Headache & Migraine

Black and Latinx older adults are up to three times as likely to develop Alzheimer’s disease than non-Latinx White adults and tend to experience onset at a younger age with more severe symptoms, according to Monica Rivera-Mindt, PhD, a professor of psychology at Fordham University and the Icahn School of Medicine at Mount Sinai, New York. Looking ahead, that means by 2030, nearly 40% of the 8.4 million Americans affected by Alzheimer’s disease will be Black and/or Latinx, she said. These facts were among the stark disparities in health care outcomes Dr. Rivera-Mindt discussed in her presentation on brain health equity at the 2022 annual meeting of the American Neurological Association.

Dr. Rivera-Mindt’s presentation opened the ANA’s plenary session on health disparities and inequities. The plenary, “Advancing Neurologic Equity: Challenges and Paths Forward,” did not simply enumerate racial and ethnic disparities that exist with various neurological conditions. Rather it went beyond the discussion of what disparities exist into understanding the roots of them as well as tips, tools, and resources that can aid clinicians in addressing or ameliorating them.

“Our most prevalent, most burdensome diseases in neurology disproportionately affect persons from minoritized and marginalized backgrounds,” Roy Hamilton, MD, an associate professor of neurology and physical medicine and rehabilitation at the University of Pennsylvania, Philadelphia, said. “If clinicians are unaware of these disparities or don’t have any sense of how to start to address or think about them, then they’re really missing out on an important component of their education as persons who take care of patients with brain disorders.”

Dr. Hamilton, who organized the plenary, noted that awareness of these disparities is crucial to comprehensively caring for patients.
 

Missed opportunities

“We’re talking about disadvantages that are structural and large scale, but those disadvantages play themselves out in the individual encounter,” Dr. Hamilton said. “When physicians see patients, they have to treat the whole patient in front of them,” which means being aware of the risks and factors that could affect a patient’s clinical presentation. “Being aware of disparities has practical impacts on physician judgment,” he said.

For example, recent research in multiple sclerosis (MS) has highlighted how clinicians may be missing diagnosis of this condition in non-White populations because the condition has been regarded for so long as a “White person’s” disease, Dr. Hamilton said. In non-White patients exhibiting MS symptoms, then, clinicians may have been less likely to consider MS as a possibility, thereby delaying diagnosis and treatment.

Those patterns may partly explain why the mortality rate for MS is greater in Black patients, who also show more rapid neurodegeneration than White patients with MS, Lilyana Amezcua, MD, an associate professor of neurology at the University of Southern California, Los Angeles, reported in the plenary’s second presentation.
 

Transgender issues

The third session, presented by Nicole Rosendale, MD, an assistant professor of neurology at the University of California, San Francisco, and director of the San Francisco General Hospital neurology inpatient services, examined disparities in neurology within the LGBTQ+ community through representative case studies and then offered specific ways that neurologists could make their practices more inclusive and equitable for sexual and gender minorities.

Her first case study was a 52-year-old man who presented with new-onset seizures, right hemiparesis, and aphasia. A brain biopsy consistent with adenocarcinoma eventually led his physician to discover he had metastatic breast cancer. It turned out the man was transgender and, despite a family history of breast cancer, hadn’t been advised to get breast cancer screenings.

“Breast cancer was not initially on the differential as no one had identified that the patient was transmasculine,” Dr. Rosendale said. A major challenge to providing care to transgender patients is a dearth of data on risks and screening recommendations. Another barrier is low knowledge of LGBTQ+ health among neurologists, Dr. Rosendale said while sharing findings from her 2019 study on the topic and calling for more research in LGBTQ+ populations.

Dr. Rosendale’s second case study dealt with a nonbinary patient who suffered from debilitating headaches for decades, first because they lacked access to health insurance and then because negative experiences with providers dissuaded them from seeking care. In data from the Center for American Progress she shared, 8% of LGB respondents and 22% of transgender respondents said they had avoided or delayed care because of fear of discrimination or mistreatment.

“So it’s not only access but also what experiences people are having when they go in and whether they’re actually even getting access to care or being taken care of,” Dr. Rosendale said. Other findings from the CAP found that:

• 8% of LGB patients and 29% of transgender patients reported having a clinician refuse to see them.
• 6% of LGB patients and 12% of transgender patients reported that a clinician refused to give them health care.
• 9% of LGB patients and 21% of transgender patients experienced harsh or abusive language during a health care experience.
• 7% of LGB patients and nearly a third (29%) of transgender patients experienced unwanted physical contact, such as fondling or sexual assault.

Reducing the disparities

Adys Mendizabal, MD, an assistant professor of neurology at the Institute of Society and Genetics at the University of California, Los Angeles, who attended the presentation, was grateful to see how the various lectures enriched the discussion beyond stating the fact of racial/ethnic disparities and dug into the nuances on how to think about and address these disparities. She particularly appreciated discussion about the need to go out of the way to recruit diverse patient populations for clinical trials while also providing them care.

“It is definitely complicated, but it’s not impossible for an individual neurologist or an individual department to do something to reduce some of the disparities,” Dr. Mendizabal said. “It starts with just knowing that they exist and being aware of some of the things that may be impacting care for a particular patient.”
 

Tools to counter disparity

In the final presentation, Amy Kind, MD, PhD, the associate dean for social health sciences and programs at the University of Wisconsin–Madison, rounded out the discussion by exploring social determinants of health and their influence on outcomes.

“Social determinants impact brain health, and brain health is not distributed equally,” Dr. Kind told attendees. “We have known this for decades, yet disparities persist.”

Dr. Kind described the “exposome,” a “measure of all the exposures of an individual in a lifetime and how those exposures relate to health,” according to the CDC, and then introduced a tool clinicians can use to better understand social determinants of health in specific geographic areas. The Neighborhood Atlas, which Dr. Kind described in the New England Journal of Medicine in 2018, measures 17 social determinants across small population-sensitive areas and provides an area deprivation index. A high area deprivation index is linked to a range of negative outcomes, including reshopitalization, later diagnoses, less comprehensive diagnostic evaluation, increased risk of postsurgical complications, and decreased life expectancy.

“One of the things that really stood out to me about Dr. Kind’s discussion of the use of the area deprivation index was the fact that understanding and quantifying these kinds of risks and exposures is the vehicle for creating the kinds of social changes, including policy changes, that will actually lead to addressing and mitigating some of these lifelong risks and exposures,” Dr. Hamilton said. “It is implausible to think that a specific group of people would be genetically more susceptible to basically every disease that we know,” he added. “It makes much more sense to think that groups of individuals have been subjected systematically to conditions that impair health in a variety of ways.”
 

Not just race, ethnicity, sex, and gender

Following the four presentations from researchers in health inequities was an Emerging Scholar presentation in which Jay B. Lusk, an MD/MBA candidate at Duke University, Durham, N.C., shared new research findings on the role of neighborhood disadvantage in predicting mortality from coma, stroke, and other neurologic conditions. His findings revealed that living in a neighborhood with greater deprivation substantially increased risk of mortality even after accounting for individual wealth and demographics.

Maria Eugenia Diaz-Ortiz, PhD, of the department of neurology, University of Pennsylvania, Philadelphia, said she found the five presentations to be an excellent introduction to people like herself who are in the earlier stages of learning about health equity research.

“I think they introduced various important concepts and frameworks and provided tools for people who don’t know about them,” Dr. Diaz-Ortiz said. “Then they asked important questions and provided some solutions to them.”

Dr. Diaz-Ortiz also appreciated seemingly minor but actually important details in how the speakers presented themselves, such as Dr. Rivera-Mindt opening with a land acknowledgment and her disclosures of “positionality.” The former recognized the traditional Native American custodians of the land on which she lives and works, and the latter revealed details about her as an individual – such as being the Afro-Latinx daughter of immigrants yet being cisgender, able-bodied, and U.S.-born – that show where she falls on the axis of adversity and axis of privilege.
 

Implications for research

The biggest takeaway for Dr. Diaz-Ortiz, however, came from the first Q&A session when someone asked how to increase underrepresented populations in dementia research. Dr. Rivera-Mindt described her experience engaging these communities by employing “community-based participatory research practices, which involves making yourself a part of the community and making the community active participants in the research,” Dr. Diaz-Ortiz said. “It’s an evidence-based approach that has been shown to increase participation in research not only in her work but in the work of others.”

Preaching to the choir

Dr. Diaz-Ortiz was pleased overall with the plenary but disappointed in its placement at the end of the meeting, when attendance is always lower as attendees head home.

“The people who stayed were people who already know and recognize the value of health equity work, so I think that was a missed opportunity where the session could have been included on day one or two to boost attendance and also to educate like a broader group of neurologists,” Dr. Diaz-Ortiz said in an interview.

Dr. Mendizabal felt similarly, appreciating the plenary but noting it was “definitely overdue” and that it should not be the last session. Instead, sessions on health equity should be as easy as possible to attend to bring in larger audiences. “Perhaps having that session on a Saturday or Sunday would have a higher likelihood of greater attendance than on a Tuesday,” she said. That said, Dr. Mendizabal also noticed that greater attention to health care disparities was woven into many other sessions throughout the conference, which is “the best way of addressing health equity instead of trying to just designate a session,” she said.

Dr. Mendizabal hopes that plenaries like this one and the weaving of health equity issues into presentations throughout neurology conferences continue.

“After the racial reckoning in 2020, there was a big impetus and a big wave of energy in addressing health disparities in the field, and I hope that that momentum is not starting to wane,” Dr. Mendizabal said. “It’s important because not talking about is not going to make this issue go away.”

Dr. Hamilton agreed that it is important that the conversation continue and that physicians recognize the importance of understanding health care disparities and determinants of health, regardless of where they fall on the political spectrum or whether they choose to get involved in policy or advocacy.

“Irrespective of whether you think race or ethnicity or socioeconomic status are political issues or not, it is the case that you’re obligated to have an objective understanding of the factors that contribute to your patient’s health and as points of intervention,” Dr. Hamilton said. “So even if you don’t want to sit down and jot off that email to your senator, you still have to take these factors into account when you’re treating the person who’s sitting right in front of you, and that’s not political. That’s the promise of being a physician.”

Dr. Amezcua has received personal compensation for consulting, speaking, or serving on steering committees or advisory boards for Biogen Idec, Novartis, Genentech, and EMD Serono, and she has received research support from Biogen Idec and Bristol Myers Squibb Foundation. Dr. Kind reported support from the Alzheimer’s Association. Dr. Diaz-Ortiz is coinventor of a provisional patent submitted by the University of Pennsylvania that relates to a potential therapeutic in Parkinson’s disease. Mr. Lusk reported fellowship support from American Heart Association and travel support from the American Neurological Association. No other speakers or sources had relevant disclosures.
 

Black and Latinx older adults are up to three times as likely to develop Alzheimer’s disease than non-Latinx White adults and tend to experience onset at a younger age with more severe symptoms, according to Monica Rivera-Mindt, PhD, a professor of psychology at Fordham University and the Icahn School of Medicine at Mount Sinai, New York. Looking ahead, that means by 2030, nearly 40% of the 8.4 million Americans affected by Alzheimer’s disease will be Black and/or Latinx, she said. These facts were among the stark disparities in health care outcomes Dr. Rivera-Mindt discussed in her presentation on brain health equity at the 2022 annual meeting of the American Neurological Association.

Dr. Rivera-Mindt’s presentation opened the ANA’s plenary session on health disparities and inequities. The plenary, “Advancing Neurologic Equity: Challenges and Paths Forward,” did not simply enumerate racial and ethnic disparities that exist with various neurological conditions. Rather it went beyond the discussion of what disparities exist into understanding the roots of them as well as tips, tools, and resources that can aid clinicians in addressing or ameliorating them.

“Our most prevalent, most burdensome diseases in neurology disproportionately affect persons from minoritized and marginalized backgrounds,” Roy Hamilton, MD, an associate professor of neurology and physical medicine and rehabilitation at the University of Pennsylvania, Philadelphia, said. “If clinicians are unaware of these disparities or don’t have any sense of how to start to address or think about them, then they’re really missing out on an important component of their education as persons who take care of patients with brain disorders.”

Dr. Hamilton, who organized the plenary, noted that awareness of these disparities is crucial to comprehensively caring for patients.
 

Missed opportunities

“We’re talking about disadvantages that are structural and large scale, but those disadvantages play themselves out in the individual encounter,” Dr. Hamilton said. “When physicians see patients, they have to treat the whole patient in front of them,” which means being aware of the risks and factors that could affect a patient’s clinical presentation. “Being aware of disparities has practical impacts on physician judgment,” he said.

For example, recent research in multiple sclerosis (MS) has highlighted how clinicians may be missing diagnosis of this condition in non-White populations because the condition has been regarded for so long as a “White person’s” disease, Dr. Hamilton said. In non-White patients exhibiting MS symptoms, then, clinicians may have been less likely to consider MS as a possibility, thereby delaying diagnosis and treatment.

Those patterns may partly explain why the mortality rate for MS is greater in Black patients, who also show more rapid neurodegeneration than White patients with MS, Lilyana Amezcua, MD, an associate professor of neurology at the University of Southern California, Los Angeles, reported in the plenary’s second presentation.
 

Transgender issues

The third session, presented by Nicole Rosendale, MD, an assistant professor of neurology at the University of California, San Francisco, and director of the San Francisco General Hospital neurology inpatient services, examined disparities in neurology within the LGBTQ+ community through representative case studies and then offered specific ways that neurologists could make their practices more inclusive and equitable for sexual and gender minorities.

Her first case study was a 52-year-old man who presented with new-onset seizures, right hemiparesis, and aphasia. A brain biopsy consistent with adenocarcinoma eventually led his physician to discover he had metastatic breast cancer. It turned out the man was transgender and, despite a family history of breast cancer, hadn’t been advised to get breast cancer screenings.

“Breast cancer was not initially on the differential as no one had identified that the patient was transmasculine,” Dr. Rosendale said. A major challenge to providing care to transgender patients is a dearth of data on risks and screening recommendations. Another barrier is low knowledge of LGBTQ+ health among neurologists, Dr. Rosendale said while sharing findings from her 2019 study on the topic and calling for more research in LGBTQ+ populations.

Dr. Rosendale’s second case study dealt with a nonbinary patient who suffered from debilitating headaches for decades, first because they lacked access to health insurance and then because negative experiences with providers dissuaded them from seeking care. In data from the Center for American Progress she shared, 8% of LGB respondents and 22% of transgender respondents said they had avoided or delayed care because of fear of discrimination or mistreatment.

“So it’s not only access but also what experiences people are having when they go in and whether they’re actually even getting access to care or being taken care of,” Dr. Rosendale said. Other findings from the CAP found that:

• 8% of LGB patients and 29% of transgender patients reported having a clinician refuse to see them.
• 6% of LGB patients and 12% of transgender patients reported that a clinician refused to give them health care.
• 9% of LGB patients and 21% of transgender patients experienced harsh or abusive language during a health care experience.
• 7% of LGB patients and nearly a third (29%) of transgender patients experienced unwanted physical contact, such as fondling or sexual assault.

Reducing the disparities

Adys Mendizabal, MD, an assistant professor of neurology at the Institute of Society and Genetics at the University of California, Los Angeles, who attended the presentation, was grateful to see how the various lectures enriched the discussion beyond stating the fact of racial/ethnic disparities and dug into the nuances on how to think about and address these disparities. She particularly appreciated discussion about the need to go out of the way to recruit diverse patient populations for clinical trials while also providing them care.

“It is definitely complicated, but it’s not impossible for an individual neurologist or an individual department to do something to reduce some of the disparities,” Dr. Mendizabal said. “It starts with just knowing that they exist and being aware of some of the things that may be impacting care for a particular patient.”
 

Tools to counter disparity

In the final presentation, Amy Kind, MD, PhD, the associate dean for social health sciences and programs at the University of Wisconsin–Madison, rounded out the discussion by exploring social determinants of health and their influence on outcomes.

“Social determinants impact brain health, and brain health is not distributed equally,” Dr. Kind told attendees. “We have known this for decades, yet disparities persist.”

Dr. Kind described the “exposome,” a “measure of all the exposures of an individual in a lifetime and how those exposures relate to health,” according to the CDC, and then introduced a tool clinicians can use to better understand social determinants of health in specific geographic areas. The Neighborhood Atlas, which Dr. Kind described in the New England Journal of Medicine in 2018, measures 17 social determinants across small population-sensitive areas and provides an area deprivation index. A high area deprivation index is linked to a range of negative outcomes, including reshopitalization, later diagnoses, less comprehensive diagnostic evaluation, increased risk of postsurgical complications, and decreased life expectancy.

“One of the things that really stood out to me about Dr. Kind’s discussion of the use of the area deprivation index was the fact that understanding and quantifying these kinds of risks and exposures is the vehicle for creating the kinds of social changes, including policy changes, that will actually lead to addressing and mitigating some of these lifelong risks and exposures,” Dr. Hamilton said. “It is implausible to think that a specific group of people would be genetically more susceptible to basically every disease that we know,” he added. “It makes much more sense to think that groups of individuals have been subjected systematically to conditions that impair health in a variety of ways.”
 

Not just race, ethnicity, sex, and gender

Following the four presentations from researchers in health inequities was an Emerging Scholar presentation in which Jay B. Lusk, an MD/MBA candidate at Duke University, Durham, N.C., shared new research findings on the role of neighborhood disadvantage in predicting mortality from coma, stroke, and other neurologic conditions. His findings revealed that living in a neighborhood with greater deprivation substantially increased risk of mortality even after accounting for individual wealth and demographics.

Maria Eugenia Diaz-Ortiz, PhD, of the department of neurology, University of Pennsylvania, Philadelphia, said she found the five presentations to be an excellent introduction to people like herself who are in the earlier stages of learning about health equity research.

“I think they introduced various important concepts and frameworks and provided tools for people who don’t know about them,” Dr. Diaz-Ortiz said. “Then they asked important questions and provided some solutions to them.”

Dr. Diaz-Ortiz also appreciated seemingly minor but actually important details in how the speakers presented themselves, such as Dr. Rivera-Mindt opening with a land acknowledgment and her disclosures of “positionality.” The former recognized the traditional Native American custodians of the land on which she lives and works, and the latter revealed details about her as an individual – such as being the Afro-Latinx daughter of immigrants yet being cisgender, able-bodied, and U.S.-born – that show where she falls on the axis of adversity and axis of privilege.
 

Implications for research

The biggest takeaway for Dr. Diaz-Ortiz, however, came from the first Q&A session when someone asked how to increase underrepresented populations in dementia research. Dr. Rivera-Mindt described her experience engaging these communities by employing “community-based participatory research practices, which involves making yourself a part of the community and making the community active participants in the research,” Dr. Diaz-Ortiz said. “It’s an evidence-based approach that has been shown to increase participation in research not only in her work but in the work of others.”

Preaching to the choir

Dr. Diaz-Ortiz was pleased overall with the plenary but disappointed in its placement at the end of the meeting, when attendance is always lower as attendees head home.

“The people who stayed were people who already know and recognize the value of health equity work, so I think that was a missed opportunity where the session could have been included on day one or two to boost attendance and also to educate like a broader group of neurologists,” Dr. Diaz-Ortiz said in an interview.

Dr. Mendizabal felt similarly, appreciating the plenary but noting it was “definitely overdue” and that it should not be the last session. Instead, sessions on health equity should be as easy as possible to attend to bring in larger audiences. “Perhaps having that session on a Saturday or Sunday would have a higher likelihood of greater attendance than on a Tuesday,” she said. That said, Dr. Mendizabal also noticed that greater attention to health care disparities was woven into many other sessions throughout the conference, which is “the best way of addressing health equity instead of trying to just designate a session,” she said.

Dr. Mendizabal hopes that plenaries like this one and the weaving of health equity issues into presentations throughout neurology conferences continue.

“After the racial reckoning in 2020, there was a big impetus and a big wave of energy in addressing health disparities in the field, and I hope that that momentum is not starting to wane,” Dr. Mendizabal said. “It’s important because not talking about is not going to make this issue go away.”

Dr. Hamilton agreed that it is important that the conversation continue and that physicians recognize the importance of understanding health care disparities and determinants of health, regardless of where they fall on the political spectrum or whether they choose to get involved in policy or advocacy.

“Irrespective of whether you think race or ethnicity or socioeconomic status are political issues or not, it is the case that you’re obligated to have an objective understanding of the factors that contribute to your patient’s health and as points of intervention,” Dr. Hamilton said. “So even if you don’t want to sit down and jot off that email to your senator, you still have to take these factors into account when you’re treating the person who’s sitting right in front of you, and that’s not political. That’s the promise of being a physician.”

Dr. Amezcua has received personal compensation for consulting, speaking, or serving on steering committees or advisory boards for Biogen Idec, Novartis, Genentech, and EMD Serono, and she has received research support from Biogen Idec and Bristol Myers Squibb Foundation. Dr. Kind reported support from the Alzheimer’s Association. Dr. Diaz-Ortiz is coinventor of a provisional patent submitted by the University of Pennsylvania that relates to a potential therapeutic in Parkinson’s disease. Mr. Lusk reported fellowship support from American Heart Association and travel support from the American Neurological Association. No other speakers or sources had relevant disclosures.
 

Black and Latinx older adults are up to three times as likely to develop Alzheimer’s disease than non-Latinx White adults and tend to experience onset at a younger age with more severe symptoms, according to Monica Rivera-Mindt, PhD, a professor of psychology at Fordham University and the Icahn School of Medicine at Mount Sinai, New York. Looking ahead, that means by 2030, nearly 40% of the 8.4 million Americans affected by Alzheimer’s disease will be Black and/or Latinx, she said. These facts were among the stark disparities in health care outcomes Dr. Rivera-Mindt discussed in her presentation on brain health equity at the 2022 annual meeting of the American Neurological Association.

Dr. Rivera-Mindt’s presentation opened the ANA’s plenary session on health disparities and inequities. The plenary, “Advancing Neurologic Equity: Challenges and Paths Forward,” did not simply enumerate racial and ethnic disparities that exist with various neurological conditions. Rather it went beyond the discussion of what disparities exist into understanding the roots of them as well as tips, tools, and resources that can aid clinicians in addressing or ameliorating them.

“Our most prevalent, most burdensome diseases in neurology disproportionately affect persons from minoritized and marginalized backgrounds,” Roy Hamilton, MD, an associate professor of neurology and physical medicine and rehabilitation at the University of Pennsylvania, Philadelphia, said. “If clinicians are unaware of these disparities or don’t have any sense of how to start to address or think about them, then they’re really missing out on an important component of their education as persons who take care of patients with brain disorders.”

Dr. Hamilton, who organized the plenary, noted that awareness of these disparities is crucial to comprehensively caring for patients.
 

Missed opportunities

“We’re talking about disadvantages that are structural and large scale, but those disadvantages play themselves out in the individual encounter,” Dr. Hamilton said. “When physicians see patients, they have to treat the whole patient in front of them,” which means being aware of the risks and factors that could affect a patient’s clinical presentation. “Being aware of disparities has practical impacts on physician judgment,” he said.

For example, recent research in multiple sclerosis (MS) has highlighted how clinicians may be missing diagnosis of this condition in non-White populations because the condition has been regarded for so long as a “White person’s” disease, Dr. Hamilton said. In non-White patients exhibiting MS symptoms, then, clinicians may have been less likely to consider MS as a possibility, thereby delaying diagnosis and treatment.

Those patterns may partly explain why the mortality rate for MS is greater in Black patients, who also show more rapid neurodegeneration than White patients with MS, Lilyana Amezcua, MD, an associate professor of neurology at the University of Southern California, Los Angeles, reported in the plenary’s second presentation.
 

Transgender issues

The third session, presented by Nicole Rosendale, MD, an assistant professor of neurology at the University of California, San Francisco, and director of the San Francisco General Hospital neurology inpatient services, examined disparities in neurology within the LGBTQ+ community through representative case studies and then offered specific ways that neurologists could make their practices more inclusive and equitable for sexual and gender minorities.

Her first case study was a 52-year-old man who presented with new-onset seizures, right hemiparesis, and aphasia. A brain biopsy consistent with adenocarcinoma eventually led his physician to discover he had metastatic breast cancer. It turned out the man was transgender and, despite a family history of breast cancer, hadn’t been advised to get breast cancer screenings.

“Breast cancer was not initially on the differential as no one had identified that the patient was transmasculine,” Dr. Rosendale said. A major challenge to providing care to transgender patients is a dearth of data on risks and screening recommendations. Another barrier is low knowledge of LGBTQ+ health among neurologists, Dr. Rosendale said while sharing findings from her 2019 study on the topic and calling for more research in LGBTQ+ populations.

Dr. Rosendale’s second case study dealt with a nonbinary patient who suffered from debilitating headaches for decades, first because they lacked access to health insurance and then because negative experiences with providers dissuaded them from seeking care. In data from the Center for American Progress she shared, 8% of LGB respondents and 22% of transgender respondents said they had avoided or delayed care because of fear of discrimination or mistreatment.

“So it’s not only access but also what experiences people are having when they go in and whether they’re actually even getting access to care or being taken care of,” Dr. Rosendale said. Other findings from the CAP found that:

• 8% of LGB patients and 29% of transgender patients reported having a clinician refuse to see them.
• 6% of LGB patients and 12% of transgender patients reported that a clinician refused to give them health care.
• 9% of LGB patients and 21% of transgender patients experienced harsh or abusive language during a health care experience.
• 7% of LGB patients and nearly a third (29%) of transgender patients experienced unwanted physical contact, such as fondling or sexual assault.

Reducing the disparities

Adys Mendizabal, MD, an assistant professor of neurology at the Institute of Society and Genetics at the University of California, Los Angeles, who attended the presentation, was grateful to see how the various lectures enriched the discussion beyond stating the fact of racial/ethnic disparities and dug into the nuances on how to think about and address these disparities. She particularly appreciated discussion about the need to go out of the way to recruit diverse patient populations for clinical trials while also providing them care.

“It is definitely complicated, but it’s not impossible for an individual neurologist or an individual department to do something to reduce some of the disparities,” Dr. Mendizabal said. “It starts with just knowing that they exist and being aware of some of the things that may be impacting care for a particular patient.”
 

Tools to counter disparity

In the final presentation, Amy Kind, MD, PhD, the associate dean for social health sciences and programs at the University of Wisconsin–Madison, rounded out the discussion by exploring social determinants of health and their influence on outcomes.

“Social determinants impact brain health, and brain health is not distributed equally,” Dr. Kind told attendees. “We have known this for decades, yet disparities persist.”

Dr. Kind described the “exposome,” a “measure of all the exposures of an individual in a lifetime and how those exposures relate to health,” according to the CDC, and then introduced a tool clinicians can use to better understand social determinants of health in specific geographic areas. The Neighborhood Atlas, which Dr. Kind described in the New England Journal of Medicine in 2018, measures 17 social determinants across small population-sensitive areas and provides an area deprivation index. A high area deprivation index is linked to a range of negative outcomes, including reshopitalization, later diagnoses, less comprehensive diagnostic evaluation, increased risk of postsurgical complications, and decreased life expectancy.

“One of the things that really stood out to me about Dr. Kind’s discussion of the use of the area deprivation index was the fact that understanding and quantifying these kinds of risks and exposures is the vehicle for creating the kinds of social changes, including policy changes, that will actually lead to addressing and mitigating some of these lifelong risks and exposures,” Dr. Hamilton said. “It is implausible to think that a specific group of people would be genetically more susceptible to basically every disease that we know,” he added. “It makes much more sense to think that groups of individuals have been subjected systematically to conditions that impair health in a variety of ways.”
 

Not just race, ethnicity, sex, and gender

Following the four presentations from researchers in health inequities was an Emerging Scholar presentation in which Jay B. Lusk, an MD/MBA candidate at Duke University, Durham, N.C., shared new research findings on the role of neighborhood disadvantage in predicting mortality from coma, stroke, and other neurologic conditions. His findings revealed that living in a neighborhood with greater deprivation substantially increased risk of mortality even after accounting for individual wealth and demographics.

Maria Eugenia Diaz-Ortiz, PhD, of the department of neurology, University of Pennsylvania, Philadelphia, said she found the five presentations to be an excellent introduction to people like herself who are in the earlier stages of learning about health equity research.

“I think they introduced various important concepts and frameworks and provided tools for people who don’t know about them,” Dr. Diaz-Ortiz said. “Then they asked important questions and provided some solutions to them.”

Dr. Diaz-Ortiz also appreciated seemingly minor but actually important details in how the speakers presented themselves, such as Dr. Rivera-Mindt opening with a land acknowledgment and her disclosures of “positionality.” The former recognized the traditional Native American custodians of the land on which she lives and works, and the latter revealed details about her as an individual – such as being the Afro-Latinx daughter of immigrants yet being cisgender, able-bodied, and U.S.-born – that show where she falls on the axis of adversity and axis of privilege.
 

Implications for research

The biggest takeaway for Dr. Diaz-Ortiz, however, came from the first Q&A session when someone asked how to increase underrepresented populations in dementia research. Dr. Rivera-Mindt described her experience engaging these communities by employing “community-based participatory research practices, which involves making yourself a part of the community and making the community active participants in the research,” Dr. Diaz-Ortiz said. “It’s an evidence-based approach that has been shown to increase participation in research not only in her work but in the work of others.”

Preaching to the choir

Dr. Diaz-Ortiz was pleased overall with the plenary but disappointed in its placement at the end of the meeting, when attendance is always lower as attendees head home.

“The people who stayed were people who already know and recognize the value of health equity work, so I think that was a missed opportunity where the session could have been included on day one or two to boost attendance and also to educate like a broader group of neurologists,” Dr. Diaz-Ortiz said in an interview.

Dr. Mendizabal felt similarly, appreciating the plenary but noting it was “definitely overdue” and that it should not be the last session. Instead, sessions on health equity should be as easy as possible to attend to bring in larger audiences. “Perhaps having that session on a Saturday or Sunday would have a higher likelihood of greater attendance than on a Tuesday,” she said. That said, Dr. Mendizabal also noticed that greater attention to health care disparities was woven into many other sessions throughout the conference, which is “the best way of addressing health equity instead of trying to just designate a session,” she said.

Dr. Mendizabal hopes that plenaries like this one and the weaving of health equity issues into presentations throughout neurology conferences continue.

“After the racial reckoning in 2020, there was a big impetus and a big wave of energy in addressing health disparities in the field, and I hope that that momentum is not starting to wane,” Dr. Mendizabal said. “It’s important because not talking about is not going to make this issue go away.”

Dr. Hamilton agreed that it is important that the conversation continue and that physicians recognize the importance of understanding health care disparities and determinants of health, regardless of where they fall on the political spectrum or whether they choose to get involved in policy or advocacy.

“Irrespective of whether you think race or ethnicity or socioeconomic status are political issues or not, it is the case that you’re obligated to have an objective understanding of the factors that contribute to your patient’s health and as points of intervention,” Dr. Hamilton said. “So even if you don’t want to sit down and jot off that email to your senator, you still have to take these factors into account when you’re treating the person who’s sitting right in front of you, and that’s not political. That’s the promise of being a physician.”

Dr. Amezcua has received personal compensation for consulting, speaking, or serving on steering committees or advisory boards for Biogen Idec, Novartis, Genentech, and EMD Serono, and she has received research support from Biogen Idec and Bristol Myers Squibb Foundation. Dr. Kind reported support from the Alzheimer’s Association. Dr. Diaz-Ortiz is coinventor of a provisional patent submitted by the University of Pennsylvania that relates to a potential therapeutic in Parkinson’s disease. Mr. Lusk reported fellowship support from American Heart Association and travel support from the American Neurological Association. No other speakers or sources had relevant disclosures.
 

Strength training is the most effective form of exercise for reducing migraine, with high-intensity aerobics coming in second, and both beating top-line migraine medications topiramate and amitriptyline, new research suggests.

The new results should encourage clinicians to recommend patients with migraine engage in strength-training exercise whenever possible, study investigator Yohannes W. Woldeamanuel, MD, a physician-scientist and instructor, department of neurology and neurological sciences, Stanford (Calif.) University, told this news organization.

“Exercise is something patients can do all their lives and use it to prevent migraine attacks instead of taking daily medications or repetitive injections that have several adverse effects.”

The findings were published online in the Journal of Headache and Pain.
 

Head-to-head comparison

Several clinical trials have shown exercise is effective for migraine management, but to date, there have been no head-to-head comparisons of strength training and aerobic exercise, said Dr. Woldeamanuel.

This new study used a systematic review with network meta-analysis (NMA), which compares multiple interventions and ranks the efficacy of each one.

After a literature search, researchers included 21 clinical trials with an exercise regimen arm and a comparison control arm. All study data reported monthly frequency of migraine at baseline and at the end of the intervention.

The total combined sample size was 1,195 patients with migraine, who were a mean age of 35.5 years, with a female-to-male ratio of 6.7:1. All studies used International Classification of Headache Disorders (ICHD) criteria for migraine diagnosis.

The NMA provided 27 pairwise comparisons and 8 indirect comparisons. The pairwise comparisons provided direct evidence between the different interventions.

Researchers combined strength training, including weightlifting, with resistance training. Both modalities target muscles, while aerobic exercise targets cardiovascular health.

The average number of weeks was 9.3, 9.3, and 10.7, and the average number of hours per session for strength/resistance training, high-intensity aerobic exercise, and moderate-intensity aerobic exercise interventions was 50, 56, and 45.3, respectively.

The analysis showed all exercise interventions were more effective than the placebo groups in reducing the frequency of migraine. In terms of ranking, strength training came out on top, with a mean difference in monthly migraine days of −3.55 (95% confidence interval, −6.15 to −0.95) between the active and placebo groups.

Next was high-intensity aerobic exercise (−3.13; 95% CI, −5.28 to −0.97) and moderate-intensity aerobic exercise (−2.18; 95% CI, −3.25 to −1.11), followed by topiramate, placebo, and then amitriptyline.

Strength/resistance training was superior possibly because it targets muscle strengthening, particularly major muscles in the neck and shoulder area, which can be a source of the pain trigger, said Dr. Woldeamanuel. He added neck pain is highly comorbid with migraine.

Interestingly, patients doing exercises that focus on unaffected muscles – for example, squats – still get the benefits of less migraine burden, said Dr. Woldeamanuel.
 

Training recommendations

Strength training also increases or preserves lean muscle mass, which is associated with reduced migraine frequency. Research shows preservation of lean body mass combats central sensitization in various pain syndromes, said Dr. Woldeamanuel.

The superior effects of high- versus moderate-intensity aerobic exercise may be due to recruitment of endogenous molecules involved in exercise-mediated hypoalgesia (pain reduction).

The most common pathways are the opioid and endocannabinoid systems, although other systems are also likely involved, said Dr. Woldeamanuel. He noted migraine has been linked to a deficiency of both opioidergic and endocannabinoidergic signaling.

Dr. Woldeamanuel commented on the difficulty of comparing exercise interventions for patients with chronic versus episodic migraine, as many studies include both.

However, the two studies with moderate-intensity aerobic exercise exclusively involving patients with chronic migraine showed large effect sizes (Cohen’s d) of 0.80 and 1.10 in reducing monthly headache frequency.

Based on these new results and their own experience, the researchers recommend strength training start with 50% of repetition maximum (RM) with 2-3 sets of 12-15 repetitions three times a week along with 10 minutes of warm-up, stretching, and cool-down, totaling 45-60 minutes per session. Weight/resistance load can then be increased weekly by 5% of RM if the patient is capable of successfully completing three sets.

They also recommend including active recovery days (low-intensity exercise) between training days. All major muscles, including neck, shoulder, and upper limb muscles, should be trained in a rotation.

For high-intensity aerobic exercise, the authors recommend starting with interval training at 55% VO_2max (maximum respiratory capacity), or 50% HRmax (maximal heart rate) for 45-60 minutes per session, including 10 minutes of warm-up and cool-down, three times per week. The intensity can then be increased by 5%-10% each week to reach a maximum target of 80%-90% by week 12.

It is best for patients to start with a trainer for guidance and supervision, but once they master the routines, they can do the exercises independently, said Dr. Woldeamanuel.
 

Managing flare-ups

Headache flare-ups are normal during exercise, which may be caused by “boom and bust cycles” – exercising excessively when feeling good then completely stopping when feeling bad, said Dr. Woldeamanuel. He noted these flare-ups don’t mean “there’s something wrong with the brain or there’s some injury to muscles.”

The best way to manage such flare-ups is to use a pacing strategy that involves “not going overboard on good days and avoiding excessive rest on bad days,” the investigators note.

Dr. Woldeamanuel noted exercise is a lifestyle-based intervention; it not only helps reduce migraine attacks but also helps control other known comorbidities such as obesity and hypertension.

In a comment, Elizabeth Loder, MD, vice-chair, academic affairs, department of neurology, Brigham and Women’s Hospital, and professor of neurology, Harvard Medical School, both in Boston, said, “It’s useful to collect and summarize all of these studies, and to focus on helping patients and doctors understand the possible value of different kinds of exercise.”

The review was “well done,” said Dr. Loder, adding the researchers “have looked carefully at the quality of included studies.”

The study received support from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health. Dr. Woldeamanuel has reported no relevant financial relationships.

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

Strength training is the most effective form of exercise for reducing migraine, with high-intensity aerobics coming in second, and both beating top-line migraine medications topiramate and amitriptyline, new research suggests.

The new results should encourage clinicians to recommend patients with migraine engage in strength-training exercise whenever possible, study investigator Yohannes W. Woldeamanuel, MD, a physician-scientist and instructor, department of neurology and neurological sciences, Stanford (Calif.) University, told this news organization.

“Exercise is something patients can do all their lives and use it to prevent migraine attacks instead of taking daily medications or repetitive injections that have several adverse effects.”

The findings were published online in the Journal of Headache and Pain.
 

Head-to-head comparison

Several clinical trials have shown exercise is effective for migraine management, but to date, there have been no head-to-head comparisons of strength training and aerobic exercise, said Dr. Woldeamanuel.

This new study used a systematic review with network meta-analysis (NMA), which compares multiple interventions and ranks the efficacy of each one.

After a literature search, researchers included 21 clinical trials with an exercise regimen arm and a comparison control arm. All study data reported monthly frequency of migraine at baseline and at the end of the intervention.

The total combined sample size was 1,195 patients with migraine, who were a mean age of 35.5 years, with a female-to-male ratio of 6.7:1. All studies used International Classification of Headache Disorders (ICHD) criteria for migraine diagnosis.

The NMA provided 27 pairwise comparisons and 8 indirect comparisons. The pairwise comparisons provided direct evidence between the different interventions.

Researchers combined strength training, including weightlifting, with resistance training. Both modalities target muscles, while aerobic exercise targets cardiovascular health.

The average number of weeks was 9.3, 9.3, and 10.7, and the average number of hours per session for strength/resistance training, high-intensity aerobic exercise, and moderate-intensity aerobic exercise interventions was 50, 56, and 45.3, respectively.

The analysis showed all exercise interventions were more effective than the placebo groups in reducing the frequency of migraine. In terms of ranking, strength training came out on top, with a mean difference in monthly migraine days of −3.55 (95% confidence interval, −6.15 to −0.95) between the active and placebo groups.

Next was high-intensity aerobic exercise (−3.13; 95% CI, −5.28 to −0.97) and moderate-intensity aerobic exercise (−2.18; 95% CI, −3.25 to −1.11), followed by topiramate, placebo, and then amitriptyline.

Strength/resistance training was superior possibly because it targets muscle strengthening, particularly major muscles in the neck and shoulder area, which can be a source of the pain trigger, said Dr. Woldeamanuel. He added neck pain is highly comorbid with migraine.

Interestingly, patients doing exercises that focus on unaffected muscles – for example, squats – still get the benefits of less migraine burden, said Dr. Woldeamanuel.
 

Training recommendations

Strength training also increases or preserves lean muscle mass, which is associated with reduced migraine frequency. Research shows preservation of lean body mass combats central sensitization in various pain syndromes, said Dr. Woldeamanuel.

The superior effects of high- versus moderate-intensity aerobic exercise may be due to recruitment of endogenous molecules involved in exercise-mediated hypoalgesia (pain reduction).

The most common pathways are the opioid and endocannabinoid systems, although other systems are also likely involved, said Dr. Woldeamanuel. He noted migraine has been linked to a deficiency of both opioidergic and endocannabinoidergic signaling.

Dr. Woldeamanuel commented on the difficulty of comparing exercise interventions for patients with chronic versus episodic migraine, as many studies include both.

However, the two studies with moderate-intensity aerobic exercise exclusively involving patients with chronic migraine showed large effect sizes (Cohen’s d) of 0.80 and 1.10 in reducing monthly headache frequency.

Based on these new results and their own experience, the researchers recommend strength training start with 50% of repetition maximum (RM) with 2-3 sets of 12-15 repetitions three times a week along with 10 minutes of warm-up, stretching, and cool-down, totaling 45-60 minutes per session. Weight/resistance load can then be increased weekly by 5% of RM if the patient is capable of successfully completing three sets.

They also recommend including active recovery days (low-intensity exercise) between training days. All major muscles, including neck, shoulder, and upper limb muscles, should be trained in a rotation.

For high-intensity aerobic exercise, the authors recommend starting with interval training at 55% VO_2max (maximum respiratory capacity), or 50% HRmax (maximal heart rate) for 45-60 minutes per session, including 10 minutes of warm-up and cool-down, three times per week. The intensity can then be increased by 5%-10% each week to reach a maximum target of 80%-90% by week 12.

It is best for patients to start with a trainer for guidance and supervision, but once they master the routines, they can do the exercises independently, said Dr. Woldeamanuel.
 

Managing flare-ups

Headache flare-ups are normal during exercise, which may be caused by “boom and bust cycles” – exercising excessively when feeling good then completely stopping when feeling bad, said Dr. Woldeamanuel. He noted these flare-ups don’t mean “there’s something wrong with the brain or there’s some injury to muscles.”

The best way to manage such flare-ups is to use a pacing strategy that involves “not going overboard on good days and avoiding excessive rest on bad days,” the investigators note.

Dr. Woldeamanuel noted exercise is a lifestyle-based intervention; it not only helps reduce migraine attacks but also helps control other known comorbidities such as obesity and hypertension.

In a comment, Elizabeth Loder, MD, vice-chair, academic affairs, department of neurology, Brigham and Women’s Hospital, and professor of neurology, Harvard Medical School, both in Boston, said, “It’s useful to collect and summarize all of these studies, and to focus on helping patients and doctors understand the possible value of different kinds of exercise.”

The review was “well done,” said Dr. Loder, adding the researchers “have looked carefully at the quality of included studies.”

The study received support from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health. Dr. Woldeamanuel has reported no relevant financial relationships.

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

Strength training is the most effective form of exercise for reducing migraine, with high-intensity aerobics coming in second, and both beating top-line migraine medications topiramate and amitriptyline, new research suggests.

The new results should encourage clinicians to recommend patients with migraine engage in strength-training exercise whenever possible, study investigator Yohannes W. Woldeamanuel, MD, a physician-scientist and instructor, department of neurology and neurological sciences, Stanford (Calif.) University, told this news organization.

“Exercise is something patients can do all their lives and use it to prevent migraine attacks instead of taking daily medications or repetitive injections that have several adverse effects.”

The findings were published online in the Journal of Headache and Pain.
 

Head-to-head comparison

Several clinical trials have shown exercise is effective for migraine management, but to date, there have been no head-to-head comparisons of strength training and aerobic exercise, said Dr. Woldeamanuel.

This new study used a systematic review with network meta-analysis (NMA), which compares multiple interventions and ranks the efficacy of each one.

After a literature search, researchers included 21 clinical trials with an exercise regimen arm and a comparison control arm. All study data reported monthly frequency of migraine at baseline and at the end of the intervention.

The total combined sample size was 1,195 patients with migraine, who were a mean age of 35.5 years, with a female-to-male ratio of 6.7:1. All studies used International Classification of Headache Disorders (ICHD) criteria for migraine diagnosis.

The NMA provided 27 pairwise comparisons and 8 indirect comparisons. The pairwise comparisons provided direct evidence between the different interventions.

Researchers combined strength training, including weightlifting, with resistance training. Both modalities target muscles, while aerobic exercise targets cardiovascular health.

The average number of weeks was 9.3, 9.3, and 10.7, and the average number of hours per session for strength/resistance training, high-intensity aerobic exercise, and moderate-intensity aerobic exercise interventions was 50, 56, and 45.3, respectively.

The analysis showed all exercise interventions were more effective than the placebo groups in reducing the frequency of migraine. In terms of ranking, strength training came out on top, with a mean difference in monthly migraine days of −3.55 (95% confidence interval, −6.15 to −0.95) between the active and placebo groups.

Next was high-intensity aerobic exercise (−3.13; 95% CI, −5.28 to −0.97) and moderate-intensity aerobic exercise (−2.18; 95% CI, −3.25 to −1.11), followed by topiramate, placebo, and then amitriptyline.

Strength/resistance training was superior possibly because it targets muscle strengthening, particularly major muscles in the neck and shoulder area, which can be a source of the pain trigger, said Dr. Woldeamanuel. He added neck pain is highly comorbid with migraine.

Interestingly, patients doing exercises that focus on unaffected muscles – for example, squats – still get the benefits of less migraine burden, said Dr. Woldeamanuel.
 

Training recommendations

Strength training also increases or preserves lean muscle mass, which is associated with reduced migraine frequency. Research shows preservation of lean body mass combats central sensitization in various pain syndromes, said Dr. Woldeamanuel.

The superior effects of high- versus moderate-intensity aerobic exercise may be due to recruitment of endogenous molecules involved in exercise-mediated hypoalgesia (pain reduction).

The most common pathways are the opioid and endocannabinoid systems, although other systems are also likely involved, said Dr. Woldeamanuel. He noted migraine has been linked to a deficiency of both opioidergic and endocannabinoidergic signaling.

Dr. Woldeamanuel commented on the difficulty of comparing exercise interventions for patients with chronic versus episodic migraine, as many studies include both.

However, the two studies with moderate-intensity aerobic exercise exclusively involving patients with chronic migraine showed large effect sizes (Cohen’s d) of 0.80 and 1.10 in reducing monthly headache frequency.

Based on these new results and their own experience, the researchers recommend strength training start with 50% of repetition maximum (RM) with 2-3 sets of 12-15 repetitions three times a week along with 10 minutes of warm-up, stretching, and cool-down, totaling 45-60 minutes per session. Weight/resistance load can then be increased weekly by 5% of RM if the patient is capable of successfully completing three sets.

They also recommend including active recovery days (low-intensity exercise) between training days. All major muscles, including neck, shoulder, and upper limb muscles, should be trained in a rotation.

For high-intensity aerobic exercise, the authors recommend starting with interval training at 55% VO_2max (maximum respiratory capacity), or 50% HRmax (maximal heart rate) for 45-60 minutes per session, including 10 minutes of warm-up and cool-down, three times per week. The intensity can then be increased by 5%-10% each week to reach a maximum target of 80%-90% by week 12.

It is best for patients to start with a trainer for guidance and supervision, but once they master the routines, they can do the exercises independently, said Dr. Woldeamanuel.
 

Managing flare-ups

Headache flare-ups are normal during exercise, which may be caused by “boom and bust cycles” – exercising excessively when feeling good then completely stopping when feeling bad, said Dr. Woldeamanuel. He noted these flare-ups don’t mean “there’s something wrong with the brain or there’s some injury to muscles.”

The best way to manage such flare-ups is to use a pacing strategy that involves “not going overboard on good days and avoiding excessive rest on bad days,” the investigators note.

Dr. Woldeamanuel noted exercise is a lifestyle-based intervention; it not only helps reduce migraine attacks but also helps control other known comorbidities such as obesity and hypertension.

In a comment, Elizabeth Loder, MD, vice-chair, academic affairs, department of neurology, Brigham and Women’s Hospital, and professor of neurology, Harvard Medical School, both in Boston, said, “It’s useful to collect and summarize all of these studies, and to focus on helping patients and doctors understand the possible value of different kinds of exercise.”

The review was “well done,” said Dr. Loder, adding the researchers “have looked carefully at the quality of included studies.”

The study received support from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health. Dr. Woldeamanuel has reported no relevant financial relationships.

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

Key clinical point: Once-monthly galcanezumab significantly reduced the frequency of migraine-associated symptoms and migraine headache severity in patients with episodic migraine.

Major finding: Moderate-to-severe migraine headache days (MHD) reduced significantly with 240 mg galcanezumab (difference in least-squares mean change from baseline [Δ] −1.8 days,  95% CI −2.5 to −1.2) and 120 mg (Δ −1.9 days, 95% CI −2.5 to −1.2) vs placebo, with 240 mg galcanezumab also leading to significant reductions in the proportion of monthly MHD during menstrual periods (P = .04), and MHDswith nausea or vomiting (P = .02).

Study details: This was a secondary analysis of a phase 2 trial including 440 patients with episodic migraine who were randomly assigned to receive monthly galcanezumab (240 or 120 mg) or placebo.

Disclosures: This study was funded by Eli Lilly Japan K.K. Two authors declared being employees and minor shareholders of Eli Lilly. Two authors reported receiving personal fees for speaker or consulting services from Eli Lilly Japan K.K. and other sources.

Source: Igarashi H et al. Galcanezumab effects on migraine severity and symptoms in Japanese patients with episodic migraine: Secondary analysis of a phase 2 randomized trial. Neurol Ther. 2022 (Oct 20). Doi: 10.1007/s40120-022-00410-3

Key clinical point: Once-monthly galcanezumab significantly reduced the frequency of migraine-associated symptoms and migraine headache severity in patients with episodic migraine.

Major finding: Moderate-to-severe migraine headache days (MHD) reduced significantly with 240 mg galcanezumab (difference in least-squares mean change from baseline [Δ] −1.8 days,  95% CI −2.5 to −1.2) and 120 mg (Δ −1.9 days, 95% CI −2.5 to −1.2) vs placebo, with 240 mg galcanezumab also leading to significant reductions in the proportion of monthly MHD during menstrual periods (P = .04), and MHDswith nausea or vomiting (P = .02).

Study details: This was a secondary analysis of a phase 2 trial including 440 patients with episodic migraine who were randomly assigned to receive monthly galcanezumab (240 or 120 mg) or placebo.

Disclosures: This study was funded by Eli Lilly Japan K.K. Two authors declared being employees and minor shareholders of Eli Lilly. Two authors reported receiving personal fees for speaker or consulting services from Eli Lilly Japan K.K. and other sources.

Source: Igarashi H et al. Galcanezumab effects on migraine severity and symptoms in Japanese patients with episodic migraine: Secondary analysis of a phase 2 randomized trial. Neurol Ther. 2022 (Oct 20). Doi: 10.1007/s40120-022-00410-3

Key clinical point: Once-monthly galcanezumab significantly reduced the frequency of migraine-associated symptoms and migraine headache severity in patients with episodic migraine.

Major finding: Moderate-to-severe migraine headache days (MHD) reduced significantly with 240 mg galcanezumab (difference in least-squares mean change from baseline [Δ] −1.8 days,  95% CI −2.5 to −1.2) and 120 mg (Δ −1.9 days, 95% CI −2.5 to −1.2) vs placebo, with 240 mg galcanezumab also leading to significant reductions in the proportion of monthly MHD during menstrual periods (P = .04), and MHDswith nausea or vomiting (P = .02).

Study details: This was a secondary analysis of a phase 2 trial including 440 patients with episodic migraine who were randomly assigned to receive monthly galcanezumab (240 or 120 mg) or placebo.

Disclosures: This study was funded by Eli Lilly Japan K.K. Two authors declared being employees and minor shareholders of Eli Lilly. Two authors reported receiving personal fees for speaker or consulting services from Eli Lilly Japan K.K. and other sources.

Source: Igarashi H et al. Galcanezumab effects on migraine severity and symptoms in Japanese patients with episodic migraine: Secondary analysis of a phase 2 randomized trial. Neurol Ther. 2022 (Oct 20). Doi: 10.1007/s40120-022-00410-3

Key clinical point: Adenosine vs placebo infusion increased headaches and short-lasting vasodilation without a significant induction of migraine attacks in patients with migraine without aura.

Major finding: The incidence of migraine attacks was not significantly different after adenosine vs placebo infusion (39% vs 17%; P = .29); however, a higher proportion of patients receiving adenosine vs placebo reported headache (78% vs 33%; P < .01). Adenosine vs placebo increased heart rate (area under the curve [AUC]_{T0-120 min}, P < .001), facial skin blood flow (AUC_{T0-120 min}, P < .05), and left superficial temporal artery diameter (AUC_{T0-20 min}, P = .01), but decreased middle cerebral artery blood flow velocity (AUC_{T0-20 min}, P < .001).

Study details: This randomized controlled trial included 18 patients with migraine without aura who received adenosine or placebo infusion over 20 minutes on two study days separated by a 1 week washout period.

Disclosures: This study received support from the Lundbeck Foundation. M Ashina reported receiving consulting fees, honoraria for lectures and presentations, and royalties from various sources, including Lundbeck.

Source: Thuraiaiyah J et al. Adenosine causes short-lasting vasodilation and headache, but not migraine attacks in migraine patients: A randomized clinical trial. Pain. 2022 (Oct 17). Doi: 10.1097/j.pain.0000000000002804

Key clinical point: Adenosine vs placebo infusion increased headaches and short-lasting vasodilation without a significant induction of migraine attacks in patients with migraine without aura.

Major finding: The incidence of migraine attacks was not significantly different after adenosine vs placebo infusion (39% vs 17%; P = .29); however, a higher proportion of patients receiving adenosine vs placebo reported headache (78% vs 33%; P < .01). Adenosine vs placebo increased heart rate (area under the curve [AUC]_{T0-120 min}, P < .001), facial skin blood flow (AUC_{T0-120 min}, P < .05), and left superficial temporal artery diameter (AUC_{T0-20 min}, P = .01), but decreased middle cerebral artery blood flow velocity (AUC_{T0-20 min}, P < .001).

Study details: This randomized controlled trial included 18 patients with migraine without aura who received adenosine or placebo infusion over 20 minutes on two study days separated by a 1 week washout period.

Disclosures: This study received support from the Lundbeck Foundation. M Ashina reported receiving consulting fees, honoraria for lectures and presentations, and royalties from various sources, including Lundbeck.

Source: Thuraiaiyah J et al. Adenosine causes short-lasting vasodilation and headache, but not migraine attacks in migraine patients: A randomized clinical trial. Pain. 2022 (Oct 17). Doi: 10.1097/j.pain.0000000000002804

Key clinical point: Adenosine vs placebo infusion increased headaches and short-lasting vasodilation without a significant induction of migraine attacks in patients with migraine without aura.

Major finding: The incidence of migraine attacks was not significantly different after adenosine vs placebo infusion (39% vs 17%; P = .29); however, a higher proportion of patients receiving adenosine vs placebo reported headache (78% vs 33%; P < .01). Adenosine vs placebo increased heart rate (area under the curve [AUC]_{T0-120 min}, P < .001), facial skin blood flow (AUC_{T0-120 min}, P < .05), and left superficial temporal artery diameter (AUC_{T0-20 min}, P = .01), but decreased middle cerebral artery blood flow velocity (AUC_{T0-20 min}, P < .001).

Study details: This randomized controlled trial included 18 patients with migraine without aura who received adenosine or placebo infusion over 20 minutes on two study days separated by a 1 week washout period.

Disclosures: This study received support from the Lundbeck Foundation. M Ashina reported receiving consulting fees, honoraria for lectures and presentations, and royalties from various sources, including Lundbeck.

Source: Thuraiaiyah J et al. Adenosine causes short-lasting vasodilation and headache, but not migraine attacks in migraine patients: A randomized clinical trial. Pain. 2022 (Oct 17). Doi: 10.1097/j.pain.0000000000002804

Key clinical point: Individuals diagnosed with childhood cancer were at an increased risk for antimigraine medication and hospitalization due to migraine.

Major finding: Compared with unaffected individuals, those diagnosed with childhood cancer were at an elevated risk for initiating antimigraine therapy (standardized incidence ratios [SIR] 1.22; 95% CI 1.09-1.36) and hospitalization due to migraine (SIR 2.44; 95% CI 1.87-3.12), with the risk for initiating antimigraine therapy being the highest among individuals diagnosed with cancer at 15-19 years of age (SIR 1.48; 95% CI 1.25-1.74).

Study details: This was a population-based cohort study including individuals diagnosed with childhood cancer who had data available for antimigraine prescriptions (n = 6564) and migraine hospitalization (n = 7771).

Disclosures: This study was funded by Danmarks Frie Forskningsfond, Denmark. The authors declared no conflicts of interest.

Source: Davidsson OB et al. Childhood cancer confers increased risk of migraine – A Danish nationwide register study. Cancer Epidemiol. 2022;81:102278 (Oct 13). Doi: 10.1016/j.canep.2022.102278

Key clinical point: Individuals diagnosed with childhood cancer were at an increased risk for antimigraine medication and hospitalization due to migraine.

Major finding: Compared with unaffected individuals, those diagnosed with childhood cancer were at an elevated risk for initiating antimigraine therapy (standardized incidence ratios [SIR] 1.22; 95% CI 1.09-1.36) and hospitalization due to migraine (SIR 2.44; 95% CI 1.87-3.12), with the risk for initiating antimigraine therapy being the highest among individuals diagnosed with cancer at 15-19 years of age (SIR 1.48; 95% CI 1.25-1.74).

Study details: This was a population-based cohort study including individuals diagnosed with childhood cancer who had data available for antimigraine prescriptions (n = 6564) and migraine hospitalization (n = 7771).

Disclosures: This study was funded by Danmarks Frie Forskningsfond, Denmark. The authors declared no conflicts of interest.

Source: Davidsson OB et al. Childhood cancer confers increased risk of migraine – A Danish nationwide register study. Cancer Epidemiol. 2022;81:102278 (Oct 13). Doi: 10.1016/j.canep.2022.102278

Key clinical point: Individuals diagnosed with childhood cancer were at an increased risk for antimigraine medication and hospitalization due to migraine.

Major finding: Compared with unaffected individuals, those diagnosed with childhood cancer were at an elevated risk for initiating antimigraine therapy (standardized incidence ratios [SIR] 1.22; 95% CI 1.09-1.36) and hospitalization due to migraine (SIR 2.44; 95% CI 1.87-3.12), with the risk for initiating antimigraine therapy being the highest among individuals diagnosed with cancer at 15-19 years of age (SIR 1.48; 95% CI 1.25-1.74).

Study details: This was a population-based cohort study including individuals diagnosed with childhood cancer who had data available for antimigraine prescriptions (n = 6564) and migraine hospitalization (n = 7771).

Disclosures: This study was funded by Danmarks Frie Forskningsfond, Denmark. The authors declared no conflicts of interest.

Source: Davidsson OB et al. Childhood cancer confers increased risk of migraine – A Danish nationwide register study. Cancer Epidemiol. 2022;81:102278 (Oct 13). Doi: 10.1016/j.canep.2022.102278

Key clinical point: The presence of seemingly inert calcified lesions of neurocysticercosis (CLN) influences the course of migraine by increasing headache frequency, pain severity, and migraine-associated disability; however, patients with CLN showed a better response to amitriptyline treatment.

Major finding: In patients with vs without CLN, the headache frequency (P < .001), visual analog scale score (P < .001), and Migraine Disability Assessment score (P < .001) were significantly higher at baseline and not significantly different at 3 months after amitriptyline treatment; however, the magnitude of treatment response was significantly higher in patients with vs without CLN (P < .001).

Study details: This case-control study included age- and sex-matched patients with migraine with (n = 78) and without (n = 78) CLN on cranial computed tomography who received preventive treatment with amitriptyline.

Disclosures: The publication expenses were supported by the American Society of Tropical Medicine and Hygiene. RK Garg reported receiving royalties for writing UpToDate articles and an honorarium for writing for MedLink Neurology.

Source: Sharma K et al. Does calcified neurocysticercosis affect migraine characteristics and treatment responsiveness? A case-control study. Am J Trop Med Hyg. 2022 (Oct 10). Doi: 10.4269/ajtmh.22-0335

Key clinical point: The presence of seemingly inert calcified lesions of neurocysticercosis (CLN) influences the course of migraine by increasing headache frequency, pain severity, and migraine-associated disability; however, patients with CLN showed a better response to amitriptyline treatment.

Major finding: In patients with vs without CLN, the headache frequency (P < .001), visual analog scale score (P < .001), and Migraine Disability Assessment score (P < .001) were significantly higher at baseline and not significantly different at 3 months after amitriptyline treatment; however, the magnitude of treatment response was significantly higher in patients with vs without CLN (P < .001).

Study details: This case-control study included age- and sex-matched patients with migraine with (n = 78) and without (n = 78) CLN on cranial computed tomography who received preventive treatment with amitriptyline.

Disclosures: The publication expenses were supported by the American Society of Tropical Medicine and Hygiene. RK Garg reported receiving royalties for writing UpToDate articles and an honorarium for writing for MedLink Neurology.

Source: Sharma K et al. Does calcified neurocysticercosis affect migraine characteristics and treatment responsiveness? A case-control study. Am J Trop Med Hyg. 2022 (Oct 10). Doi: 10.4269/ajtmh.22-0335

Key clinical point: The presence of seemingly inert calcified lesions of neurocysticercosis (CLN) influences the course of migraine by increasing headache frequency, pain severity, and migraine-associated disability; however, patients with CLN showed a better response to amitriptyline treatment.

Major finding: In patients with vs without CLN, the headache frequency (P < .001), visual analog scale score (P < .001), and Migraine Disability Assessment score (P < .001) were significantly higher at baseline and not significantly different at 3 months after amitriptyline treatment; however, the magnitude of treatment response was significantly higher in patients with vs without CLN (P < .001).

Study details: This case-control study included age- and sex-matched patients with migraine with (n = 78) and without (n = 78) CLN on cranial computed tomography who received preventive treatment with amitriptyline.

Disclosures: The publication expenses were supported by the American Society of Tropical Medicine and Hygiene. RK Garg reported receiving royalties for writing UpToDate articles and an honorarium for writing for MedLink Neurology.

Source: Sharma K et al. Does calcified neurocysticercosis affect migraine characteristics and treatment responsiveness? A case-control study. Am J Trop Med Hyg. 2022 (Oct 10). Doi: 10.4269/ajtmh.22-0335

Key clinical point: Autonomic symptoms were prevalent in patients with episodic or chronic migraine but demonstrated no significant correlation with headache frequency, treatment response, or reversion from chronic to episodic migraine.

Major finding: Overall, 60.5% of patients reported a Composite Autonomic Symptom Scale (COMPASS-31) score of ≥30. The median monthly headache days (P = .002) and Migraine Disability Assessment Score (P = .01) reduced significantly during the study period but change in the mean weighted COMPASS-31 score was not significant (P = .885), with no correlation observed between the COMPASS-31 score and monthly headache frequency or reversion from chronic to episodic migraine.

Study details: This was a prospective longitudinal cohort study including 43 patients with episodic or chronic migraine who completed 12 months of treatment and follow-up surveys.

Disclosures: This study did not report the source of funding. Four authors declared receiving funding, grants, or payment for developing educational presentations, serving on advisory boards, or being involved in clinical trials sponsored by various sources.

Source: Ray JC et al. Autonomic symptoms in migraine: Results of a prospective longitudinal study. Front Neurol. 2022;13:1036798 (Nov 3). Doi: 10.3389/fneur.2022.1036798

Key clinical point: Autonomic symptoms were prevalent in patients with episodic or chronic migraine but demonstrated no significant correlation with headache frequency, treatment response, or reversion from chronic to episodic migraine.

Major finding: Overall, 60.5% of patients reported a Composite Autonomic Symptom Scale (COMPASS-31) score of ≥30. The median monthly headache days (P = .002) and Migraine Disability Assessment Score (P = .01) reduced significantly during the study period but change in the mean weighted COMPASS-31 score was not significant (P = .885), with no correlation observed between the COMPASS-31 score and monthly headache frequency or reversion from chronic to episodic migraine.

Study details: This was a prospective longitudinal cohort study including 43 patients with episodic or chronic migraine who completed 12 months of treatment and follow-up surveys.

Disclosures: This study did not report the source of funding. Four authors declared receiving funding, grants, or payment for developing educational presentations, serving on advisory boards, or being involved in clinical trials sponsored by various sources.

Source: Ray JC et al. Autonomic symptoms in migraine: Results of a prospective longitudinal study. Front Neurol. 2022;13:1036798 (Nov 3). Doi: 10.3389/fneur.2022.1036798

Key clinical point: Autonomic symptoms were prevalent in patients with episodic or chronic migraine but demonstrated no significant correlation with headache frequency, treatment response, or reversion from chronic to episodic migraine.

Major finding: Overall, 60.5% of patients reported a Composite Autonomic Symptom Scale (COMPASS-31) score of ≥30. The median monthly headache days (P = .002) and Migraine Disability Assessment Score (P = .01) reduced significantly during the study period but change in the mean weighted COMPASS-31 score was not significant (P = .885), with no correlation observed between the COMPASS-31 score and monthly headache frequency or reversion from chronic to episodic migraine.

Study details: This was a prospective longitudinal cohort study including 43 patients with episodic or chronic migraine who completed 12 months of treatment and follow-up surveys.

Disclosures: This study did not report the source of funding. Four authors declared receiving funding, grants, or payment for developing educational presentations, serving on advisory boards, or being involved in clinical trials sponsored by various sources.

Source: Ray JC et al. Autonomic symptoms in migraine: Results of a prospective longitudinal study. Front Neurol. 2022;13:1036798 (Nov 3). Doi: 10.3389/fneur.2022.1036798

Key clinical point: During acute headaches, patients with migraine had elevated levels of peripheral inflammatory markers (PIM), specifically the neutrophil-to-lymphocyte ratio (NLR) and the neutrophil-to-monocyte ratio (NMR), which could fairly differentiate between the migraine and no headache groups.

Major finding: Patients with migraine had higher NLR, NMR, and monocyte-to-lymphocyte ratio (all P < .001) compared with control individuals without headache and higher NMR (P < .001) and higher NLR (P = .051) compared with patients with non-migraine headaches during acute headache attacks. NLR and NMR could fairly differentiate between the migraine and no headache groups (NLR: area under the curve [AUC] 0.65; NMR: AUC 0.61; P < .001).

Study details: This was a retrospective analysis of 4005 patients with acute headache attack, including those with migraine (n = 1453) or non-migraine (n = 2552) headaches, and 88,586 control individuals without headache.

Disclosures: This study was supported by Basic Science Research Program through the National Research Foundataion of Korea funded by the Ministry of Education and others. The authors declared no conflicts of interest.

Source: Lee S-H et al. Role of peripheral inflammatory markers in patients with acute headache attack to differentiate between migraine and non-migraine headache. J Clin Med. 2022;11(21):6538 (Nov 3). Doi: 10.3390/jcm11216538

Key clinical point: During acute headaches, patients with migraine had elevated levels of peripheral inflammatory markers (PIM), specifically the neutrophil-to-lymphocyte ratio (NLR) and the neutrophil-to-monocyte ratio (NMR), which could fairly differentiate between the migraine and no headache groups.

Major finding: Patients with migraine had higher NLR, NMR, and monocyte-to-lymphocyte ratio (all P < .001) compared with control individuals without headache and higher NMR (P < .001) and higher NLR (P = .051) compared with patients with non-migraine headaches during acute headache attacks. NLR and NMR could fairly differentiate between the migraine and no headache groups (NLR: area under the curve [AUC] 0.65; NMR: AUC 0.61; P < .001).

Study details: This was a retrospective analysis of 4005 patients with acute headache attack, including those with migraine (n = 1453) or non-migraine (n = 2552) headaches, and 88,586 control individuals without headache.

Disclosures: This study was supported by Basic Science Research Program through the National Research Foundataion of Korea funded by the Ministry of Education and others. The authors declared no conflicts of interest.

Source: Lee S-H et al. Role of peripheral inflammatory markers in patients with acute headache attack to differentiate between migraine and non-migraine headache. J Clin Med. 2022;11(21):6538 (Nov 3). Doi: 10.3390/jcm11216538

Key clinical point: During acute headaches, patients with migraine had elevated levels of peripheral inflammatory markers (PIM), specifically the neutrophil-to-lymphocyte ratio (NLR) and the neutrophil-to-monocyte ratio (NMR), which could fairly differentiate between the migraine and no headache groups.

Major finding: Patients with migraine had higher NLR, NMR, and monocyte-to-lymphocyte ratio (all P < .001) compared with control individuals without headache and higher NMR (P < .001) and higher NLR (P = .051) compared with patients with non-migraine headaches during acute headache attacks. NLR and NMR could fairly differentiate between the migraine and no headache groups (NLR: area under the curve [AUC] 0.65; NMR: AUC 0.61; P < .001).

Study details: This was a retrospective analysis of 4005 patients with acute headache attack, including those with migraine (n = 1453) or non-migraine (n = 2552) headaches, and 88,586 control individuals without headache.

Disclosures: This study was supported by Basic Science Research Program through the National Research Foundataion of Korea funded by the Ministry of Education and others. The authors declared no conflicts of interest.

Source: Lee S-H et al. Role of peripheral inflammatory markers in patients with acute headache attack to differentiate between migraine and non-migraine headache. J Clin Med. 2022;11(21):6538 (Nov 3). Doi: 10.3390/jcm11216538

Key clinical point: Migraine pain characteristics indicating peripheral or central sensitization may help predict ≥50% response to anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) in patients with high frequency episodic migraine (HFEM) or chronic migraine (CM).

Major finding: In HFEM, unilateral pain (UP) + unilateral cranial autonomic symptoms (UA) positively predicted ≥50% response (odds ratio [OR] 4.23; P = .004), whereas in CM, UP (OR 1.46; P = .039), UA (OR 1.49; P = .026), UP+UA (OR 1.90; P = .012), and UP+allodynia (OR 1.71; P = .034) positively predicted ≥50% response and obesity negatively predicted ≥50% response (OR 0.21; P = .006).

Study details: This was a real-life prospective cohort study including 864 anti-CGRP mAb-naive patients with HFEM or CM and unresponsiveness or contraindications for or low tolerability to >3 migraine preventive medications, who were prescribed erenumab, galcanezumab, or fremanezumab for ≥24 weeks.

Disclosures: This study was partially supported by the Italian Ministry of Health IRCCS San Raffaele Roma. Several authors reported receiving personal compensation, travel grants, honoraria, or research support from various sources.

Source: Barbanti P et al. Predictors of response to anti-CGRP monoclonal antibodies: A 24-week, multicenter, prospective study on 864 migraine patients. J Headache Pain. 2022;23:138 (Nov 1). Doi: 10.1186/s10194-022-01498-6

Key clinical point: Migraine pain characteristics indicating peripheral or central sensitization may help predict ≥50% response to anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) in patients with high frequency episodic migraine (HFEM) or chronic migraine (CM).

Major finding: In HFEM, unilateral pain (UP) + unilateral cranial autonomic symptoms (UA) positively predicted ≥50% response (odds ratio [OR] 4.23; P = .004), whereas in CM, UP (OR 1.46; P = .039), UA (OR 1.49; P = .026), UP+UA (OR 1.90; P = .012), and UP+allodynia (OR 1.71; P = .034) positively predicted ≥50% response and obesity negatively predicted ≥50% response (OR 0.21; P = .006).

Study details: This was a real-life prospective cohort study including 864 anti-CGRP mAb-naive patients with HFEM or CM and unresponsiveness or contraindications for or low tolerability to >3 migraine preventive medications, who were prescribed erenumab, galcanezumab, or fremanezumab for ≥24 weeks.

Disclosures: This study was partially supported by the Italian Ministry of Health IRCCS San Raffaele Roma. Several authors reported receiving personal compensation, travel grants, honoraria, or research support from various sources.

Source: Barbanti P et al. Predictors of response to anti-CGRP monoclonal antibodies: A 24-week, multicenter, prospective study on 864 migraine patients. J Headache Pain. 2022;23:138 (Nov 1). Doi: 10.1186/s10194-022-01498-6

Key clinical point: Migraine pain characteristics indicating peripheral or central sensitization may help predict ≥50% response to anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) in patients with high frequency episodic migraine (HFEM) or chronic migraine (CM).

Major finding: In HFEM, unilateral pain (UP) + unilateral cranial autonomic symptoms (UA) positively predicted ≥50% response (odds ratio [OR] 4.23; P = .004), whereas in CM, UP (OR 1.46; P = .039), UA (OR 1.49; P = .026), UP+UA (OR 1.90; P = .012), and UP+allodynia (OR 1.71; P = .034) positively predicted ≥50% response and obesity negatively predicted ≥50% response (OR 0.21; P = .006).

Study details: This was a real-life prospective cohort study including 864 anti-CGRP mAb-naive patients with HFEM or CM and unresponsiveness or contraindications for or low tolerability to >3 migraine preventive medications, who were prescribed erenumab, galcanezumab, or fremanezumab for ≥24 weeks.

Disclosures: This study was partially supported by the Italian Ministry of Health IRCCS San Raffaele Roma. Several authors reported receiving personal compensation, travel grants, honoraria, or research support from various sources.

Source: Barbanti P et al. Predictors of response to anti-CGRP monoclonal antibodies: A 24-week, multicenter, prospective study on 864 migraine patients. J Headache Pain. 2022;23:138 (Nov 1). Doi: 10.1186/s10194-022-01498-6

Key clinical point: Despite no significant improvement in pain-free status, high-dose zolmitriptan nasal spray (ZNS) provided clinically relevant improvements with a favorable safety profile in the acute treatment of migraine in patients aged 6-11 years.

Major finding: At 2 hours postdose, high-dose ZNS vs placebo led to a numerically higher proportion of patients achieving pain-free status (odds ratio [OR] 1.51; 95% CI 0.96-2.38) and a significantly higher proportion of patients reporting a headache response (OR 1.75; P = .009). No serious treatment-emergent adverse events were reported.

Study details: This was a phase 3 crossover trial with an open-label extension including 186 patients aged 6-11 years with migraine with or without aura who were randomly assigned to receive ZNS (patients <50 kg: 2.5 or 1 mg; patients ≥50 kg: 5 or 2.5 mg) or placebo.

Disclosures: This trial was funded by AstraZeneca and conducted by Amneal Pharmaceuticals LLC, which also supported the study’s publication. Two authors declared being employees of Amneal or a company contracted by Amneal. Two authors reported ties with various other sources.

Source: Yonker ME et al. A multicenter, randomized, double-blind, placebo-controlled, crossover trial to evaluate the efficacy and safety of zolmitriptan nasal spray for the acute treatment of migraine in patients aged 6 to 11 years, with an open-label extension. Headache. 2022;62(9):1207-1217 (Oct 26). Doi: 10.1111/head.14391

Key clinical point: Despite no significant improvement in pain-free status, high-dose zolmitriptan nasal spray (ZNS) provided clinically relevant improvements with a favorable safety profile in the acute treatment of migraine in patients aged 6-11 years.

Major finding: At 2 hours postdose, high-dose ZNS vs placebo led to a numerically higher proportion of patients achieving pain-free status (odds ratio [OR] 1.51; 95% CI 0.96-2.38) and a significantly higher proportion of patients reporting a headache response (OR 1.75; P = .009). No serious treatment-emergent adverse events were reported.

Study details: This was a phase 3 crossover trial with an open-label extension including 186 patients aged 6-11 years with migraine with or without aura who were randomly assigned to receive ZNS (patients <50 kg: 2.5 or 1 mg; patients ≥50 kg: 5 or 2.5 mg) or placebo.

Disclosures: This trial was funded by AstraZeneca and conducted by Amneal Pharmaceuticals LLC, which also supported the study’s publication. Two authors declared being employees of Amneal or a company contracted by Amneal. Two authors reported ties with various other sources.

Source: Yonker ME et al. A multicenter, randomized, double-blind, placebo-controlled, crossover trial to evaluate the efficacy and safety of zolmitriptan nasal spray for the acute treatment of migraine in patients aged 6 to 11 years, with an open-label extension. Headache. 2022;62(9):1207-1217 (Oct 26). Doi: 10.1111/head.14391

Key clinical point: Despite no significant improvement in pain-free status, high-dose zolmitriptan nasal spray (ZNS) provided clinically relevant improvements with a favorable safety profile in the acute treatment of migraine in patients aged 6-11 years.

Major finding: At 2 hours postdose, high-dose ZNS vs placebo led to a numerically higher proportion of patients achieving pain-free status (odds ratio [OR] 1.51; 95% CI 0.96-2.38) and a significantly higher proportion of patients reporting a headache response (OR 1.75; P = .009). No serious treatment-emergent adverse events were reported.

Study details: This was a phase 3 crossover trial with an open-label extension including 186 patients aged 6-11 years with migraine with or without aura who were randomly assigned to receive ZNS (patients <50 kg: 2.5 or 1 mg; patients ≥50 kg: 5 or 2.5 mg) or placebo.

Disclosures: This trial was funded by AstraZeneca and conducted by Amneal Pharmaceuticals LLC, which also supported the study’s publication. Two authors declared being employees of Amneal or a company contracted by Amneal. Two authors reported ties with various other sources.

Source: Yonker ME et al. A multicenter, randomized, double-blind, placebo-controlled, crossover trial to evaluate the efficacy and safety of zolmitriptan nasal spray for the acute treatment of migraine in patients aged 6 to 11 years, with an open-label extension. Headache. 2022;62(9):1207-1217 (Oct 26). Doi: 10.1111/head.14391