Headache & Migraine

Key clinical point: Increased intake of dietary fiber seemed protective against migraine or severe headache in a large population of US adults.

Major finding: Risk for migraine or severe headache was 26% lower among patients in the highest (22.10-95.50 g/day) vs lowest (0.0-7.79 g/day) quintile of dietary fiber intake (adjusted odds ratio 0.74; P  =  .0029).

Study details: This cross-sectional study included 12,710 participants from the US National Health and Nutrition Examination Survey, of which 2527 experienced migraine or severe headache.

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

Source: Huang H and He K. The association between dietary fiber intake and severe headaches or migraine in US adults. Front Nutr. 2023;9:1044066  (Jan 4). Doi: 10.3389/fnut.2022.1044066

Key clinical point: Increased intake of dietary fiber seemed protective against migraine or severe headache in a large population of US adults.

Major finding: Risk for migraine or severe headache was 26% lower among patients in the highest (22.10-95.50 g/day) vs lowest (0.0-7.79 g/day) quintile of dietary fiber intake (adjusted odds ratio 0.74; P  =  .0029).

Study details: This cross-sectional study included 12,710 participants from the US National Health and Nutrition Examination Survey, of which 2527 experienced migraine or severe headache.

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

Source: Huang H and He K. The association between dietary fiber intake and severe headaches or migraine in US adults. Front Nutr. 2023;9:1044066  (Jan 4). Doi: 10.3389/fnut.2022.1044066

Key clinical point: Increased intake of dietary fiber seemed protective against migraine or severe headache in a large population of US adults.

Major finding: Risk for migraine or severe headache was 26% lower among patients in the highest (22.10-95.50 g/day) vs lowest (0.0-7.79 g/day) quintile of dietary fiber intake (adjusted odds ratio 0.74; P  =  .0029).

Study details: This cross-sectional study included 12,710 participants from the US National Health and Nutrition Examination Survey, of which 2527 experienced migraine or severe headache.

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

Source: Huang H and He K. The association between dietary fiber intake and severe headaches or migraine in US adults. Front Nutr. 2023;9:1044066  (Jan 4). Doi: 10.3389/fnut.2022.1044066

Key clinical point: Index vein served as a good biomarker for migraine aura with a high diagnostic specificity and sensitivity in the emergency setting in patients with acute neurological deficit.

Major finding: Prevalence of index vein was more frequent in patients with migraine aura (17%) vs those with stroke (2%)/epileptic seizure (4%) or control participants (1%; P < .001). Index vein was highly specific to migraine aura (specificity 97%; 95% CI 95%-99%), with an ability to diagnose migraine aura with 94% sensitivity (95% CI 87.4%-97.8%) and 73.5% specificity (95% CI 66.8%-79.5%) at a cut-off of 4 points.

Study details: This retrospective case-control study included 400 patients who presented to the emergency department with an acute neurological deficit, underwent brain magnetic resonance imaging, and were discharged with a diagnosis of migraine aura/ischemic stroke/epileptic seizure or none of these (control participants).

Disclosures: This study did not receive any specific funding. Two authors declared serving as part-time employees at Zynnon or as a consultant, speaker, or advisory board member for various sources.

Source: Scutelnic A et al. The “index vein” as a sign for migraine aura in the emergency setting. Cephalalgia. 2023 (Jan 9). Doi: 10.1177/033310242211320

Key clinical point: Index vein served as a good biomarker for migraine aura with a high diagnostic specificity and sensitivity in the emergency setting in patients with acute neurological deficit.

Major finding: Prevalence of index vein was more frequent in patients with migraine aura (17%) vs those with stroke (2%)/epileptic seizure (4%) or control participants (1%; P < .001). Index vein was highly specific to migraine aura (specificity 97%; 95% CI 95%-99%), with an ability to diagnose migraine aura with 94% sensitivity (95% CI 87.4%-97.8%) and 73.5% specificity (95% CI 66.8%-79.5%) at a cut-off of 4 points.

Study details: This retrospective case-control study included 400 patients who presented to the emergency department with an acute neurological deficit, underwent brain magnetic resonance imaging, and were discharged with a diagnosis of migraine aura/ischemic stroke/epileptic seizure or none of these (control participants).

Disclosures: This study did not receive any specific funding. Two authors declared serving as part-time employees at Zynnon or as a consultant, speaker, or advisory board member for various sources.

Source: Scutelnic A et al. The “index vein” as a sign for migraine aura in the emergency setting. Cephalalgia. 2023 (Jan 9). Doi: 10.1177/033310242211320

Key clinical point: Index vein served as a good biomarker for migraine aura with a high diagnostic specificity and sensitivity in the emergency setting in patients with acute neurological deficit.

Major finding: Prevalence of index vein was more frequent in patients with migraine aura (17%) vs those with stroke (2%)/epileptic seizure (4%) or control participants (1%; P < .001). Index vein was highly specific to migraine aura (specificity 97%; 95% CI 95%-99%), with an ability to diagnose migraine aura with 94% sensitivity (95% CI 87.4%-97.8%) and 73.5% specificity (95% CI 66.8%-79.5%) at a cut-off of 4 points.

Study details: This retrospective case-control study included 400 patients who presented to the emergency department with an acute neurological deficit, underwent brain magnetic resonance imaging, and were discharged with a diagnosis of migraine aura/ischemic stroke/epileptic seizure or none of these (control participants).

Disclosures: This study did not receive any specific funding. Two authors declared serving as part-time employees at Zynnon or as a consultant, speaker, or advisory board member for various sources.

Source: Scutelnic A et al. The “index vein” as a sign for migraine aura in the emergency setting. Cephalalgia. 2023 (Jan 9). Doi: 10.1177/033310242211320

Key clinical point: American adults with higher dietary zinc intake were at a lower risk for migraine, demonstrating an inverse association between dietary zinc intake and migraine.

Major finding: The risk for migraine was significantly lower among participants in the highest (≥15.8 mg/day) vs lowest (≤5.9 mg/day) quintile of dietary zinc intake (adjusted odds ratio [aOR] 0.70; P  =  .029) and remained low among participants with dietary zinc intake of at least 6.0-8.4 mg/day (aOR 0.73; P  =  .004).

Study details: This cross-sectional study included 11,088 adults with or without migraine from the US National Health and Nutrition Examination Survey (1999-2004).

Disclosures: This study was supported by grants from the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Liu H et al. Dietary zinc intake and migraine in adults: A cross-sectional analysis of the National Health and Nutrition Examination Survey 1999-2004. Headache. 2023 (Jan 1). Doi: 10.1111/head.14431

Key clinical point: American adults with higher dietary zinc intake were at a lower risk for migraine, demonstrating an inverse association between dietary zinc intake and migraine.

Major finding: The risk for migraine was significantly lower among participants in the highest (≥15.8 mg/day) vs lowest (≤5.9 mg/day) quintile of dietary zinc intake (adjusted odds ratio [aOR] 0.70; P  =  .029) and remained low among participants with dietary zinc intake of at least 6.0-8.4 mg/day (aOR 0.73; P  =  .004).

Study details: This cross-sectional study included 11,088 adults with or without migraine from the US National Health and Nutrition Examination Survey (1999-2004).

Disclosures: This study was supported by grants from the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Liu H et al. Dietary zinc intake and migraine in adults: A cross-sectional analysis of the National Health and Nutrition Examination Survey 1999-2004. Headache. 2023 (Jan 1). Doi: 10.1111/head.14431

Key clinical point: American adults with higher dietary zinc intake were at a lower risk for migraine, demonstrating an inverse association between dietary zinc intake and migraine.

Major finding: The risk for migraine was significantly lower among participants in the highest (≥15.8 mg/day) vs lowest (≤5.9 mg/day) quintile of dietary zinc intake (adjusted odds ratio [aOR] 0.70; P  =  .029) and remained low among participants with dietary zinc intake of at least 6.0-8.4 mg/day (aOR 0.73; P  =  .004).

Study details: This cross-sectional study included 11,088 adults with or without migraine from the US National Health and Nutrition Examination Survey (1999-2004).

Disclosures: This study was supported by grants from the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Liu H et al. Dietary zinc intake and migraine in adults: A cross-sectional analysis of the National Health and Nutrition Examination Survey 1999-2004. Headache. 2023 (Jan 1). Doi: 10.1111/head.14431

Key clinical point: Eptinezumab vs placebo demonstrated significantly greater and sustained improvements in patient-reported overall health, quality of life, and most bothersome symptoms in patients with migraine and 2-4 preventive treatment failures.

Major finding: At week 12, 100 and 300 mg eptinezumab vs placebo led to significantly greater improvements in EQ-5D-5L visual analog scale scores (difference from placebo [Δ] 5.1; P < .001, and Δ 7.5; P < .0001, respectively), 6-item Headache Impact Test total scores (Δ −3.8 and −5.4, respectively; both P < .0001), Migraine-Specific Quality of Life Questionnaire scores (both P < .0001), and patient-identified most bothersome symptoms (both P < .0001), with effects sustained until week 24.

Study details: Findings are from the phase 3b DELIVER trial including 890 adults with episodic/chronic migraine and 2-4 prior preventive treatment failures who were randomly assigned to receive eptinezumab (100/300 mg) or placebo.

Disclosures: The clinical trial and publication was funded by H. Lundbeck A/S. Five authors declared being employees of H. Lundbeck A/S. Three authors reported ties with various sources.

Source: Goadsby PJ et al. Eptinezumab improved patient-reported outcomes and quality of life in patients with migraine and prior preventive treatment failures. Eur J Neurol. 2022 (Dec 30). Doi: 10.1111/ene.15670

Key clinical point: Eptinezumab vs placebo demonstrated significantly greater and sustained improvements in patient-reported overall health, quality of life, and most bothersome symptoms in patients with migraine and 2-4 preventive treatment failures.

Major finding: At week 12, 100 and 300 mg eptinezumab vs placebo led to significantly greater improvements in EQ-5D-5L visual analog scale scores (difference from placebo [Δ] 5.1; P < .001, and Δ 7.5; P < .0001, respectively), 6-item Headache Impact Test total scores (Δ −3.8 and −5.4, respectively; both P < .0001), Migraine-Specific Quality of Life Questionnaire scores (both P < .0001), and patient-identified most bothersome symptoms (both P < .0001), with effects sustained until week 24.

Study details: Findings are from the phase 3b DELIVER trial including 890 adults with episodic/chronic migraine and 2-4 prior preventive treatment failures who were randomly assigned to receive eptinezumab (100/300 mg) or placebo.

Disclosures: The clinical trial and publication was funded by H. Lundbeck A/S. Five authors declared being employees of H. Lundbeck A/S. Three authors reported ties with various sources.

Source: Goadsby PJ et al. Eptinezumab improved patient-reported outcomes and quality of life in patients with migraine and prior preventive treatment failures. Eur J Neurol. 2022 (Dec 30). Doi: 10.1111/ene.15670

Key clinical point: Eptinezumab vs placebo demonstrated significantly greater and sustained improvements in patient-reported overall health, quality of life, and most bothersome symptoms in patients with migraine and 2-4 preventive treatment failures.

Major finding: At week 12, 100 and 300 mg eptinezumab vs placebo led to significantly greater improvements in EQ-5D-5L visual analog scale scores (difference from placebo [Δ] 5.1; P < .001, and Δ 7.5; P < .0001, respectively), 6-item Headache Impact Test total scores (Δ −3.8 and −5.4, respectively; both P < .0001), Migraine-Specific Quality of Life Questionnaire scores (both P < .0001), and patient-identified most bothersome symptoms (both P < .0001), with effects sustained until week 24.

Study details: Findings are from the phase 3b DELIVER trial including 890 adults with episodic/chronic migraine and 2-4 prior preventive treatment failures who were randomly assigned to receive eptinezumab (100/300 mg) or placebo.

Disclosures: The clinical trial and publication was funded by H. Lundbeck A/S. Five authors declared being employees of H. Lundbeck A/S. Three authors reported ties with various sources.

Source: Goadsby PJ et al. Eptinezumab improved patient-reported outcomes and quality of life in patients with migraine and prior preventive treatment failures. Eur J Neurol. 2022 (Dec 30). Doi: 10.1111/ene.15670

Key clinical point: Single session of onabotulinumtoxinA effectively reduced neck and migraine-related disability and pain intensity over 3 months in patients with chronic migraine.

Major finding: OnabotulinumtoxinA significantly reduced Neck Disability Index scores (median −16.5 points; P < .001) and Migraine Disability Assessment scores (median −28 points; P < .001) after 4 weeks. The neck pain intensity and migraine headache intensity reduced by almost half (both P < .001) and the median number of monthly headache days reduced from 20 to 6 days (P < .001) after 3 months of onabotulinumtoxinA treatment.

Study details: This retrospective study included 134 patients with chronic migraine who received one session of onabotulinumtoxinA treatment.

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

Source: Onan D et al. OnabotulinumtoxinA treatment in chronic migraine: Investigation of its effects on disability, headache and neck pain intensity. Toxins (Basel). 2022;15(1):29 (Dec 30). Doi: 10.3390/toxins15010029

Key clinical point: Single session of onabotulinumtoxinA effectively reduced neck and migraine-related disability and pain intensity over 3 months in patients with chronic migraine.

Major finding: OnabotulinumtoxinA significantly reduced Neck Disability Index scores (median −16.5 points; P < .001) and Migraine Disability Assessment scores (median −28 points; P < .001) after 4 weeks. The neck pain intensity and migraine headache intensity reduced by almost half (both P < .001) and the median number of monthly headache days reduced from 20 to 6 days (P < .001) after 3 months of onabotulinumtoxinA treatment.

Study details: This retrospective study included 134 patients with chronic migraine who received one session of onabotulinumtoxinA treatment.

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

Source: Onan D et al. OnabotulinumtoxinA treatment in chronic migraine: Investigation of its effects on disability, headache and neck pain intensity. Toxins (Basel). 2022;15(1):29 (Dec 30). Doi: 10.3390/toxins15010029

Key clinical point: Single session of onabotulinumtoxinA effectively reduced neck and migraine-related disability and pain intensity over 3 months in patients with chronic migraine.

Major finding: OnabotulinumtoxinA significantly reduced Neck Disability Index scores (median −16.5 points; P < .001) and Migraine Disability Assessment scores (median −28 points; P < .001) after 4 weeks. The neck pain intensity and migraine headache intensity reduced by almost half (both P < .001) and the median number of monthly headache days reduced from 20 to 6 days (P < .001) after 3 months of onabotulinumtoxinA treatment.

Study details: This retrospective study included 134 patients with chronic migraine who received one session of onabotulinumtoxinA treatment.

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

Source: Onan D et al. OnabotulinumtoxinA treatment in chronic migraine: Investigation of its effects on disability, headache and neck pain intensity. Toxins (Basel). 2022;15(1):29 (Dec 30). Doi: 10.3390/toxins15010029

Key clinical point: The safety and tolerability of once-daily atogepant observed over 40 weeks in this extension trial aligns with profiles from the pivotal phase 3 trials with no new safety signals identified in patients with episodic migraine.

Major finding: Nearly 63% of patients reported treatment-emergent adverse events, most being mild or moderate, with upper respiratory tract infection (5.5%) and urinary tract infection (5.3%) being most frequent. Treatment discontinuation rates due to lack of efficacy (0.6%) or adverse events (3.6%) were low. No deaths were reported.

Study details: Findings are from the 309-OLEX trial, an open-label extension of phase 3 ADVANCE trial, including 685 patients with episodic migraine with or without aura who received 60 mg atogepant once daily for 40 weeks.

Disclosures: This study was supported by AbbVie Inc. (formerly Allergan). Five authors declared being full-time or former employees of or holding stock or stock options in AbbVie. Several authors reported ties with various sources, including AbbVie.

Source: Klein BC et al. Safety and tolerability results of atogepant for the preventive treatment of episodic migraine from a 40-week, open-label multicenter extension of the phase 3 ADVANCE trial. Cephalalgia. 2023 (Jan 9). Doi: 10.1177/03331024221128250

Key clinical point: The safety and tolerability of once-daily atogepant observed over 40 weeks in this extension trial aligns with profiles from the pivotal phase 3 trials with no new safety signals identified in patients with episodic migraine.

Major finding: Nearly 63% of patients reported treatment-emergent adverse events, most being mild or moderate, with upper respiratory tract infection (5.5%) and urinary tract infection (5.3%) being most frequent. Treatment discontinuation rates due to lack of efficacy (0.6%) or adverse events (3.6%) were low. No deaths were reported.

Study details: Findings are from the 309-OLEX trial, an open-label extension of phase 3 ADVANCE trial, including 685 patients with episodic migraine with or without aura who received 60 mg atogepant once daily for 40 weeks.

Disclosures: This study was supported by AbbVie Inc. (formerly Allergan). Five authors declared being full-time or former employees of or holding stock or stock options in AbbVie. Several authors reported ties with various sources, including AbbVie.

Source: Klein BC et al. Safety and tolerability results of atogepant for the preventive treatment of episodic migraine from a 40-week, open-label multicenter extension of the phase 3 ADVANCE trial. Cephalalgia. 2023 (Jan 9). Doi: 10.1177/03331024221128250

Key clinical point: The safety and tolerability of once-daily atogepant observed over 40 weeks in this extension trial aligns with profiles from the pivotal phase 3 trials with no new safety signals identified in patients with episodic migraine.

Major finding: Nearly 63% of patients reported treatment-emergent adverse events, most being mild or moderate, with upper respiratory tract infection (5.5%) and urinary tract infection (5.3%) being most frequent. Treatment discontinuation rates due to lack of efficacy (0.6%) or adverse events (3.6%) were low. No deaths were reported.

Study details: Findings are from the 309-OLEX trial, an open-label extension of phase 3 ADVANCE trial, including 685 patients with episodic migraine with or without aura who received 60 mg atogepant once daily for 40 weeks.

Disclosures: This study was supported by AbbVie Inc. (formerly Allergan). Five authors declared being full-time or former employees of or holding stock or stock options in AbbVie. Several authors reported ties with various sources, including AbbVie.

Source: Klein BC et al. Safety and tolerability results of atogepant for the preventive treatment of episodic migraine from a 40-week, open-label multicenter extension of the phase 3 ADVANCE trial. Cephalalgia. 2023 (Jan 9). Doi: 10.1177/03331024221128250

Key clinical point: A preconception history of migraine showed no significant association with the risk for spontaneous abortion (SAB); however, routine use of medication, suggesting more severe migraine, may confer a greater SAB risk.

Major finding: Preconception migraine history did not increase the risk for SAB (adjusted hazard ratio [aHR] 1.03; 95% CI 0.91-1.16), but daily migraine medication use (aHR 1.38; 95% CI 0.81-2.35), use of prescription migraine prophylaxis medication (aHR 1.43; 95% CI 0.72-2.84), or analgesic/caffeine medication use (aHR 1.42; 95% CI 0.99-2.04) showed a modest but non-significant association with SAB risk.

Study details: This study evaluated 7890 participants from an ongoing prospective study who conceived during follow-up and had or did not have a preconception diagnosis of migraine or migraine medication use, of which 1537 experienced SAB.

Disclosures: This study was funded by the National Institute of Child Health and Human Development, US National Institutes of Health. The authors declared no conflicts of interest.

Source: Crowe HM et al. Pre‑pregnancy migraine diagnosis, medication use, and spontaneous abortion: A prospective cohort study. J Headache Pain. 2022;23:162 (Dec 20). Doi: 10.1186/s10194-022-01533-6

Key clinical point: A preconception history of migraine showed no significant association with the risk for spontaneous abortion (SAB); however, routine use of medication, suggesting more severe migraine, may confer a greater SAB risk.

Major finding: Preconception migraine history did not increase the risk for SAB (adjusted hazard ratio [aHR] 1.03; 95% CI 0.91-1.16), but daily migraine medication use (aHR 1.38; 95% CI 0.81-2.35), use of prescription migraine prophylaxis medication (aHR 1.43; 95% CI 0.72-2.84), or analgesic/caffeine medication use (aHR 1.42; 95% CI 0.99-2.04) showed a modest but non-significant association with SAB risk.

Study details: This study evaluated 7890 participants from an ongoing prospective study who conceived during follow-up and had or did not have a preconception diagnosis of migraine or migraine medication use, of which 1537 experienced SAB.

Disclosures: This study was funded by the National Institute of Child Health and Human Development, US National Institutes of Health. The authors declared no conflicts of interest.

Source: Crowe HM et al. Pre‑pregnancy migraine diagnosis, medication use, and spontaneous abortion: A prospective cohort study. J Headache Pain. 2022;23:162 (Dec 20). Doi: 10.1186/s10194-022-01533-6

Key clinical point: A preconception history of migraine showed no significant association with the risk for spontaneous abortion (SAB); however, routine use of medication, suggesting more severe migraine, may confer a greater SAB risk.

Major finding: Preconception migraine history did not increase the risk for SAB (adjusted hazard ratio [aHR] 1.03; 95% CI 0.91-1.16), but daily migraine medication use (aHR 1.38; 95% CI 0.81-2.35), use of prescription migraine prophylaxis medication (aHR 1.43; 95% CI 0.72-2.84), or analgesic/caffeine medication use (aHR 1.42; 95% CI 0.99-2.04) showed a modest but non-significant association with SAB risk.

Study details: This study evaluated 7890 participants from an ongoing prospective study who conceived during follow-up and had or did not have a preconception diagnosis of migraine or migraine medication use, of which 1537 experienced SAB.

Disclosures: This study was funded by the National Institute of Child Health and Human Development, US National Institutes of Health. The authors declared no conflicts of interest.

Source: Crowe HM et al. Pre‑pregnancy migraine diagnosis, medication use, and spontaneous abortion: A prospective cohort study. J Headache Pain. 2022;23:162 (Dec 20). Doi: 10.1186/s10194-022-01533-6

Key clinical point: A brief group education and supportive self-management program had no beneficial effects on clinically relevant outcomes in patients with chronic migraine or chronic tension type headache and episodic migraine, with or without medication overuse headache.

Major finding: At 12 months, Headache Impact Test scores (adjusted mean difference [AMD] −0.3; P  =  .56), number of headache days (AMD 0.2; P  =  .234), duration of headache (estimated difference [ED] 0.4; P  =  .361), and headache severity (ED 0.2; P  =  .163) were not significantly different between patients who received self-management intervention vs usual care.

Study details: The data come from CHESS, a randomized controlled trial, including 727 participants with chronic migraine or chronic tension type headache and episodic migraine, with or without medication overuse headache, who received self-management intervention or usual care.

Disclosures: This study was funded by the UK National Institute for Health Research Programme Grants for Applied Research program. Several authors reported receiving grants, personal fees, or honoraria from various sources or owning patent.

Source: Underwood M et al. A supportive self-management program for people with chronic headaches and migraine: A randomized controlled trial and economic evaluation. Neurology. 2022 (Dec 16). Doi: 10.1212/WNL.0000000000201518

Key clinical point: A brief group education and supportive self-management program had no beneficial effects on clinically relevant outcomes in patients with chronic migraine or chronic tension type headache and episodic migraine, with or without medication overuse headache.

Major finding: At 12 months, Headache Impact Test scores (adjusted mean difference [AMD] −0.3; P  =  .56), number of headache days (AMD 0.2; P  =  .234), duration of headache (estimated difference [ED] 0.4; P  =  .361), and headache severity (ED 0.2; P  =  .163) were not significantly different between patients who received self-management intervention vs usual care.

Study details: The data come from CHESS, a randomized controlled trial, including 727 participants with chronic migraine or chronic tension type headache and episodic migraine, with or without medication overuse headache, who received self-management intervention or usual care.

Disclosures: This study was funded by the UK National Institute for Health Research Programme Grants for Applied Research program. Several authors reported receiving grants, personal fees, or honoraria from various sources or owning patent.

Source: Underwood M et al. A supportive self-management program for people with chronic headaches and migraine: A randomized controlled trial and economic evaluation. Neurology. 2022 (Dec 16). Doi: 10.1212/WNL.0000000000201518

Key clinical point: A brief group education and supportive self-management program had no beneficial effects on clinically relevant outcomes in patients with chronic migraine or chronic tension type headache and episodic migraine, with or without medication overuse headache.

Major finding: At 12 months, Headache Impact Test scores (adjusted mean difference [AMD] −0.3; P  =  .56), number of headache days (AMD 0.2; P  =  .234), duration of headache (estimated difference [ED] 0.4; P  =  .361), and headache severity (ED 0.2; P  =  .163) were not significantly different between patients who received self-management intervention vs usual care.

Study details: The data come from CHESS, a randomized controlled trial, including 727 participants with chronic migraine or chronic tension type headache and episodic migraine, with or without medication overuse headache, who received self-management intervention or usual care.

Disclosures: This study was funded by the UK National Institute for Health Research Programme Grants for Applied Research program. Several authors reported receiving grants, personal fees, or honoraria from various sources or owning patent.

Source: Underwood M et al. A supportive self-management program for people with chronic headaches and migraine: A randomized controlled trial and economic evaluation. Neurology. 2022 (Dec 16). Doi: 10.1212/WNL.0000000000201518

Key clinical point: Erenumab and onabotulinumtoxinA (onabotA) dual therapy appeared less effective than erenumab alone in patients with chronic migraine.

Major finding: After 12 weeks, patients who were taking onabotA while initiating erenumab and maintained it as dual therapy (WBT) vs those who received erenumab alone (NoBT) had a lower reduction in mean monthly headache days (MHD; 4.7 vs 8.21 days; P  =  .009) and lower mean percentage improvement in MHD (21.7% vs 35.0%; P  =  .001), with a similar trend being observed among patients who were on onabotA while initiating erenumab but discontinued onabotA (WoBT).

Study details: This retrospective cohort study included 187 patients with chronic migraine who received WBT (n = 73), WoBT (n = 44), or NoBT (n = 70).

Disclosures: This study did not receive any specific funding. A Jaimes and J Rodríguez-Vico declared receiving honoraria or speaking fees from AbbVie and other sources.

Source: Jaimes A et al. Dual therapy with Erenumab and onabotulinumtoxinA: No synergistic effect in chronic migraine: A retrospective cohort study. Pain Pract. 2022 (Dec 12). Doi: 10.1111/papr.13196

Key clinical point: Erenumab and onabotulinumtoxinA (onabotA) dual therapy appeared less effective than erenumab alone in patients with chronic migraine.

Major finding: After 12 weeks, patients who were taking onabotA while initiating erenumab and maintained it as dual therapy (WBT) vs those who received erenumab alone (NoBT) had a lower reduction in mean monthly headache days (MHD; 4.7 vs 8.21 days; P  =  .009) and lower mean percentage improvement in MHD (21.7% vs 35.0%; P  =  .001), with a similar trend being observed among patients who were on onabotA while initiating erenumab but discontinued onabotA (WoBT).

Study details: This retrospective cohort study included 187 patients with chronic migraine who received WBT (n = 73), WoBT (n = 44), or NoBT (n = 70).

Disclosures: This study did not receive any specific funding. A Jaimes and J Rodríguez-Vico declared receiving honoraria or speaking fees from AbbVie and other sources.

Source: Jaimes A et al. Dual therapy with Erenumab and onabotulinumtoxinA: No synergistic effect in chronic migraine: A retrospective cohort study. Pain Pract. 2022 (Dec 12). Doi: 10.1111/papr.13196

Key clinical point: Erenumab and onabotulinumtoxinA (onabotA) dual therapy appeared less effective than erenumab alone in patients with chronic migraine.

Major finding: After 12 weeks, patients who were taking onabotA while initiating erenumab and maintained it as dual therapy (WBT) vs those who received erenumab alone (NoBT) had a lower reduction in mean monthly headache days (MHD; 4.7 vs 8.21 days; P  =  .009) and lower mean percentage improvement in MHD (21.7% vs 35.0%; P  =  .001), with a similar trend being observed among patients who were on onabotA while initiating erenumab but discontinued onabotA (WoBT).

Study details: This retrospective cohort study included 187 patients with chronic migraine who received WBT (n = 73), WoBT (n = 44), or NoBT (n = 70).

Disclosures: This study did not receive any specific funding. A Jaimes and J Rodríguez-Vico declared receiving honoraria or speaking fees from AbbVie and other sources.

Source: Jaimes A et al. Dual therapy with Erenumab and onabotulinumtoxinA: No synergistic effect in chronic migraine: A retrospective cohort study. Pain Pract. 2022 (Dec 12). Doi: 10.1111/papr.13196

Key clinical point: Erenumab and onabotulinumtoxinA (onabotA) dual therapy appeared less effective than erenumab alone in patients with chronic migraine.

Major finding: After 12 weeks, patients who were taking onabotA while initiating erenumab and maintained it as dual therapy (WBT) vs those who received erenumab alone (NoBT) had a lower reduction in mean monthly headache days (MHD; 4.7 vs 8.21 days; P  =  .009) and lower mean percentage improvement in MHD (21.7% vs 35.0%; P  =  .001), with a similar trend being observed among patients who were on onabotA while initiating erenumab but discontinued onabotA (WoBT).

Study details: This retrospective cohort study included 187 patients with chronic migraine who received WBT (n = 73), WoBT (n = 44), or NoBT (n = 70).

Disclosures: This study did not receive any specific funding. A Jaimes and J Rodríguez-Vico declared receiving honoraria or speaking fees from AbbVie and other sources.

Source: Jaimes A et al. Dual therapy with Erenumab and onabotulinumtoxinA: No synergistic effect in chronic migraine: A retrospective cohort study. Pain Pract. 2022 (Dec 12). Doi: 10.1111/papr.13196

Key clinical point: Erenumab and onabotulinumtoxinA (onabotA) dual therapy appeared less effective than erenumab alone in patients with chronic migraine.

Major finding: After 12 weeks, patients who were taking onabotA while initiating erenumab and maintained it as dual therapy (WBT) vs those who received erenumab alone (NoBT) had a lower reduction in mean monthly headache days (MHD; 4.7 vs 8.21 days; P  =  .009) and lower mean percentage improvement in MHD (21.7% vs 35.0%; P  =  .001), with a similar trend being observed among patients who were on onabotA while initiating erenumab but discontinued onabotA (WoBT).

Study details: This retrospective cohort study included 187 patients with chronic migraine who received WBT (n = 73), WoBT (n = 44), or NoBT (n = 70).

Disclosures: This study did not receive any specific funding. A Jaimes and J Rodríguez-Vico declared receiving honoraria or speaking fees from AbbVie and other sources.

Source: Jaimes A et al. Dual therapy with Erenumab and onabotulinumtoxinA: No synergistic effect in chronic migraine: A retrospective cohort study. Pain Pract. 2022 (Dec 12). Doi: 10.1111/papr.13196

Key clinical point: Erenumab and onabotulinumtoxinA (onabotA) dual therapy appeared less effective than erenumab alone in patients with chronic migraine.

Major finding: After 12 weeks, patients who were taking onabotA while initiating erenumab and maintained it as dual therapy (WBT) vs those who received erenumab alone (NoBT) had a lower reduction in mean monthly headache days (MHD; 4.7 vs 8.21 days; P  =  .009) and lower mean percentage improvement in MHD (21.7% vs 35.0%; P  =  .001), with a similar trend being observed among patients who were on onabotA while initiating erenumab but discontinued onabotA (WoBT).

Study details: This retrospective cohort study included 187 patients with chronic migraine who received WBT (n = 73), WoBT (n = 44), or NoBT (n = 70).

Disclosures: This study did not receive any specific funding. A Jaimes and J Rodríguez-Vico declared receiving honoraria or speaking fees from AbbVie and other sources.

Source: Jaimes A et al. Dual therapy with Erenumab and onabotulinumtoxinA: No synergistic effect in chronic migraine: A retrospective cohort study. Pain Pract. 2022 (Dec 12). Doi: 10.1111/papr.13196