Headache & Migraine

Key clinical point: Meta-analysis on 10 years of real-world data confirmed the efficacy of onabotulinumtoxinA as a preventive treatment for chronic migraine.

Major finding: At week 24, onabotulinumtoxinA reduced the number of headache days per month (mean change from baseline [MCFB] −10.64; 95% CI −12.31 to −8.97), with a ≥50% reduction in migraine days response rate of 46.57% (95% CI 29.50%-63.65%) and improvements in total Headache Impact Test-6 score (MCFB −11.70; 95% CI −13.86 to −9.54) and Migraine-Specific Quality of Life v2.1 score (MCFB 23.60; 95% CI 21.56-25.64). The improvements were maintained till 52 weeks.

Study details: Findings are from a systematic review and meta-analysis of 44 studies including patients with chronic migraine who received onabotulinumtoxinA.

Disclosures: This study was supported by AbbVie. M Lanteri-Minet reported receiving personal fees and grants from various sources. Four authors declared being employees of AbbVie or working for a consultancy company commissioned by AbbVie or holding stock options in GSK and AbbVie.

Source: Lanteri-Minet M et al. Effectiveness of onabotulinumtoxinA (BOTOX®) for the preventive treatment of chronic migraine: A meta-analysis on 10 years of real-world data. Cephalalgia. 2022 (Sep 8). Doi: 10.1177/03331024221123058

Key clinical point: Meta-analysis on 10 years of real-world data confirmed the efficacy of onabotulinumtoxinA as a preventive treatment for chronic migraine.

Major finding: At week 24, onabotulinumtoxinA reduced the number of headache days per month (mean change from baseline [MCFB] −10.64; 95% CI −12.31 to −8.97), with a ≥50% reduction in migraine days response rate of 46.57% (95% CI 29.50%-63.65%) and improvements in total Headache Impact Test-6 score (MCFB −11.70; 95% CI −13.86 to −9.54) and Migraine-Specific Quality of Life v2.1 score (MCFB 23.60; 95% CI 21.56-25.64). The improvements were maintained till 52 weeks.

Study details: Findings are from a systematic review and meta-analysis of 44 studies including patients with chronic migraine who received onabotulinumtoxinA.

Disclosures: This study was supported by AbbVie. M Lanteri-Minet reported receiving personal fees and grants from various sources. Four authors declared being employees of AbbVie or working for a consultancy company commissioned by AbbVie or holding stock options in GSK and AbbVie.

Source: Lanteri-Minet M et al. Effectiveness of onabotulinumtoxinA (BOTOX®) for the preventive treatment of chronic migraine: A meta-analysis on 10 years of real-world data. Cephalalgia. 2022 (Sep 8). Doi: 10.1177/03331024221123058

Key clinical point: Meta-analysis on 10 years of real-world data confirmed the efficacy of onabotulinumtoxinA as a preventive treatment for chronic migraine.

Major finding: At week 24, onabotulinumtoxinA reduced the number of headache days per month (mean change from baseline [MCFB] −10.64; 95% CI −12.31 to −8.97), with a ≥50% reduction in migraine days response rate of 46.57% (95% CI 29.50%-63.65%) and improvements in total Headache Impact Test-6 score (MCFB −11.70; 95% CI −13.86 to −9.54) and Migraine-Specific Quality of Life v2.1 score (MCFB 23.60; 95% CI 21.56-25.64). The improvements were maintained till 52 weeks.

Study details: Findings are from a systematic review and meta-analysis of 44 studies including patients with chronic migraine who received onabotulinumtoxinA.

Disclosures: This study was supported by AbbVie. M Lanteri-Minet reported receiving personal fees and grants from various sources. Four authors declared being employees of AbbVie or working for a consultancy company commissioned by AbbVie or holding stock options in GSK and AbbVie.

Source: Lanteri-Minet M et al. Effectiveness of onabotulinumtoxinA (BOTOX®) for the preventive treatment of chronic migraine: A meta-analysis on 10 years of real-world data. Cephalalgia. 2022 (Sep 8). Doi: 10.1177/03331024221123058

Key clinical point: Patients with migraine treated with anti-calcitonin gene-related peptide (anti-CGRP) receptor monoclonal antibodies (mAb), erenumab and fremanezumab, reported an increase in systolic and diastolic blood pressure, with most having blood pressure within normal limits but some requiring antihypertensive treatment.

Major finding: At 3 months, patients treated with erenumab or fremanezumab reported a significant increase in systolic (change from baseline [Δ] 5.0 mm Hg; P < .001) and diastolic (Δ 3.3 mm Hg; P < .001) blood pressure, with sustained effects over 1 year of follow-up (P < .001). Antihypertensive treatment was required by 3.7% of patients treated with erenumab.

Study details: This prospective follow-up study included 196 patients with migraine who previously failed ≥4 migraine preventive treatments and received erenumab or fremanezumab and 109 patients with migraine who did not use any migraine prophylactic medication.

Disclosures: This study did not receive any targeted funding. AM van den Brink and GM Terwindt reported receiving independent, consultancy, or industry support from various sources.

Source: de Vries Lentsch S et al. Blood pressure in migraine patients treated with monoclonal anti-CGRP (receptor) antibodies: A prospective follow-up study. Neurology. 2022 (Oct 4). Doi: 10.1212/WNL.0000000000201008

Key clinical point: Patients with migraine treated with anti-calcitonin gene-related peptide (anti-CGRP) receptor monoclonal antibodies (mAb), erenumab and fremanezumab, reported an increase in systolic and diastolic blood pressure, with most having blood pressure within normal limits but some requiring antihypertensive treatment.

Major finding: At 3 months, patients treated with erenumab or fremanezumab reported a significant increase in systolic (change from baseline [Δ] 5.0 mm Hg; P < .001) and diastolic (Δ 3.3 mm Hg; P < .001) blood pressure, with sustained effects over 1 year of follow-up (P < .001). Antihypertensive treatment was required by 3.7% of patients treated with erenumab.

Study details: This prospective follow-up study included 196 patients with migraine who previously failed ≥4 migraine preventive treatments and received erenumab or fremanezumab and 109 patients with migraine who did not use any migraine prophylactic medication.

Disclosures: This study did not receive any targeted funding. AM van den Brink and GM Terwindt reported receiving independent, consultancy, or industry support from various sources.

Source: de Vries Lentsch S et al. Blood pressure in migraine patients treated with monoclonal anti-CGRP (receptor) antibodies: A prospective follow-up study. Neurology. 2022 (Oct 4). Doi: 10.1212/WNL.0000000000201008

Key clinical point: Patients with migraine treated with anti-calcitonin gene-related peptide (anti-CGRP) receptor monoclonal antibodies (mAb), erenumab and fremanezumab, reported an increase in systolic and diastolic blood pressure, with most having blood pressure within normal limits but some requiring antihypertensive treatment.

Major finding: At 3 months, patients treated with erenumab or fremanezumab reported a significant increase in systolic (change from baseline [Δ] 5.0 mm Hg; P < .001) and diastolic (Δ 3.3 mm Hg; P < .001) blood pressure, with sustained effects over 1 year of follow-up (P < .001). Antihypertensive treatment was required by 3.7% of patients treated with erenumab.

Study details: This prospective follow-up study included 196 patients with migraine who previously failed ≥4 migraine preventive treatments and received erenumab or fremanezumab and 109 patients with migraine who did not use any migraine prophylactic medication.

Disclosures: This study did not receive any targeted funding. AM van den Brink and GM Terwindt reported receiving independent, consultancy, or industry support from various sources.

Source: de Vries Lentsch S et al. Blood pressure in migraine patients treated with monoclonal anti-CGRP (receptor) antibodies: A prospective follow-up study. Neurology. 2022 (Oct 4). Doi: 10.1212/WNL.0000000000201008

Headache as a symptom of COVID-19 could help predict survival for inpatients with the disease, according to recent research published in the journal Headache.

In the systematic review and meta-analysis, Víctor J. Gallardo, MSc, of the headache and neurologic pain research group, Vall d’Hebron Research Institute at the Universitat Autònoma de Barcelona, and colleagues performed a search of studies in PubMed involving headache symptoms, disease survival, and inpatient COVID-19 cases published between December 2019 and December 2020. Overall, 48 studies were identified, consisting of 43,169 inpatients with COVID-19. Using random-effects pooling models, Mr. Gallardo and colleagues estimated the prevalence of headache for inpatients who survived COVID-19, compared with those who did not survive.

Within those studies, 35,132 inpatients (81.4%) survived, while 8,037 inpatients (18.6%) died from COVID-19. The researchers found that inpatients with COVID-19 and headache symptoms had a significantly higher survival rate compared with inpatients with COVID-19 without headache symptoms (risk ratio, 1.90; 95% confidence interval, 1.46-2.47; P < .0001). There was an overall pooled prevalence of headache as a COVID-19 symptom in 10.4% of inpatients, which was reduced to an estimated pooled prevalence of 9.7% after the researchers removed outlier studies in a sensitivity analysis.

Other COVID-19 symptoms that led to improved rates of survival among inpatients were anosmia (RR, 2.94; 95% CI, 1.94-4.45) and myalgia (RR, 1.57; 95% CI, 1.34-1.83) as well as nausea or vomiting (RR, 1.41; 95% CI, 1.08-1.82), while symptoms such as dyspnea, diabetes, chronic liver diseases, chronic respiratory diseases, and chronic kidney diseases were more likely to increase the risk of dying from COVID-19.

The researchers noted several limitations in their meta-analysis that may make their findings less generalizable to future SARS-CoV-2 variants, such as including only studies that were published before COVID-19 vaccines were available and before more infectious SARS-CoV-2 variants like the B.1.617.2 (Delta) variant emerged. They also included studies where inpatients were not tested for COVID-19 because access to testing was not widely available.

“Our meta-analysis points toward a novel possibility: Headache arising secondary to an infection is not a ‘nonspecific’ symptom, but rather it may be a marker of enhanced likelihood of survival. That is, we find that patients reporting headache in the setting of COVID-19 are at reduced risk of death,” Mr. Gallardo and colleagues wrote.
 

More data needed on association between headache and COVID-19

While headache appeared to affect a small proportion of overall inpatients with COVID-19, the researchers noted this might be because individuals with COVID-19 and headache symptoms are less likely to require hospitalization or a visit to the ED. Another potential explanation is that “people with primary headache disorders, including migraine, may be more likely to report symptoms of COVID-19, but they also may be relatively less likely to experience a life-threatening COVID-19 disease course.”

The researchers said this potential association should be explored in future studies as well as in other viral infections or postviral syndromes such as long COVID. “Defining specific headache mechanisms that could enhance survival from viral infections represents an opportunity for the potential discovery of improved viral therapeutics, as well as for understanding whether, and how, primary headache disorders may be adaptive.”

In a comment, Morris Levin, MD, director of the University of California San Francisco Headache Center, said the findings “of this very thought-provoking review suggest that reporting a headache during a COVID-19 infection seems to be associated with better recovery in hospitalized patients.”

Dr. Levin, who was not involved with the study, acknowledged the researchers’ explanation for the overall low rate of headache in these inpatients as one possible explanation.

“Another could be that sick COVID patients were much more troubled by other symptoms like respiratory distress, which overshadowed their headache symptoms, particularly if they were very ill or if the headache pain was of only mild to moderate severity,” he said. “That could also be an alternate explanation for why less dangerously ill hospitalized patients seemed to have more headaches.”

One limitation he saw in the meta-analysis was how clearly the clinicians characterized headache symptoms in each reviewed study. Dr. Levin suggested a retrospective assessment of premorbid migraine history in hospitalized patients with COVID-19, including survivors and fatalities, might have helped clarify this issue. “The headaches themselves were not characterized so drawing conclusions regarding migraine is challenging.”

Dr. Levin noted it is still not well understood how acute and persistent headaches and other neurological symptoms like mental fog occur in patients with COVID-19. We also do not fully understand the natural history of post-COVID headaches and other neurologic sequelae and the management options for acute and persistent neurological sequelae.

Three authors reported personal and institutional relationships in the form of grants, consultancies, speaker’s bureau positions, guidelines committee member appointments, and editorial board positions for a variety of pharmaceutical companies, agencies, societies, and other organizations. Mr. Gallardo reported no relevant financial disclosures. Dr. Levin reported no relevant financial disclosures.

Headache as a symptom of COVID-19 could help predict survival for inpatients with the disease, according to recent research published in the journal Headache.

In the systematic review and meta-analysis, Víctor J. Gallardo, MSc, of the headache and neurologic pain research group, Vall d’Hebron Research Institute at the Universitat Autònoma de Barcelona, and colleagues performed a search of studies in PubMed involving headache symptoms, disease survival, and inpatient COVID-19 cases published between December 2019 and December 2020. Overall, 48 studies were identified, consisting of 43,169 inpatients with COVID-19. Using random-effects pooling models, Mr. Gallardo and colleagues estimated the prevalence of headache for inpatients who survived COVID-19, compared with those who did not survive.

Within those studies, 35,132 inpatients (81.4%) survived, while 8,037 inpatients (18.6%) died from COVID-19. The researchers found that inpatients with COVID-19 and headache symptoms had a significantly higher survival rate compared with inpatients with COVID-19 without headache symptoms (risk ratio, 1.90; 95% confidence interval, 1.46-2.47; P < .0001). There was an overall pooled prevalence of headache as a COVID-19 symptom in 10.4% of inpatients, which was reduced to an estimated pooled prevalence of 9.7% after the researchers removed outlier studies in a sensitivity analysis.

Other COVID-19 symptoms that led to improved rates of survival among inpatients were anosmia (RR, 2.94; 95% CI, 1.94-4.45) and myalgia (RR, 1.57; 95% CI, 1.34-1.83) as well as nausea or vomiting (RR, 1.41; 95% CI, 1.08-1.82), while symptoms such as dyspnea, diabetes, chronic liver diseases, chronic respiratory diseases, and chronic kidney diseases were more likely to increase the risk of dying from COVID-19.

The researchers noted several limitations in their meta-analysis that may make their findings less generalizable to future SARS-CoV-2 variants, such as including only studies that were published before COVID-19 vaccines were available and before more infectious SARS-CoV-2 variants like the B.1.617.2 (Delta) variant emerged. They also included studies where inpatients were not tested for COVID-19 because access to testing was not widely available.

“Our meta-analysis points toward a novel possibility: Headache arising secondary to an infection is not a ‘nonspecific’ symptom, but rather it may be a marker of enhanced likelihood of survival. That is, we find that patients reporting headache in the setting of COVID-19 are at reduced risk of death,” Mr. Gallardo and colleagues wrote.
 

More data needed on association between headache and COVID-19

While headache appeared to affect a small proportion of overall inpatients with COVID-19, the researchers noted this might be because individuals with COVID-19 and headache symptoms are less likely to require hospitalization or a visit to the ED. Another potential explanation is that “people with primary headache disorders, including migraine, may be more likely to report symptoms of COVID-19, but they also may be relatively less likely to experience a life-threatening COVID-19 disease course.”

The researchers said this potential association should be explored in future studies as well as in other viral infections or postviral syndromes such as long COVID. “Defining specific headache mechanisms that could enhance survival from viral infections represents an opportunity for the potential discovery of improved viral therapeutics, as well as for understanding whether, and how, primary headache disorders may be adaptive.”

In a comment, Morris Levin, MD, director of the University of California San Francisco Headache Center, said the findings “of this very thought-provoking review suggest that reporting a headache during a COVID-19 infection seems to be associated with better recovery in hospitalized patients.”

Dr. Levin, who was not involved with the study, acknowledged the researchers’ explanation for the overall low rate of headache in these inpatients as one possible explanation.

“Another could be that sick COVID patients were much more troubled by other symptoms like respiratory distress, which overshadowed their headache symptoms, particularly if they were very ill or if the headache pain was of only mild to moderate severity,” he said. “That could also be an alternate explanation for why less dangerously ill hospitalized patients seemed to have more headaches.”

One limitation he saw in the meta-analysis was how clearly the clinicians characterized headache symptoms in each reviewed study. Dr. Levin suggested a retrospective assessment of premorbid migraine history in hospitalized patients with COVID-19, including survivors and fatalities, might have helped clarify this issue. “The headaches themselves were not characterized so drawing conclusions regarding migraine is challenging.”

Dr. Levin noted it is still not well understood how acute and persistent headaches and other neurological symptoms like mental fog occur in patients with COVID-19. We also do not fully understand the natural history of post-COVID headaches and other neurologic sequelae and the management options for acute and persistent neurological sequelae.

Three authors reported personal and institutional relationships in the form of grants, consultancies, speaker’s bureau positions, guidelines committee member appointments, and editorial board positions for a variety of pharmaceutical companies, agencies, societies, and other organizations. Mr. Gallardo reported no relevant financial disclosures. Dr. Levin reported no relevant financial disclosures.

Headache as a symptom of COVID-19 could help predict survival for inpatients with the disease, according to recent research published in the journal Headache.

In the systematic review and meta-analysis, Víctor J. Gallardo, MSc, of the headache and neurologic pain research group, Vall d’Hebron Research Institute at the Universitat Autònoma de Barcelona, and colleagues performed a search of studies in PubMed involving headache symptoms, disease survival, and inpatient COVID-19 cases published between December 2019 and December 2020. Overall, 48 studies were identified, consisting of 43,169 inpatients with COVID-19. Using random-effects pooling models, Mr. Gallardo and colleagues estimated the prevalence of headache for inpatients who survived COVID-19, compared with those who did not survive.

Within those studies, 35,132 inpatients (81.4%) survived, while 8,037 inpatients (18.6%) died from COVID-19. The researchers found that inpatients with COVID-19 and headache symptoms had a significantly higher survival rate compared with inpatients with COVID-19 without headache symptoms (risk ratio, 1.90; 95% confidence interval, 1.46-2.47; P < .0001). There was an overall pooled prevalence of headache as a COVID-19 symptom in 10.4% of inpatients, which was reduced to an estimated pooled prevalence of 9.7% after the researchers removed outlier studies in a sensitivity analysis.

Other COVID-19 symptoms that led to improved rates of survival among inpatients were anosmia (RR, 2.94; 95% CI, 1.94-4.45) and myalgia (RR, 1.57; 95% CI, 1.34-1.83) as well as nausea or vomiting (RR, 1.41; 95% CI, 1.08-1.82), while symptoms such as dyspnea, diabetes, chronic liver diseases, chronic respiratory diseases, and chronic kidney diseases were more likely to increase the risk of dying from COVID-19.

The researchers noted several limitations in their meta-analysis that may make their findings less generalizable to future SARS-CoV-2 variants, such as including only studies that were published before COVID-19 vaccines were available and before more infectious SARS-CoV-2 variants like the B.1.617.2 (Delta) variant emerged. They also included studies where inpatients were not tested for COVID-19 because access to testing was not widely available.

“Our meta-analysis points toward a novel possibility: Headache arising secondary to an infection is not a ‘nonspecific’ symptom, but rather it may be a marker of enhanced likelihood of survival. That is, we find that patients reporting headache in the setting of COVID-19 are at reduced risk of death,” Mr. Gallardo and colleagues wrote.
 

More data needed on association between headache and COVID-19

While headache appeared to affect a small proportion of overall inpatients with COVID-19, the researchers noted this might be because individuals with COVID-19 and headache symptoms are less likely to require hospitalization or a visit to the ED. Another potential explanation is that “people with primary headache disorders, including migraine, may be more likely to report symptoms of COVID-19, but they also may be relatively less likely to experience a life-threatening COVID-19 disease course.”

The researchers said this potential association should be explored in future studies as well as in other viral infections or postviral syndromes such as long COVID. “Defining specific headache mechanisms that could enhance survival from viral infections represents an opportunity for the potential discovery of improved viral therapeutics, as well as for understanding whether, and how, primary headache disorders may be adaptive.”

In a comment, Morris Levin, MD, director of the University of California San Francisco Headache Center, said the findings “of this very thought-provoking review suggest that reporting a headache during a COVID-19 infection seems to be associated with better recovery in hospitalized patients.”

Dr. Levin, who was not involved with the study, acknowledged the researchers’ explanation for the overall low rate of headache in these inpatients as one possible explanation.

“Another could be that sick COVID patients were much more troubled by other symptoms like respiratory distress, which overshadowed their headache symptoms, particularly if they were very ill or if the headache pain was of only mild to moderate severity,” he said. “That could also be an alternate explanation for why less dangerously ill hospitalized patients seemed to have more headaches.”

One limitation he saw in the meta-analysis was how clearly the clinicians characterized headache symptoms in each reviewed study. Dr. Levin suggested a retrospective assessment of premorbid migraine history in hospitalized patients with COVID-19, including survivors and fatalities, might have helped clarify this issue. “The headaches themselves were not characterized so drawing conclusions regarding migraine is challenging.”

Dr. Levin noted it is still not well understood how acute and persistent headaches and other neurological symptoms like mental fog occur in patients with COVID-19. We also do not fully understand the natural history of post-COVID headaches and other neurologic sequelae and the management options for acute and persistent neurological sequelae.

Three authors reported personal and institutional relationships in the form of grants, consultancies, speaker’s bureau positions, guidelines committee member appointments, and editorial board positions for a variety of pharmaceutical companies, agencies, societies, and other organizations. Mr. Gallardo reported no relevant financial disclosures. Dr. Levin reported no relevant financial disclosures.

Lasmiditan—the first migraine treatment in the new ditan class— is a serotonin receptor agonist, similar to triptan medications. However, it is specific for the 5HT_1F receptor rather than the 5HT_1B/1D receptor. The main purpose of this specificity is that it leads to less vascular risk; specifically, this medication should be safer for populations at higher risk for vascular events, such as myocardial infarction and stroke.

Only one triptan, naratriptan, had previously been studied for the treatment of menstrual migraine, at a recommended dose of 2.5 mg twice daily as a bridge. A new study by MacGregor and colleagues looked at taking 50, 100, or 200 mg of lasmiditan vs placebo for an individual premenstrual attack.

The participants in the study were recruited from the intention-to-treat population of two prior studies for this drug, a phase 2 trial and a phase 3 trial. The menstrual calendars of the female participants were reviewed, followed by randomization into one of the four groups. Patients with chronic migraine were excluded from the study. The primary outcome was freedom from pain at 2 hours; secondary outcomes were freedom from the most bothersome symptom and reduction in pain severity.

Of the four populations followed, all three intervention groups noted significant results in freedom from pain at 2 hours compared with placebo. The 2-hour responder rate was 33.6% for the 200 mg group, 16.7% for the 50 mg and 100 mg groups, and 7.6% for the placebo group. Freedom from the most bothersome symptom and pain reduction were also significant in these populations.

Menstruation-associated migraine and worsening headache attacks due to patients' hormonal fluctuations are some of the most common issues and triggers that neurologists and headache specialists confront. Although the responder rates for freedom from pain at 2 hours were not very robust, lasmiditan does appear to be significantly effective in this population, and in those with menstrual triggers specifically. The field of headache medicine would be even better served by additional studies on both preventive and more acute medications in association with hormonal triggers.

Another very common trigger for migraine is changes in sleep patterns. An astute headache specialist will always ask about sleep quantity and quality during an initial assessment of a patient. Many headache centers have sleep-specific questionnaires that patients fill out during intake. The precise association between migraine and sleep deserves more elucidation. Duan and colleagues specifically set out to reveal whether differences in sleep quality affect migraine frequency; whether this is the same among different gender and age groups; and whether headache disability, severity, mood, and quality of life are related to underlying sleep changes independent of other factors.

A total of 134 participants with migraine and 70 without migraine or any other headache disorder were enrolled in the study. Sleep quality was assessed through The Pittsburgh Sleep Quality Index (PSQI) questionnaire. This is a commonly used self-reported questionnaire for assessing quality and quantity of sleep over the past month and is considered the standard of care in most sleep centers. The investigators here sought to determine the predictive value of the PSQI in regard to migraine. Migraine disability was assessed via the Migraine Disability Assessment (MIDAS) scale as well as the Headache Impact Test (HIT-6). Statistical analysis was performed with logistical regression, t test, and χ² squared test.

There strongest correlations between poor sleep quality and risk of migraine were found in women, patients over 35 years old, and those with lower education levels. The results revealed that the migraine group had poorer sleep quality, as well as higher anxiety and depression scores, compared with the control group. A low PSQI score (eg, poorer sleep quality) was associated with higher migraine frequency; this was independent of body mass index (BMI), weekly exercise time, and smoking or drinking history. After participants were divided into good and poor sleep quality subgroups, the PSQI score was found to increase the odds ratio of migraine by a factor of 6.

The investigators were able to show the predictive quality of the PSQI score. Worse sleep quality was found to be associated with a higher MIDAS score and HIT-6 score as well as total pain burden, pain severity, decreased quality of life, depression, and anxiety. Although most headache specialists spend a significant amount of time discussing sleep as it relates to migraine, it may be worth considering following a sleep quality scale, such as the PSQI, over time as we monitor our patients. This may allow us to take a more proactive role and be able to prognosticate our patients' migraine journey somewhat better. Although sleep triggers and associations with migraine can be very difficult to discuss and treat, this study very clearly argues for the importance of focusing on sleep with our patients.

Although the most common aura our patients with migraine experience is visual, many patients with migraine will also experience non-aura visual changes. These can range from short-lasting episodes of blurred vision, such as transient visual obscurations, or other transient visual disturbances that do not fit the criteria of aura as defined by the International Classification of Headache Disorders (ICHD).

A prior study by Tsao and colleagues had revealed that almost half of headache patients experienced some headache-related visual change, the most common of which were short-lasting flickering lights or a movable, monochromatic scotoma. As opposed to visual aura, these transient disturbances were shorter in onset and duration and typically occurred during the headache phase of a migraine attack. In the current study, Tsao and colleagues sought to determine whether the presence of these findings was associated with a different headache burden from that typically found in migraine with aura.

The participants in this study were enrolled over a 10-year period from May 2010 to July 2020. They initially underwent a visual phenomenon questionnaire and then a thorough clinical interview to determine their headache diagnosis per ICHD criteria — specifically whether they had an underlying diagnosis of migraine with aura or migraine without aura. Participants were also separately diagnosed with chronic migraine or medication overuse headache. A visual rating scale was used in the initial questionnaires. This scale posed questions about the duration of symptoms; whether the symptoms develop gradually or suddenly; and whether the visual change was a scotoma, zigzag lines, or in a unilateral or bilateral visual field. A prior study by these investigators determined this visual rating scale to be highly sensitive and specific for diagnosing migraine with aura.

Participants were also given the MIDAS questionnaire and were assessed with the HIT-6 scale, a migraine photophobia score, and the Beck Depression Inventory. A total of 12,255 patients were enrolled, 9946 with migraine, who were subdivided on the basis of diagnosis of migraine with or without aura. Blurred vision was the most common visual complaint among all migraine patients. Patients who had transient visual disturbances that did not fit the criteria of migraine with aura were noted to have a statistically significant higher headache frequency, more severe headache-related disability, a higher likelihood of developing medication overuse headache, and a greater incidence of anxiety and depression.

An important distinction that all headache specialists make is whether their patients experience migraine with or without aura. The primary purpose for this distinction is to determine the appropriateness of specific medications (estrogen or vasoconstrictive medications), as migraine aura relates to vascular risk. We usually delve deeply into whether the visual symptoms that our patients experience do or do not fit into the ICHD criteria of migraine aura. We should not discard or think less of non-aura visual disturbances; these authors argue very clearly that these kinds of visual changes can be very relevant prognostically.

Lasmiditan—the first migraine treatment in the new ditan class— is a serotonin receptor agonist, similar to triptan medications. However, it is specific for the 5HT_1F receptor rather than the 5HT_1B/1D receptor. The main purpose of this specificity is that it leads to less vascular risk; specifically, this medication should be safer for populations at higher risk for vascular events, such as myocardial infarction and stroke.

Only one triptan, naratriptan, had previously been studied for the treatment of menstrual migraine, at a recommended dose of 2.5 mg twice daily as a bridge. A new study by MacGregor and colleagues looked at taking 50, 100, or 200 mg of lasmiditan vs placebo for an individual premenstrual attack.

The participants in the study were recruited from the intention-to-treat population of two prior studies for this drug, a phase 2 trial and a phase 3 trial. The menstrual calendars of the female participants were reviewed, followed by randomization into one of the four groups. Patients with chronic migraine were excluded from the study. The primary outcome was freedom from pain at 2 hours; secondary outcomes were freedom from the most bothersome symptom and reduction in pain severity.

Of the four populations followed, all three intervention groups noted significant results in freedom from pain at 2 hours compared with placebo. The 2-hour responder rate was 33.6% for the 200 mg group, 16.7% for the 50 mg and 100 mg groups, and 7.6% for the placebo group. Freedom from the most bothersome symptom and pain reduction were also significant in these populations.

Menstruation-associated migraine and worsening headache attacks due to patients' hormonal fluctuations are some of the most common issues and triggers that neurologists and headache specialists confront. Although the responder rates for freedom from pain at 2 hours were not very robust, lasmiditan does appear to be significantly effective in this population, and in those with menstrual triggers specifically. The field of headache medicine would be even better served by additional studies on both preventive and more acute medications in association with hormonal triggers.

Another very common trigger for migraine is changes in sleep patterns. An astute headache specialist will always ask about sleep quantity and quality during an initial assessment of a patient. Many headache centers have sleep-specific questionnaires that patients fill out during intake. The precise association between migraine and sleep deserves more elucidation. Duan and colleagues specifically set out to reveal whether differences in sleep quality affect migraine frequency; whether this is the same among different gender and age groups; and whether headache disability, severity, mood, and quality of life are related to underlying sleep changes independent of other factors.

A total of 134 participants with migraine and 70 without migraine or any other headache disorder were enrolled in the study. Sleep quality was assessed through The Pittsburgh Sleep Quality Index (PSQI) questionnaire. This is a commonly used self-reported questionnaire for assessing quality and quantity of sleep over the past month and is considered the standard of care in most sleep centers. The investigators here sought to determine the predictive value of the PSQI in regard to migraine. Migraine disability was assessed via the Migraine Disability Assessment (MIDAS) scale as well as the Headache Impact Test (HIT-6). Statistical analysis was performed with logistical regression, t test, and χ² squared test.

There strongest correlations between poor sleep quality and risk of migraine were found in women, patients over 35 years old, and those with lower education levels. The results revealed that the migraine group had poorer sleep quality, as well as higher anxiety and depression scores, compared with the control group. A low PSQI score (eg, poorer sleep quality) was associated with higher migraine frequency; this was independent of body mass index (BMI), weekly exercise time, and smoking or drinking history. After participants were divided into good and poor sleep quality subgroups, the PSQI score was found to increase the odds ratio of migraine by a factor of 6.

The investigators were able to show the predictive quality of the PSQI score. Worse sleep quality was found to be associated with a higher MIDAS score and HIT-6 score as well as total pain burden, pain severity, decreased quality of life, depression, and anxiety. Although most headache specialists spend a significant amount of time discussing sleep as it relates to migraine, it may be worth considering following a sleep quality scale, such as the PSQI, over time as we monitor our patients. This may allow us to take a more proactive role and be able to prognosticate our patients' migraine journey somewhat better. Although sleep triggers and associations with migraine can be very difficult to discuss and treat, this study very clearly argues for the importance of focusing on sleep with our patients.

Although the most common aura our patients with migraine experience is visual, many patients with migraine will also experience non-aura visual changes. These can range from short-lasting episodes of blurred vision, such as transient visual obscurations, or other transient visual disturbances that do not fit the criteria of aura as defined by the International Classification of Headache Disorders (ICHD).

A prior study by Tsao and colleagues had revealed that almost half of headache patients experienced some headache-related visual change, the most common of which were short-lasting flickering lights or a movable, monochromatic scotoma. As opposed to visual aura, these transient disturbances were shorter in onset and duration and typically occurred during the headache phase of a migraine attack. In the current study, Tsao and colleagues sought to determine whether the presence of these findings was associated with a different headache burden from that typically found in migraine with aura.

The participants in this study were enrolled over a 10-year period from May 2010 to July 2020. They initially underwent a visual phenomenon questionnaire and then a thorough clinical interview to determine their headache diagnosis per ICHD criteria — specifically whether they had an underlying diagnosis of migraine with aura or migraine without aura. Participants were also separately diagnosed with chronic migraine or medication overuse headache. A visual rating scale was used in the initial questionnaires. This scale posed questions about the duration of symptoms; whether the symptoms develop gradually or suddenly; and whether the visual change was a scotoma, zigzag lines, or in a unilateral or bilateral visual field. A prior study by these investigators determined this visual rating scale to be highly sensitive and specific for diagnosing migraine with aura.

Participants were also given the MIDAS questionnaire and were assessed with the HIT-6 scale, a migraine photophobia score, and the Beck Depression Inventory. A total of 12,255 patients were enrolled, 9946 with migraine, who were subdivided on the basis of diagnosis of migraine with or without aura. Blurred vision was the most common visual complaint among all migraine patients. Patients who had transient visual disturbances that did not fit the criteria of migraine with aura were noted to have a statistically significant higher headache frequency, more severe headache-related disability, a higher likelihood of developing medication overuse headache, and a greater incidence of anxiety and depression.

An important distinction that all headache specialists make is whether their patients experience migraine with or without aura. The primary purpose for this distinction is to determine the appropriateness of specific medications (estrogen or vasoconstrictive medications), as migraine aura relates to vascular risk. We usually delve deeply into whether the visual symptoms that our patients experience do or do not fit into the ICHD criteria of migraine aura. We should not discard or think less of non-aura visual disturbances; these authors argue very clearly that these kinds of visual changes can be very relevant prognostically.

Lasmiditan—the first migraine treatment in the new ditan class— is a serotonin receptor agonist, similar to triptan medications. However, it is specific for the 5HT_1F receptor rather than the 5HT_1B/1D receptor. The main purpose of this specificity is that it leads to less vascular risk; specifically, this medication should be safer for populations at higher risk for vascular events, such as myocardial infarction and stroke.

Only one triptan, naratriptan, had previously been studied for the treatment of menstrual migraine, at a recommended dose of 2.5 mg twice daily as a bridge. A new study by MacGregor and colleagues looked at taking 50, 100, or 200 mg of lasmiditan vs placebo for an individual premenstrual attack.

The participants in the study were recruited from the intention-to-treat population of two prior studies for this drug, a phase 2 trial and a phase 3 trial. The menstrual calendars of the female participants were reviewed, followed by randomization into one of the four groups. Patients with chronic migraine were excluded from the study. The primary outcome was freedom from pain at 2 hours; secondary outcomes were freedom from the most bothersome symptom and reduction in pain severity.

Of the four populations followed, all three intervention groups noted significant results in freedom from pain at 2 hours compared with placebo. The 2-hour responder rate was 33.6% for the 200 mg group, 16.7% for the 50 mg and 100 mg groups, and 7.6% for the placebo group. Freedom from the most bothersome symptom and pain reduction were also significant in these populations.

Menstruation-associated migraine and worsening headache attacks due to patients' hormonal fluctuations are some of the most common issues and triggers that neurologists and headache specialists confront. Although the responder rates for freedom from pain at 2 hours were not very robust, lasmiditan does appear to be significantly effective in this population, and in those with menstrual triggers specifically. The field of headache medicine would be even better served by additional studies on both preventive and more acute medications in association with hormonal triggers.

Another very common trigger for migraine is changes in sleep patterns. An astute headache specialist will always ask about sleep quantity and quality during an initial assessment of a patient. Many headache centers have sleep-specific questionnaires that patients fill out during intake. The precise association between migraine and sleep deserves more elucidation. Duan and colleagues specifically set out to reveal whether differences in sleep quality affect migraine frequency; whether this is the same among different gender and age groups; and whether headache disability, severity, mood, and quality of life are related to underlying sleep changes independent of other factors.

A total of 134 participants with migraine and 70 without migraine or any other headache disorder were enrolled in the study. Sleep quality was assessed through The Pittsburgh Sleep Quality Index (PSQI) questionnaire. This is a commonly used self-reported questionnaire for assessing quality and quantity of sleep over the past month and is considered the standard of care in most sleep centers. The investigators here sought to determine the predictive value of the PSQI in regard to migraine. Migraine disability was assessed via the Migraine Disability Assessment (MIDAS) scale as well as the Headache Impact Test (HIT-6). Statistical analysis was performed with logistical regression, t test, and χ² squared test.

There strongest correlations between poor sleep quality and risk of migraine were found in women, patients over 35 years old, and those with lower education levels. The results revealed that the migraine group had poorer sleep quality, as well as higher anxiety and depression scores, compared with the control group. A low PSQI score (eg, poorer sleep quality) was associated with higher migraine frequency; this was independent of body mass index (BMI), weekly exercise time, and smoking or drinking history. After participants were divided into good and poor sleep quality subgroups, the PSQI score was found to increase the odds ratio of migraine by a factor of 6.

The investigators were able to show the predictive quality of the PSQI score. Worse sleep quality was found to be associated with a higher MIDAS score and HIT-6 score as well as total pain burden, pain severity, decreased quality of life, depression, and anxiety. Although most headache specialists spend a significant amount of time discussing sleep as it relates to migraine, it may be worth considering following a sleep quality scale, such as the PSQI, over time as we monitor our patients. This may allow us to take a more proactive role and be able to prognosticate our patients' migraine journey somewhat better. Although sleep triggers and associations with migraine can be very difficult to discuss and treat, this study very clearly argues for the importance of focusing on sleep with our patients.

Although the most common aura our patients with migraine experience is visual, many patients with migraine will also experience non-aura visual changes. These can range from short-lasting episodes of blurred vision, such as transient visual obscurations, or other transient visual disturbances that do not fit the criteria of aura as defined by the International Classification of Headache Disorders (ICHD).

A prior study by Tsao and colleagues had revealed that almost half of headache patients experienced some headache-related visual change, the most common of which were short-lasting flickering lights or a movable, monochromatic scotoma. As opposed to visual aura, these transient disturbances were shorter in onset and duration and typically occurred during the headache phase of a migraine attack. In the current study, Tsao and colleagues sought to determine whether the presence of these findings was associated with a different headache burden from that typically found in migraine with aura.

The participants in this study were enrolled over a 10-year period from May 2010 to July 2020. They initially underwent a visual phenomenon questionnaire and then a thorough clinical interview to determine their headache diagnosis per ICHD criteria — specifically whether they had an underlying diagnosis of migraine with aura or migraine without aura. Participants were also separately diagnosed with chronic migraine or medication overuse headache. A visual rating scale was used in the initial questionnaires. This scale posed questions about the duration of symptoms; whether the symptoms develop gradually or suddenly; and whether the visual change was a scotoma, zigzag lines, or in a unilateral or bilateral visual field. A prior study by these investigators determined this visual rating scale to be highly sensitive and specific for diagnosing migraine with aura.

Participants were also given the MIDAS questionnaire and were assessed with the HIT-6 scale, a migraine photophobia score, and the Beck Depression Inventory. A total of 12,255 patients were enrolled, 9946 with migraine, who were subdivided on the basis of diagnosis of migraine with or without aura. Blurred vision was the most common visual complaint among all migraine patients. Patients who had transient visual disturbances that did not fit the criteria of migraine with aura were noted to have a statistically significant higher headache frequency, more severe headache-related disability, a higher likelihood of developing medication overuse headache, and a greater incidence of anxiety and depression.

An important distinction that all headache specialists make is whether their patients experience migraine with or without aura. The primary purpose for this distinction is to determine the appropriateness of specific medications (estrogen or vasoconstrictive medications), as migraine aura relates to vascular risk. We usually delve deeply into whether the visual symptoms that our patients experience do or do not fit into the ICHD criteria of migraine aura. We should not discard or think less of non-aura visual disturbances; these authors argue very clearly that these kinds of visual changes can be very relevant prognostically.

Key clinical point: This real-world analysis confirms the benefits of anticalcitonin gene-related peptide (anti-CGRP) drugs, erenumab, galcanezumab, and fremanezumab, in drug-resistant chronic migraine; however, intensified erenumab regimen showed limited benefits.

Major finding: At week 12, all patients treated with erenumab (P < .001), galcanezumab (P < .001), or fremanezumab (P = .028) achieved a significant reduction in mean monthly migraine headache days, with treatment-associated toxicity being higher with erenumab vs galcanezumab and fremanezumab (P  =  .04). An intensified erenumab regimen demonstrated similar efficacy but with more severe grade 3/4 toxicity (140 vs 70 mg: 14.8% vs 0%; P  =  .038).

Study details: This was a retrospective study including 104 patients with drug-resistant chronic migraine who had failed >3 conventional migraine preventive treatments and received erenumab, galcanezumab, or fremanezumab.

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

Source: Cantarelli L et al. Efficacy and safety of erenumab, galcanezumab, and fremanezumab in the treatment of drug-resistant chronic migraine: Experience in real clinical practice. Ann Pharmacother. 2022 (Aug 18). Doi: 10.1177/10600280221118402

Key clinical point: This real-world analysis confirms the benefits of anticalcitonin gene-related peptide (anti-CGRP) drugs, erenumab, galcanezumab, and fremanezumab, in drug-resistant chronic migraine; however, intensified erenumab regimen showed limited benefits.

Major finding: At week 12, all patients treated with erenumab (P < .001), galcanezumab (P < .001), or fremanezumab (P = .028) achieved a significant reduction in mean monthly migraine headache days, with treatment-associated toxicity being higher with erenumab vs galcanezumab and fremanezumab (P  =  .04). An intensified erenumab regimen demonstrated similar efficacy but with more severe grade 3/4 toxicity (140 vs 70 mg: 14.8% vs 0%; P  =  .038).

Study details: This was a retrospective study including 104 patients with drug-resistant chronic migraine who had failed >3 conventional migraine preventive treatments and received erenumab, galcanezumab, or fremanezumab.

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

Source: Cantarelli L et al. Efficacy and safety of erenumab, galcanezumab, and fremanezumab in the treatment of drug-resistant chronic migraine: Experience in real clinical practice. Ann Pharmacother. 2022 (Aug 18). Doi: 10.1177/10600280221118402

Key clinical point: This real-world analysis confirms the benefits of anticalcitonin gene-related peptide (anti-CGRP) drugs, erenumab, galcanezumab, and fremanezumab, in drug-resistant chronic migraine; however, intensified erenumab regimen showed limited benefits.

Major finding: At week 12, all patients treated with erenumab (P < .001), galcanezumab (P < .001), or fremanezumab (P = .028) achieved a significant reduction in mean monthly migraine headache days, with treatment-associated toxicity being higher with erenumab vs galcanezumab and fremanezumab (P  =  .04). An intensified erenumab regimen demonstrated similar efficacy but with more severe grade 3/4 toxicity (140 vs 70 mg: 14.8% vs 0%; P  =  .038).

Study details: This was a retrospective study including 104 patients with drug-resistant chronic migraine who had failed >3 conventional migraine preventive treatments and received erenumab, galcanezumab, or fremanezumab.

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

Source: Cantarelli L et al. Efficacy and safety of erenumab, galcanezumab, and fremanezumab in the treatment of drug-resistant chronic migraine: Experience in real clinical practice. Ann Pharmacother. 2022 (Aug 18). Doi: 10.1177/10600280221118402

Key clinical point: Erenumab vs placebo demonstrated a similar safety profile across all age groups of patients with chronic or episodic migraine, with no increase in adverse events because of age.

Major finding: Incidence of treatment-emergent adverse events was similar with 70 and 140 mg erenumab vs placebo across age groups: <40 (44.2% and 43.7% vs 44.4%, respectively), 40-49 (42.1% and 42.9% vs 49.2%, respectively), 50-59 (43.5% and 50.6% vs 41.6%, respectively), and ≥60 (39.5% and 48.6% vs 59.4%, respectively) years. The age-stratified incidence of treatment-emergent serious adverse events was low with both erenumab doses, with none reported among patients aged ≥60 years.

Study details: Findings are from a pooled and age-stratified analysis of five phase 2 and 3 randomized controlled trials including 3345 patients with chronic or episodic migraine with or without aura who were randomly assigned to receive erenumab (70 or 140 mg) or placebo.

Disclosures: This study was funded by Novartis Pharma AG, Switzerland. Erenumab was co-developed by Novartis and Amgen. Six authors declared being current or former employees or stockholders of Novartis or Amgen. C Lampl declared receiving honoraria from Novartis.

Source: Lampl C et al. Safety and tolerability of erenumab in individuals with episodic or chronic migraine across age groups: A pooled analysis of placebo-controlled trials. J Headache Pain. 2022;23:104 (Aug 18). Doi: 10.1186/s10194-022-01470-4

Key clinical point: Erenumab vs placebo demonstrated a similar safety profile across all age groups of patients with chronic or episodic migraine, with no increase in adverse events because of age.

Major finding: Incidence of treatment-emergent adverse events was similar with 70 and 140 mg erenumab vs placebo across age groups: <40 (44.2% and 43.7% vs 44.4%, respectively), 40-49 (42.1% and 42.9% vs 49.2%, respectively), 50-59 (43.5% and 50.6% vs 41.6%, respectively), and ≥60 (39.5% and 48.6% vs 59.4%, respectively) years. The age-stratified incidence of treatment-emergent serious adverse events was low with both erenumab doses, with none reported among patients aged ≥60 years.

Study details: Findings are from a pooled and age-stratified analysis of five phase 2 and 3 randomized controlled trials including 3345 patients with chronic or episodic migraine with or without aura who were randomly assigned to receive erenumab (70 or 140 mg) or placebo.

Disclosures: This study was funded by Novartis Pharma AG, Switzerland. Erenumab was co-developed by Novartis and Amgen. Six authors declared being current or former employees or stockholders of Novartis or Amgen. C Lampl declared receiving honoraria from Novartis.

Source: Lampl C et al. Safety and tolerability of erenumab in individuals with episodic or chronic migraine across age groups: A pooled analysis of placebo-controlled trials. J Headache Pain. 2022;23:104 (Aug 18). Doi: 10.1186/s10194-022-01470-4

Key clinical point: Erenumab vs placebo demonstrated a similar safety profile across all age groups of patients with chronic or episodic migraine, with no increase in adverse events because of age.

Major finding: Incidence of treatment-emergent adverse events was similar with 70 and 140 mg erenumab vs placebo across age groups: <40 (44.2% and 43.7% vs 44.4%, respectively), 40-49 (42.1% and 42.9% vs 49.2%, respectively), 50-59 (43.5% and 50.6% vs 41.6%, respectively), and ≥60 (39.5% and 48.6% vs 59.4%, respectively) years. The age-stratified incidence of treatment-emergent serious adverse events was low with both erenumab doses, with none reported among patients aged ≥60 years.

Study details: Findings are from a pooled and age-stratified analysis of five phase 2 and 3 randomized controlled trials including 3345 patients with chronic or episodic migraine with or without aura who were randomly assigned to receive erenumab (70 or 140 mg) or placebo.

Disclosures: This study was funded by Novartis Pharma AG, Switzerland. Erenumab was co-developed by Novartis and Amgen. Six authors declared being current or former employees or stockholders of Novartis or Amgen. C Lampl declared receiving honoraria from Novartis.

Source: Lampl C et al. Safety and tolerability of erenumab in individuals with episodic or chronic migraine across age groups: A pooled analysis of placebo-controlled trials. J Headache Pain. 2022;23:104 (Aug 18). Doi: 10.1186/s10194-022-01470-4

Key clinical point: Eptinezumab vs placebo significantly reduced the number of headache days with acute headache medication (AHM) use in patients with chronic migraine (CM), with the effect being greatest among those with medication-overuse headache and ≥50% response.

Major finding: Eptinezumab vs placebo resulted in a greater percentage-point reductions in the number of headache days with AHM use in the overall cohort of patients with CM (percentage-point reduction −25.1% vs −17.0%) and in patients with CM and medication-overuse headache who experienced ≥50% response (percentage-point reduction −38.3% vs −31.5%) over 24 weeks.

Study details: Findings are from a post hoc analysis of a phase 3 study, PROMISE-2, including 1072 patients with CM, of which 40.2% were diagnosed with medication-overuse headache and were randomly assigned to receive eptinezumab (100 or 300 mg) or placebo.

Disclosures: This study was funded by Lundbeck Seattle BioPharmaceuticals, Inc., USA. Four authors declared being current or former employees of Lundbeck or a subsidiary company or a company contracted by Lundbeck or owning stocks or stock options in Alder/Lundbeck. Several authors reported ties with Lundbeck or other sources.

Source: Cowan RP et al. Quantity changes in acute headache medication use among patients with chronic migraine treated with eptinezumab: Subanalysis of the PROMISE‑2 study. J Headache Pain. 2022;23:115 (Sep 6). Doi: 10.1186/s10194-022-01482-0

Key clinical point: Eptinezumab vs placebo significantly reduced the number of headache days with acute headache medication (AHM) use in patients with chronic migraine (CM), with the effect being greatest among those with medication-overuse headache and ≥50% response.

Major finding: Eptinezumab vs placebo resulted in a greater percentage-point reductions in the number of headache days with AHM use in the overall cohort of patients with CM (percentage-point reduction −25.1% vs −17.0%) and in patients with CM and medication-overuse headache who experienced ≥50% response (percentage-point reduction −38.3% vs −31.5%) over 24 weeks.

Study details: Findings are from a post hoc analysis of a phase 3 study, PROMISE-2, including 1072 patients with CM, of which 40.2% were diagnosed with medication-overuse headache and were randomly assigned to receive eptinezumab (100 or 300 mg) or placebo.

Disclosures: This study was funded by Lundbeck Seattle BioPharmaceuticals, Inc., USA. Four authors declared being current or former employees of Lundbeck or a subsidiary company or a company contracted by Lundbeck or owning stocks or stock options in Alder/Lundbeck. Several authors reported ties with Lundbeck or other sources.

Source: Cowan RP et al. Quantity changes in acute headache medication use among patients with chronic migraine treated with eptinezumab: Subanalysis of the PROMISE‑2 study. J Headache Pain. 2022;23:115 (Sep 6). Doi: 10.1186/s10194-022-01482-0

Key clinical point: Eptinezumab vs placebo significantly reduced the number of headache days with acute headache medication (AHM) use in patients with chronic migraine (CM), with the effect being greatest among those with medication-overuse headache and ≥50% response.

Major finding: Eptinezumab vs placebo resulted in a greater percentage-point reductions in the number of headache days with AHM use in the overall cohort of patients with CM (percentage-point reduction −25.1% vs −17.0%) and in patients with CM and medication-overuse headache who experienced ≥50% response (percentage-point reduction −38.3% vs −31.5%) over 24 weeks.

Study details: Findings are from a post hoc analysis of a phase 3 study, PROMISE-2, including 1072 patients with CM, of which 40.2% were diagnosed with medication-overuse headache and were randomly assigned to receive eptinezumab (100 or 300 mg) or placebo.

Disclosures: This study was funded by Lundbeck Seattle BioPharmaceuticals, Inc., USA. Four authors declared being current or former employees of Lundbeck or a subsidiary company or a company contracted by Lundbeck or owning stocks or stock options in Alder/Lundbeck. Several authors reported ties with Lundbeck or other sources.

Source: Cowan RP et al. Quantity changes in acute headache medication use among patients with chronic migraine treated with eptinezumab: Subanalysis of the PROMISE‑2 study. J Headache Pain. 2022;23:115 (Sep 6). Doi: 10.1186/s10194-022-01482-0

Key clinical point: Patients with migraine without aura who experienced transient visual disturbance (MwTVD) had worse headache, higher migraine-related disability, more psychiatric comorbidities, and a higher risk for chronic migraine than those with migraine with visual aura (MA).

Major finding: MwTVD vs MA group had a higher prevalence of chronic migraine (41.9% vs 11.8%; P < .001) and higher mean Migraine Disability Assessment, anxiety, and depression scores (all P < .001), with transient visual disturbance being a significant risk factor for chronic migraine even after adjusting for confounding factors (adjusted odds ratio 4.75; P < .001).

Study details: This was a post hoc analysis of previously collected data of 2551 patients with migraine, of which 743 had MA and 1808 had MwTVD.

Disclosures: This study was supported by Brain Research Center, the Ministry of Education in Taiwan, and other sources. The authors declared no conflicts of interest.

Source: Tsao Y-C et al. Non-aura visual disturbance with high visual aura rating scale scores has stronger association with migraine chronification than typical aura. Cephalalgia. 2022 (Sep 6). Doi: 10.1177/03331024221123074

Key clinical point: Patients with migraine without aura who experienced transient visual disturbance (MwTVD) had worse headache, higher migraine-related disability, more psychiatric comorbidities, and a higher risk for chronic migraine than those with migraine with visual aura (MA).

Major finding: MwTVD vs MA group had a higher prevalence of chronic migraine (41.9% vs 11.8%; P < .001) and higher mean Migraine Disability Assessment, anxiety, and depression scores (all P < .001), with transient visual disturbance being a significant risk factor for chronic migraine even after adjusting for confounding factors (adjusted odds ratio 4.75; P < .001).

Study details: This was a post hoc analysis of previously collected data of 2551 patients with migraine, of which 743 had MA and 1808 had MwTVD.

Disclosures: This study was supported by Brain Research Center, the Ministry of Education in Taiwan, and other sources. The authors declared no conflicts of interest.

Source: Tsao Y-C et al. Non-aura visual disturbance with high visual aura rating scale scores has stronger association with migraine chronification than typical aura. Cephalalgia. 2022 (Sep 6). Doi: 10.1177/03331024221123074

Key clinical point: Patients with migraine without aura who experienced transient visual disturbance (MwTVD) had worse headache, higher migraine-related disability, more psychiatric comorbidities, and a higher risk for chronic migraine than those with migraine with visual aura (MA).

Major finding: MwTVD vs MA group had a higher prevalence of chronic migraine (41.9% vs 11.8%; P < .001) and higher mean Migraine Disability Assessment, anxiety, and depression scores (all P < .001), with transient visual disturbance being a significant risk factor for chronic migraine even after adjusting for confounding factors (adjusted odds ratio 4.75; P < .001).

Study details: This was a post hoc analysis of previously collected data of 2551 patients with migraine, of which 743 had MA and 1808 had MwTVD.

Disclosures: This study was supported by Brain Research Center, the Ministry of Education in Taiwan, and other sources. The authors declared no conflicts of interest.

Source: Tsao Y-C et al. Non-aura visual disturbance with high visual aura rating scale scores has stronger association with migraine chronification than typical aura. Cephalalgia. 2022 (Sep 6). Doi: 10.1177/03331024221123074

Key clinical point: Poor sleep quality significantly increased the risk of developing migraine and migraine-related burden.

Major finding: Poor sleep quality was more prevalent in patients with migraine vs healthy controls (66.9% vs 24.3%; P < .001), with the risk for migraine being 3.981-times higher in those with poor vs good sleep quality (P  =  .001). Poor sleep quality in patients with migraine was significantly associated with increases in total pain burden, decreased quality of life, and increased anxiety and depression (all P_trend < .05).

Study details: Findings are from a case-control and cross-sectional analysis including 134 patients with migraine with or without aura and 70 sex- and age-matched healthy controls.

Disclosures: This study was supported by the Elite Medical Professionals project of China-Japan Friendship Hospital. The authors declared no conflicts of interest.

Source: Duan S et al. Association between sleep quality, migraine and migraine burden. Front Neurol. 2022 (Aug 26). Doi: 10.3389/fneur.2022.955298

Key clinical point: Poor sleep quality significantly increased the risk of developing migraine and migraine-related burden.

Major finding: Poor sleep quality was more prevalent in patients with migraine vs healthy controls (66.9% vs 24.3%; P < .001), with the risk for migraine being 3.981-times higher in those with poor vs good sleep quality (P  =  .001). Poor sleep quality in patients with migraine was significantly associated with increases in total pain burden, decreased quality of life, and increased anxiety and depression (all P_trend < .05).

Study details: Findings are from a case-control and cross-sectional analysis including 134 patients with migraine with or without aura and 70 sex- and age-matched healthy controls.

Disclosures: This study was supported by the Elite Medical Professionals project of China-Japan Friendship Hospital. The authors declared no conflicts of interest.

Source: Duan S et al. Association between sleep quality, migraine and migraine burden. Front Neurol. 2022 (Aug 26). Doi: 10.3389/fneur.2022.955298

Key clinical point: Poor sleep quality significantly increased the risk of developing migraine and migraine-related burden.

Major finding: Poor sleep quality was more prevalent in patients with migraine vs healthy controls (66.9% vs 24.3%; P < .001), with the risk for migraine being 3.981-times higher in those with poor vs good sleep quality (P  =  .001). Poor sleep quality in patients with migraine was significantly associated with increases in total pain burden, decreased quality of life, and increased anxiety and depression (all P_trend < .05).

Study details: Findings are from a case-control and cross-sectional analysis including 134 patients with migraine with or without aura and 70 sex- and age-matched healthy controls.

Disclosures: This study was supported by the Elite Medical Professionals project of China-Japan Friendship Hospital. The authors declared no conflicts of interest.

Source: Duan S et al. Association between sleep quality, migraine and migraine burden. Front Neurol. 2022 (Aug 26). Doi: 10.3389/fneur.2022.955298

Key clinical point: Participants, especially women and those aged 50-85 years, who had a high intake of dietary thiamine were less likely to develop severe headache or migraine.

Major finding: Dietary thiamine intake was associated with a reduced risk for migraine or headache (adjusted odds ratio [aOR] 0.93; P  =  .046), particularly among women (aOR 0.90; P  =  .022) and those aged 50-85 years (aOR 0.86; P  =  .023).

Study details: Findings are from a cross-sectional study including 13,439 American adults, of which 2745 experienced migraine or severe headache in the past 3 months.

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

Source: Li D et al. Dietary intake of thiamine and riboflavin in relation to severe headache or migraine: A cross-sectional survey. Headache. 2022 (Sep 1). Doi: 10.1111/head.14384

Key clinical point: Participants, especially women and those aged 50-85 years, who had a high intake of dietary thiamine were less likely to develop severe headache or migraine.

Major finding: Dietary thiamine intake was associated with a reduced risk for migraine or headache (adjusted odds ratio [aOR] 0.93; P  =  .046), particularly among women (aOR 0.90; P  =  .022) and those aged 50-85 years (aOR 0.86; P  =  .023).

Study details: Findings are from a cross-sectional study including 13,439 American adults, of which 2745 experienced migraine or severe headache in the past 3 months.

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

Source: Li D et al. Dietary intake of thiamine and riboflavin in relation to severe headache or migraine: A cross-sectional survey. Headache. 2022 (Sep 1). Doi: 10.1111/head.14384

Key clinical point: Participants, especially women and those aged 50-85 years, who had a high intake of dietary thiamine were less likely to develop severe headache or migraine.

Major finding: Dietary thiamine intake was associated with a reduced risk for migraine or headache (adjusted odds ratio [aOR] 0.93; P  =  .046), particularly among women (aOR 0.90; P  =  .022) and those aged 50-85 years (aOR 0.86; P  =  .023).

Study details: Findings are from a cross-sectional study including 13,439 American adults, of which 2745 experienced migraine or severe headache in the past 3 months.

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

Source: Li D et al. Dietary intake of thiamine and riboflavin in relation to severe headache or migraine: A cross-sectional survey. Headache. 2022 (Sep 1). Doi: 10.1111/head.14384