFEM (n = 97) or CM (n = 107) who received ≥3 monthly courses of fremanezumab.

Disclosures: This study did not receive any funding. Some authors declared receiving investigator fees or travel grants from, or serving as consultants or advisory board members for various sources.

Source: Argyriou AA et al. Efficacy and safety of fremanezumab for migraine prophylaxis in patients with at least three previous preventive failures: Prospective, multicenter, real-world data from a Greek registry. Eur J Neurol. 2023 (Feb 11). Doi: 10.1111/ene.15740

Key clinical point: Real-world data support fremanezumab as an effective, safe, and well-tolerated treatment option in patients with difficult-to-treat migraine and multiple preventive treatment failures.

Major finding: Overall, 83.5% and 62.6% of patients with high-frequency episodic migraine (HFEM) and chronic migraine (CM) receiving fremanezumab achieved ≥50% reduction in monthly headache days (MHD), respectively, along with a significant improvement in mean MHD, MHD with peak headache intensity of ≤5, intake of any abortive medications, migraine-related disability, and quality of life (all P < .001). Only 36 cases of mild adverse events were reported.

Study details: This open-label, single-arm, prospective, multicenter, clinical study included 204 patients with HFEM (n = 97) or CM (n = 107) who received ≥3 monthly courses of fremanezumab.

Disclosures: This study did not receive any funding. Some authors declared receiving investigator fees or travel grants from, or serving as consultants or advisory board members for various sources.

Source: Argyriou AA et al. Efficacy and safety of fremanezumab for migraine prophylaxis in patients with at least three previous preventive failures: Prospective, multicenter, real-world data from a Greek registry. Eur J Neurol. 2023 (Feb 11). Doi: 10.1111/ene.15740

Key clinical point: Real-world data support fremanezumab as an effective, safe, and well-tolerated treatment option in patients with difficult-to-treat migraine and multiple preventive treatment failures.

Major finding: Overall, 83.5% and 62.6% of patients with high-frequency episodic migraine (HFEM) and chronic migraine (CM) receiving fremanezumab achieved ≥50% reduction in monthly headache days (MHD), respectively, along with a significant improvement in mean MHD, MHD with peak headache intensity of ≤5, intake of any abortive medications, migraine-related disability, and quality of life (all P < .001). Only 36 cases of mild adverse events were reported.

Study details: This open-label, single-arm, prospective, multicenter, clinical study included 204 patients with HFEM (n = 97) or CM (n = 107) who received ≥3 monthly courses of fremanezumab.

Disclosures: This study did not receive any funding. Some authors declared receiving investigator fees or travel grants from, or serving as consultants or advisory board members for various sources.

Source: Argyriou AA et al. Efficacy and safety of fremanezumab for migraine prophylaxis in patients with at least three previous preventive failures: Prospective, multicenter, real-world data from a Greek registry. Eur J Neurol. 2023 (Feb 11). Doi: 10.1111/ene.15740

Key clinical point: Clinical characteristics differed significantly among patients with migraine who experienced ≥75% (super-responders [SR]) vs ≤25% (non-responders [NR]) reduction in monthly headache days in the third month after initiating prophylactic treatment with calcitonin gene-related peptide receptor (CGRP-R) monoclonal antibodies (mAb).

Major finding: SR vs NR were more likely to report vomiting (P = .031) and a significant improvement in acute migraine headache with triptan treatment (P = .010). However, NR vs SR experienced chronic migraine (P = .001), medication overuse headache (P = .024), and concomitant depression (P = .005) more frequently.

Study details: This was a retrospective real-world study including 260 patients with migraine who received ≥1 treatment with CGRP-R mAbs for migraine prevention, of which 29 and 26 were SR and NR, respectively.

Disclosures: This study did not report the source of funding. Four authors declared receiving research grants, personal fees, or honoraria for consulting and lectures from various sources.

Source: Raffaelli B et al. Clinical evaluation of super-responders vs non-responders to CGRP(-receptor) monoclonal antibodies: A real-world experience. J Headache Pain. 2023;24(1):16 (Feb 27). Doi: 10.1186/s10194-023-01552-x

Key clinical point: Clinical characteristics differed significantly among patients with migraine who experienced ≥75% (super-responders [SR]) vs ≤25% (non-responders [NR]) reduction in monthly headache days in the third month after initiating prophylactic treatment with calcitonin gene-related peptide receptor (CGRP-R) monoclonal antibodies (mAb).

Major finding: SR vs NR were more likely to report vomiting (P = .031) and a significant improvement in acute migraine headache with triptan treatment (P = .010). However, NR vs SR experienced chronic migraine (P = .001), medication overuse headache (P = .024), and concomitant depression (P = .005) more frequently.

Study details: This was a retrospective real-world study including 260 patients with migraine who received ≥1 treatment with CGRP-R mAbs for migraine prevention, of which 29 and 26 were SR and NR, respectively.

Disclosures: This study did not report the source of funding. Four authors declared receiving research grants, personal fees, or honoraria for consulting and lectures from various sources.

Source: Raffaelli B et al. Clinical evaluation of super-responders vs non-responders to CGRP(-receptor) monoclonal antibodies: A real-world experience. J Headache Pain. 2023;24(1):16 (Feb 27). Doi: 10.1186/s10194-023-01552-x

Key clinical point: Clinical characteristics differed significantly among patients with migraine who experienced ≥75% (super-responders [SR]) vs ≤25% (non-responders [NR]) reduction in monthly headache days in the third month after initiating prophylactic treatment with calcitonin gene-related peptide receptor (CGRP-R) monoclonal antibodies (mAb).

Major finding: SR vs NR were more likely to report vomiting (P = .031) and a significant improvement in acute migraine headache with triptan treatment (P = .010). However, NR vs SR experienced chronic migraine (P = .001), medication overuse headache (P = .024), and concomitant depression (P = .005) more frequently.

Study details: This was a retrospective real-world study including 260 patients with migraine who received ≥1 treatment with CGRP-R mAbs for migraine prevention, of which 29 and 26 were SR and NR, respectively.

Disclosures: This study did not report the source of funding. Four authors declared receiving research grants, personal fees, or honoraria for consulting and lectures from various sources.

Source: Raffaelli B et al. Clinical evaluation of super-responders vs non-responders to CGRP(-receptor) monoclonal antibodies: A real-world experience. J Headache Pain. 2023;24(1):16 (Feb 27). Doi: 10.1186/s10194-023-01552-x

Key clinical point: Patients with traumatic brain injury (TBI) were at a significantly higher risk for subsequent migraine, with the risk being even higher among patients with TBI who were hospitalized and those who had a major trauma.

Major finding: The risk for migraine was significantly higher among patients with vs without TBI (adjusted hazard ratio [aHR] 1.484), with migraine incidence being higher after major vs minor trauma (aHR 1.670) and among hospitalized patients vs patients visiting the outpatient department (aHR 1.557; all P < .001).

Study details: This retrospective cohort study included 151,098 patients with newly diagnosed TBI and 604,394 propensity score-matched patients without TBI.

Disclosures: This study was supported by the National Science and Technology Council of the Republic of China, Cardinal Tien Hospital, and Tri-Service General Hospital Research Foundation. The authors declared no conflicts of interest.

Source: Chen MH et al. Risk of migraine after traumatic brain injury and effects of injury management levels and treatment modalities: A nationwide population-based cohort study in Taiwan. J Clin Med. 2023;12(4):1530 (Feb 15). Doi: 10.3390/jcm12041530

Key clinical point: Patients with traumatic brain injury (TBI) were at a significantly higher risk for subsequent migraine, with the risk being even higher among patients with TBI who were hospitalized and those who had a major trauma.

Major finding: The risk for migraine was significantly higher among patients with vs without TBI (adjusted hazard ratio [aHR] 1.484), with migraine incidence being higher after major vs minor trauma (aHR 1.670) and among hospitalized patients vs patients visiting the outpatient department (aHR 1.557; all P < .001).

Study details: This retrospective cohort study included 151,098 patients with newly diagnosed TBI and 604,394 propensity score-matched patients without TBI.

Disclosures: This study was supported by the National Science and Technology Council of the Republic of China, Cardinal Tien Hospital, and Tri-Service General Hospital Research Foundation. The authors declared no conflicts of interest.

Source: Chen MH et al. Risk of migraine after traumatic brain injury and effects of injury management levels and treatment modalities: A nationwide population-based cohort study in Taiwan. J Clin Med. 2023;12(4):1530 (Feb 15). Doi: 10.3390/jcm12041530

Key clinical point: Patients with traumatic brain injury (TBI) were at a significantly higher risk for subsequent migraine, with the risk being even higher among patients with TBI who were hospitalized and those who had a major trauma.

Major finding: The risk for migraine was significantly higher among patients with vs without TBI (adjusted hazard ratio [aHR] 1.484), with migraine incidence being higher after major vs minor trauma (aHR 1.670) and among hospitalized patients vs patients visiting the outpatient department (aHR 1.557; all P < .001).

Study details: This retrospective cohort study included 151,098 patients with newly diagnosed TBI and 604,394 propensity score-matched patients without TBI.

Disclosures: This study was supported by the National Science and Technology Council of the Republic of China, Cardinal Tien Hospital, and Tri-Service General Hospital Research Foundation. The authors declared no conflicts of interest.

Source: Chen MH et al. Risk of migraine after traumatic brain injury and effects of injury management levels and treatment modalities: A nationwide population-based cohort study in Taiwan. J Clin Med. 2023;12(4):1530 (Feb 15). Doi: 10.3390/jcm12041530

Key clinical point: Patients with benign paroxysmal positional vertigo (BPPV) are at a higher risk for migraine diagnosis, with female sex, hyperlipidemia, and anxiety being significant risk factors for migraine among patients with BPPV.

Major finding: In 11 years of follow-up, 1.35% vs 0.41% of participants with vs without BPPV had migraine, respectively. The risk for migraine was 2.96-fold higher among those with BPPV (adjusted hazard ratio [aHR] 2.96; 95% CI 2.30-3.80; P < .001) and significantly higher among women (aHR 2.91; 95% CI 2.30-3.80), those with hyperlipidemia (aHR 1.77; 95% CI 1.16-2.70), and those with anxiety (aHR 1.49; 95% CI 1.03-2.14).

Study details: Findings are from a retrospective cohort study including 1386 patients with BPPV and 5544 age- and sex-matched control individuals without a history of BPPV or migraine.

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

Source: Shih I-A et al. Benign paroxysmal positional vertigo is associated with an increased risk for migraine diagnosis: A nationwide population-based cohort study. Int J Environ Res Public Health. 2023;20(4):3563 (Feb 17). Doi: 10.3390/ijerph20043563

Key clinical point: Patients with benign paroxysmal positional vertigo (BPPV) are at a higher risk for migraine diagnosis, with female sex, hyperlipidemia, and anxiety being significant risk factors for migraine among patients with BPPV.

Major finding: In 11 years of follow-up, 1.35% vs 0.41% of participants with vs without BPPV had migraine, respectively. The risk for migraine was 2.96-fold higher among those with BPPV (adjusted hazard ratio [aHR] 2.96; 95% CI 2.30-3.80; P < .001) and significantly higher among women (aHR 2.91; 95% CI 2.30-3.80), those with hyperlipidemia (aHR 1.77; 95% CI 1.16-2.70), and those with anxiety (aHR 1.49; 95% CI 1.03-2.14).

Study details: Findings are from a retrospective cohort study including 1386 patients with BPPV and 5544 age- and sex-matched control individuals without a history of BPPV or migraine.

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

Source: Shih I-A et al. Benign paroxysmal positional vertigo is associated with an increased risk for migraine diagnosis: A nationwide population-based cohort study. Int J Environ Res Public Health. 2023;20(4):3563 (Feb 17). Doi: 10.3390/ijerph20043563

Key clinical point: Patients with benign paroxysmal positional vertigo (BPPV) are at a higher risk for migraine diagnosis, with female sex, hyperlipidemia, and anxiety being significant risk factors for migraine among patients with BPPV.

Major finding: In 11 years of follow-up, 1.35% vs 0.41% of participants with vs without BPPV had migraine, respectively. The risk for migraine was 2.96-fold higher among those with BPPV (adjusted hazard ratio [aHR] 2.96; 95% CI 2.30-3.80; P < .001) and significantly higher among women (aHR 2.91; 95% CI 2.30-3.80), those with hyperlipidemia (aHR 1.77; 95% CI 1.16-2.70), and those with anxiety (aHR 1.49; 95% CI 1.03-2.14).

Study details: Findings are from a retrospective cohort study including 1386 patients with BPPV and 5544 age- and sex-matched control individuals without a history of BPPV or migraine.

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

Source: Shih I-A et al. Benign paroxysmal positional vertigo is associated with an increased risk for migraine diagnosis: A nationwide population-based cohort study. Int J Environ Res Public Health. 2023;20(4):3563 (Feb 17). Doi: 10.3390/ijerph20043563

Key clinical point: About two-thirds of patients with chronic migraine (CM) showed response to galcanezumab, and everyday headache, presence of depression, and absence of accompanying symptoms were independent predictors of a poor response to galcanezumab treatment.

Major finding: After 3 months, 64.3% of patients receiving galcanezumab achieved ≥50% reduction in monthly migraine days, with everyday headache (odds ratio [OR] 0.351; P = .017), presence of depression (OR 0.439; P = .024), and absence of accompanying symptoms (OR 0.314; P = .020) being significant predictors of response to galcanezumab.

Study details: The data come from a real-world, prospective observational study including 238 patients aged ≥18 years with CM who received preventive treatment with galcanezumab injections for 3 months.

Disclosures: This study did not report the source of funding. BK Kim declared receiving honoraria and personal fees, serving on advisory boards, and being a principal investigator of trials sponsored by various sources.

Source: Lee HC et al. Predictors of response to galcanezumab in patients with chronic migraine: A real-world prospective observational study. Neurol Sci. 2023 (Feb 24). Doi: 10.1007/s10072-023-06683-2.

Key clinical point: About two-thirds of patients with chronic migraine (CM) showed response to galcanezumab, and everyday headache, presence of depression, and absence of accompanying symptoms were independent predictors of a poor response to galcanezumab treatment.

Major finding: After 3 months, 64.3% of patients receiving galcanezumab achieved ≥50% reduction in monthly migraine days, with everyday headache (odds ratio [OR] 0.351; P = .017), presence of depression (OR 0.439; P = .024), and absence of accompanying symptoms (OR 0.314; P = .020) being significant predictors of response to galcanezumab.

Study details: The data come from a real-world, prospective observational study including 238 patients aged ≥18 years with CM who received preventive treatment with galcanezumab injections for 3 months.

Disclosures: This study did not report the source of funding. BK Kim declared receiving honoraria and personal fees, serving on advisory boards, and being a principal investigator of trials sponsored by various sources.

Source: Lee HC et al. Predictors of response to galcanezumab in patients with chronic migraine: A real-world prospective observational study. Neurol Sci. 2023 (Feb 24). Doi: 10.1007/s10072-023-06683-2.

Key clinical point: About two-thirds of patients with chronic migraine (CM) showed response to galcanezumab, and everyday headache, presence of depression, and absence of accompanying symptoms were independent predictors of a poor response to galcanezumab treatment.

Major finding: After 3 months, 64.3% of patients receiving galcanezumab achieved ≥50% reduction in monthly migraine days, with everyday headache (odds ratio [OR] 0.351; P = .017), presence of depression (OR 0.439; P = .024), and absence of accompanying symptoms (OR 0.314; P = .020) being significant predictors of response to galcanezumab.

Study details: The data come from a real-world, prospective observational study including 238 patients aged ≥18 years with CM who received preventive treatment with galcanezumab injections for 3 months.

Disclosures: This study did not report the source of funding. BK Kim declared receiving honoraria and personal fees, serving on advisory boards, and being a principal investigator of trials sponsored by various sources.

Source: Lee HC et al. Predictors of response to galcanezumab in patients with chronic migraine: A real-world prospective observational study. Neurol Sci. 2023 (Feb 24). Doi: 10.1007/s10072-023-06683-2.

Key clinical point: Galcanezumab significantly reduced interictal burden, as measured by the 4-item Migraine Interictal Burden Scale (MIBS-4), in patients with episodic or chronic migraine and multiple prior migraine preventive treatment failures.

Major finding: At 3 months, the mean MIBS-4 score reduced significantly with galcanezumab vs placebo in the overall population (least-squares mean change [Δ] −1.9 vs −0.8; P < .0001) and in patients with episodic (Δ −1.8 vs −1.1; P = .033) and chronic (Δ −1.8 vs −0.3; P < .001) migraine.

Study details: This was a post hoc analysis of the CONQUER study including 462 patients with chronic or episodic migraine and multiple prior migraine preventive treatment failures who were randomly assigned to receive galcanezumab or placebo.

Disclosures: This study was funded by Eli Lilly and Company. Some authors declared receiving research funding or support from various pharmaceutical sources, including Eli Lilly and Company. Some others declared being employees and minor stockholders of Eli Lilly and Company.

Source: Lipton RB et al. Changes in migraine interictal burden following treatment with galcanezumab: Results from a phase III randomized, placebo-controlled study. Headache. 2023 (Feb 16). Doi: 10.1111/head.14460

Key clinical point: Galcanezumab significantly reduced interictal burden, as measured by the 4-item Migraine Interictal Burden Scale (MIBS-4), in patients with episodic or chronic migraine and multiple prior migraine preventive treatment failures.

Major finding: At 3 months, the mean MIBS-4 score reduced significantly with galcanezumab vs placebo in the overall population (least-squares mean change [Δ] −1.9 vs −0.8; P < .0001) and in patients with episodic (Δ −1.8 vs −1.1; P = .033) and chronic (Δ −1.8 vs −0.3; P < .001) migraine.

Study details: This was a post hoc analysis of the CONQUER study including 462 patients with chronic or episodic migraine and multiple prior migraine preventive treatment failures who were randomly assigned to receive galcanezumab or placebo.

Disclosures: This study was funded by Eli Lilly and Company. Some authors declared receiving research funding or support from various pharmaceutical sources, including Eli Lilly and Company. Some others declared being employees and minor stockholders of Eli Lilly and Company.

Source: Lipton RB et al. Changes in migraine interictal burden following treatment with galcanezumab: Results from a phase III randomized, placebo-controlled study. Headache. 2023 (Feb 16). Doi: 10.1111/head.14460

Key clinical point: Galcanezumab significantly reduced interictal burden, as measured by the 4-item Migraine Interictal Burden Scale (MIBS-4), in patients with episodic or chronic migraine and multiple prior migraine preventive treatment failures.

Major finding: At 3 months, the mean MIBS-4 score reduced significantly with galcanezumab vs placebo in the overall population (least-squares mean change [Δ] −1.9 vs −0.8; P < .0001) and in patients with episodic (Δ −1.8 vs −1.1; P = .033) and chronic (Δ −1.8 vs −0.3; P < .001) migraine.

Study details: This was a post hoc analysis of the CONQUER study including 462 patients with chronic or episodic migraine and multiple prior migraine preventive treatment failures who were randomly assigned to receive galcanezumab or placebo.

Disclosures: This study was funded by Eli Lilly and Company. Some authors declared receiving research funding or support from various pharmaceutical sources, including Eli Lilly and Company. Some others declared being employees and minor stockholders of Eli Lilly and Company.

Source: Lipton RB et al. Changes in migraine interictal burden following treatment with galcanezumab: Results from a phase III randomized, placebo-controlled study. Headache. 2023 (Feb 16). Doi: 10.1111/head.14460

Key clinical point: Network meta-analysis confirms the overall safety of anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies and gepants for migraine prevention, with rare instances of treatment discontinuation.

Major finding: The risk for serious adverse events was not significantly different with active treatments and placebo, with 30 mg eptinezumab being the only treatment significantly associated with higher odds of adverse events leading to treatment discontinuation (odds ratio [OR] 2.62; 95% CI 1.03-6.66). Compared with placebo, the risk for treatment-emergent adverse events was not significantly different with 30 mg and 100 mg eptinezumab and was the highest with 240 mg galcanezumab (OR 1.63; 95% CI 1.33-2.00) and 120 mg galcanezumab (OR 1.40; 95% CI 1.16-1.70), with the most frequent being injection site erythema, induration, and pruritus.

Study details: The data come from a network meta-analysis of 19 phase 3 randomized controlled trials including 14,584 patients with migraine.

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

Source: Messina R et al. Safety and tolerability of monoclonal antibodies targeting the CGRP pathway and gepants in migraine prevention: A systematic review and network meta-analysis. Cephalalgia. 2023;43(3):3331024231152169 (Feb 14). Doi: 10.1177/03331024231152169

Key clinical point: Network meta-analysis confirms the overall safety of anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies and gepants for migraine prevention, with rare instances of treatment discontinuation.

Major finding: The risk for serious adverse events was not significantly different with active treatments and placebo, with 30 mg eptinezumab being the only treatment significantly associated with higher odds of adverse events leading to treatment discontinuation (odds ratio [OR] 2.62; 95% CI 1.03-6.66). Compared with placebo, the risk for treatment-emergent adverse events was not significantly different with 30 mg and 100 mg eptinezumab and was the highest with 240 mg galcanezumab (OR 1.63; 95% CI 1.33-2.00) and 120 mg galcanezumab (OR 1.40; 95% CI 1.16-1.70), with the most frequent being injection site erythema, induration, and pruritus.

Study details: The data come from a network meta-analysis of 19 phase 3 randomized controlled trials including 14,584 patients with migraine.

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

Source: Messina R et al. Safety and tolerability of monoclonal antibodies targeting the CGRP pathway and gepants in migraine prevention: A systematic review and network meta-analysis. Cephalalgia. 2023;43(3):3331024231152169 (Feb 14). Doi: 10.1177/03331024231152169

Key clinical point: Network meta-analysis confirms the overall safety of anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies and gepants for migraine prevention, with rare instances of treatment discontinuation.

Major finding: The risk for serious adverse events was not significantly different with active treatments and placebo, with 30 mg eptinezumab being the only treatment significantly associated with higher odds of adverse events leading to treatment discontinuation (odds ratio [OR] 2.62; 95% CI 1.03-6.66). Compared with placebo, the risk for treatment-emergent adverse events was not significantly different with 30 mg and 100 mg eptinezumab and was the highest with 240 mg galcanezumab (OR 1.63; 95% CI 1.33-2.00) and 120 mg galcanezumab (OR 1.40; 95% CI 1.16-1.70), with the most frequent being injection site erythema, induration, and pruritus.

Study details: The data come from a network meta-analysis of 19 phase 3 randomized controlled trials including 14,584 patients with migraine.

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

Source: Messina R et al. Safety and tolerability of monoclonal antibodies targeting the CGRP pathway and gepants in migraine prevention: A systematic review and network meta-analysis. Cephalalgia. 2023;43(3):3331024231152169 (Feb 14). Doi: 10.1177/03331024231152169

Key clinical point: Zavegepant nasal spray was effective in the acute treatment of migraine, with favorable tolerability and safety profiles.

Major finding: At 2 hours post-dose, higher proportions of patients treated with zavegepant vs placebo were free from pain (risk difference 8.8 percentage points; P < .0001) and from their most bothersome symptom (risk difference 8.7 percentage points; P = .0012). Dysgeusia (21% vs 5%), nasal discomfort (4% vs 1%), and nausea (3% vs 1%) were the most common adverse events in the zavegepant vs placebo group.

Study details: Findings are from a phase 3 trial including 1405 patients with ≥1-year history of migraine with or without aura who were randomly assigned to receive zavegepant 10 mg nasal spray (n = 703) or matching placebo (n = 702).

Disclosures: This study was funded by Biohaven Pharmaceuticals. Some authors declared being employees of and holding stocks or stock options in Biohaven Pharmaceuticals. Some others declared ties with various sources, including Biohaven Pharmaceuticals.

Source: Lipton RB et al. Safety, tolerability, and efficacy of zavegepant 10 mg nasal spray for the acute treatment of migraine in the USA: A phase 3, double-blind, randomised, placebo-controlled multicentre trial. Lancet Neurol. 2023;22(3):209-217 (Mar). Doi: 10.1016/S1474-4422(22)00517-8

Key clinical point: Zavegepant nasal spray was effective in the acute treatment of migraine, with favorable tolerability and safety profiles.

Major finding: At 2 hours post-dose, higher proportions of patients treated with zavegepant vs placebo were free from pain (risk difference 8.8 percentage points; P < .0001) and from their most bothersome symptom (risk difference 8.7 percentage points; P = .0012). Dysgeusia (21% vs 5%), nasal discomfort (4% vs 1%), and nausea (3% vs 1%) were the most common adverse events in the zavegepant vs placebo group.

Study details: Findings are from a phase 3 trial including 1405 patients with ≥1-year history of migraine with or without aura who were randomly assigned to receive zavegepant 10 mg nasal spray (n = 703) or matching placebo (n = 702).

Disclosures: This study was funded by Biohaven Pharmaceuticals. Some authors declared being employees of and holding stocks or stock options in Biohaven Pharmaceuticals. Some others declared ties with various sources, including Biohaven Pharmaceuticals.

Source: Lipton RB et al. Safety, tolerability, and efficacy of zavegepant 10 mg nasal spray for the acute treatment of migraine in the USA: A phase 3, double-blind, randomised, placebo-controlled multicentre trial. Lancet Neurol. 2023;22(3):209-217 (Mar). Doi: 10.1016/S1474-4422(22)00517-8

Key clinical point: Zavegepant nasal spray was effective in the acute treatment of migraine, with favorable tolerability and safety profiles.

Major finding: At 2 hours post-dose, higher proportions of patients treated with zavegepant vs placebo were free from pain (risk difference 8.8 percentage points; P < .0001) and from their most bothersome symptom (risk difference 8.7 percentage points; P = .0012). Dysgeusia (21% vs 5%), nasal discomfort (4% vs 1%), and nausea (3% vs 1%) were the most common adverse events in the zavegepant vs placebo group.

Study details: Findings are from a phase 3 trial including 1405 patients with ≥1-year history of migraine with or without aura who were randomly assigned to receive zavegepant 10 mg nasal spray (n = 703) or matching placebo (n = 702).

Disclosures: This study was funded by Biohaven Pharmaceuticals. Some authors declared being employees of and holding stocks or stock options in Biohaven Pharmaceuticals. Some others declared ties with various sources, including Biohaven Pharmaceuticals.

Source: Lipton RB et al. Safety, tolerability, and efficacy of zavegepant 10 mg nasal spray for the acute treatment of migraine in the USA: A phase 3, double-blind, randomised, placebo-controlled multicentre trial. Lancet Neurol. 2023;22(3):209-217 (Mar). Doi: 10.1016/S1474-4422(22)00517-8