Headache & Migraine

Key clinical point: Fremanezumab vs placebo demonstrated significant and clinically meaningful improvements in migraine- and headache-related disability in patients with chronic and episodic migraine, including those with difficult-to-treat migraine.

Major finding: At 12 weeks of treatment, a significantly higher proportion of patients receiving quarterly and monthly fremanezumab vs placebo reported ≥5-point reduction in 6-item Headache Impact Test scores (53% and 55% vs 39%, respectively; both P < .0001) and ≥30% reduction in Migraine Disability Assessment scores among patients with severe disability (69% and 79% vs 58%, respectively; both P < .001).

Study details: Findings are from a pooled analysis of three phase 3 trials including 3660 patients with episodic or chronic migraine with or without aura who were randomly assigned to receive quarterly or monthly fremanezumab or placebo.

Disclosures: This study was funded by Teva Pharmaceuticals. Five authors declared being current or former employees of Teva Pharmaceuticals. P McAllister reported receiving research support and serving as a consultant for Teva Pharmaceuticals and other sources.

Source: McAllister P et al. Impact of fremanezumab on disability outcomes in patients with episodic and chronic migraine: A pooled analysis of phase 3 studies. J Headache Pain. 2022;23:112 (Aug 29). Doi: 10.1186/s10194-022-01438-4

Key clinical point: Fremanezumab vs placebo demonstrated significant and clinically meaningful improvements in migraine- and headache-related disability in patients with chronic and episodic migraine, including those with difficult-to-treat migraine.

Major finding: At 12 weeks of treatment, a significantly higher proportion of patients receiving quarterly and monthly fremanezumab vs placebo reported ≥5-point reduction in 6-item Headache Impact Test scores (53% and 55% vs 39%, respectively; both P < .0001) and ≥30% reduction in Migraine Disability Assessment scores among patients with severe disability (69% and 79% vs 58%, respectively; both P < .001).

Study details: Findings are from a pooled analysis of three phase 3 trials including 3660 patients with episodic or chronic migraine with or without aura who were randomly assigned to receive quarterly or monthly fremanezumab or placebo.

Disclosures: This study was funded by Teva Pharmaceuticals. Five authors declared being current or former employees of Teva Pharmaceuticals. P McAllister reported receiving research support and serving as a consultant for Teva Pharmaceuticals and other sources.

Source: McAllister P et al. Impact of fremanezumab on disability outcomes in patients with episodic and chronic migraine: A pooled analysis of phase 3 studies. J Headache Pain. 2022;23:112 (Aug 29). Doi: 10.1186/s10194-022-01438-4

Key clinical point: Fremanezumab vs placebo demonstrated significant and clinically meaningful improvements in migraine- and headache-related disability in patients with chronic and episodic migraine, including those with difficult-to-treat migraine.

Major finding: At 12 weeks of treatment, a significantly higher proportion of patients receiving quarterly and monthly fremanezumab vs placebo reported ≥5-point reduction in 6-item Headache Impact Test scores (53% and 55% vs 39%, respectively; both P < .0001) and ≥30% reduction in Migraine Disability Assessment scores among patients with severe disability (69% and 79% vs 58%, respectively; both P < .001).

Study details: Findings are from a pooled analysis of three phase 3 trials including 3660 patients with episodic or chronic migraine with or without aura who were randomly assigned to receive quarterly or monthly fremanezumab or placebo.

Disclosures: This study was funded by Teva Pharmaceuticals. Five authors declared being current or former employees of Teva Pharmaceuticals. P McAllister reported receiving research support and serving as a consultant for Teva Pharmaceuticals and other sources.

Source: McAllister P et al. Impact of fremanezumab on disability outcomes in patients with episodic and chronic migraine: A pooled analysis of phase 3 studies. J Headache Pain. 2022;23:112 (Aug 29). Doi: 10.1186/s10194-022-01438-4

Key clinical point: Treatment of a migraine attack with 50 or 100 mg ubrogepant leads to more favorable treatment outcomes when pain is mild vs moderate or severe.

Major finding: At 2 hours after ubrogepant treatment, the rates of freedom from pain (50 mg: odds ratio [OR] 2.89; 100 mg: OR 3.50; both P < .0001) and migraine symptoms (all P < .001) were higher when pain was mild vs moderate or severe.

Study details: Findings are from a post hoc analysis of a phase 3, long-term extension trial including patients with migraine with or without aura who were randomly assigned to receive 50 mg ubrogepant (n = 401), 100 mg ubrogepant (n = 407), or usual care (n = 417).

Disclosures: This study was sponsored by AbbVie Six authors reported being current or former employees or stockholders of AbbVie. Several authors including the lead author reported serving as consultants or advisory board members or receiving honoraria or research support from various sources.

Source: Lipton RB et al. Efficacy of ubrogepant in the acute treatment of migraine with mild pain versus moderate or severe pain. Neurology. 2022 (Aug 17). Doi:  10.1212/WNL.0000000000201031

Key clinical point: Treatment of a migraine attack with 50 or 100 mg ubrogepant leads to more favorable treatment outcomes when pain is mild vs moderate or severe.

Major finding: At 2 hours after ubrogepant treatment, the rates of freedom from pain (50 mg: odds ratio [OR] 2.89; 100 mg: OR 3.50; both P < .0001) and migraine symptoms (all P < .001) were higher when pain was mild vs moderate or severe.

Study details: Findings are from a post hoc analysis of a phase 3, long-term extension trial including patients with migraine with or without aura who were randomly assigned to receive 50 mg ubrogepant (n = 401), 100 mg ubrogepant (n = 407), or usual care (n = 417).

Disclosures: This study was sponsored by AbbVie Six authors reported being current or former employees or stockholders of AbbVie. Several authors including the lead author reported serving as consultants or advisory board members or receiving honoraria or research support from various sources.

Source: Lipton RB et al. Efficacy of ubrogepant in the acute treatment of migraine with mild pain versus moderate or severe pain. Neurology. 2022 (Aug 17). Doi:  10.1212/WNL.0000000000201031

Key clinical point: Treatment of a migraine attack with 50 or 100 mg ubrogepant leads to more favorable treatment outcomes when pain is mild vs moderate or severe.

Major finding: At 2 hours after ubrogepant treatment, the rates of freedom from pain (50 mg: odds ratio [OR] 2.89; 100 mg: OR 3.50; both P < .0001) and migraine symptoms (all P < .001) were higher when pain was mild vs moderate or severe.

Study details: Findings are from a post hoc analysis of a phase 3, long-term extension trial including patients with migraine with or without aura who were randomly assigned to receive 50 mg ubrogepant (n = 401), 100 mg ubrogepant (n = 407), or usual care (n = 417).

Disclosures: This study was sponsored by AbbVie Six authors reported being current or former employees or stockholders of AbbVie. Several authors including the lead author reported serving as consultants or advisory board members or receiving honoraria or research support from various sources.

Source: Lipton RB et al. Efficacy of ubrogepant in the acute treatment of migraine with mild pain versus moderate or severe pain. Neurology. 2022 (Aug 17). Doi:  10.1212/WNL.0000000000201031

Key clinical point: A combined manual therapeutic approach that included soft-tissue and articulatory manual therapy techniques was more effective in reducing migraine impact than either technique alone.

Major finding: After 4 weeks of intervention, the improvement in pain intensity was greater with combined soft-tissue and articulatory manual therapy vs only soft-tissue (P < .001) or articulatory (P = .014) manual therapy. Reduction in migraine duration was significant with combined vs soft-tissue therapy (P  =  .02), with improvements maintained through a  4-week follow-up. No serious side-effects were reported.

Study details: Findings are from a randomized controlled trial including 75 patients with chronic or episodic migraine who were randomly assigned to receive soft-tissue therapy, articulatory therapy, or combination of both manual therapies.

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

Source: Muñoz-Gómez E et al. Potential add-on effects of manual therapy techniques in migraine patients: A randomised controlled trial. J Clin Med. 2022;11(16):4686 (Aug 11). Doi: 10.3390/jcm11164686

Key clinical point: A combined manual therapeutic approach that included soft-tissue and articulatory manual therapy techniques was more effective in reducing migraine impact than either technique alone.

Major finding: After 4 weeks of intervention, the improvement in pain intensity was greater with combined soft-tissue and articulatory manual therapy vs only soft-tissue (P < .001) or articulatory (P = .014) manual therapy. Reduction in migraine duration was significant with combined vs soft-tissue therapy (P  =  .02), with improvements maintained through a  4-week follow-up. No serious side-effects were reported.

Study details: Findings are from a randomized controlled trial including 75 patients with chronic or episodic migraine who were randomly assigned to receive soft-tissue therapy, articulatory therapy, or combination of both manual therapies.

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

Source: Muñoz-Gómez E et al. Potential add-on effects of manual therapy techniques in migraine patients: A randomised controlled trial. J Clin Med. 2022;11(16):4686 (Aug 11). Doi: 10.3390/jcm11164686

Key clinical point: A combined manual therapeutic approach that included soft-tissue and articulatory manual therapy techniques was more effective in reducing migraine impact than either technique alone.

Major finding: After 4 weeks of intervention, the improvement in pain intensity was greater with combined soft-tissue and articulatory manual therapy vs only soft-tissue (P < .001) or articulatory (P = .014) manual therapy. Reduction in migraine duration was significant with combined vs soft-tissue therapy (P  =  .02), with improvements maintained through a  4-week follow-up. No serious side-effects were reported.

Study details: Findings are from a randomized controlled trial including 75 patients with chronic or episodic migraine who were randomly assigned to receive soft-tissue therapy, articulatory therapy, or combination of both manual therapies.

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

Source: Muñoz-Gómez E et al. Potential add-on effects of manual therapy techniques in migraine patients: A randomised controlled trial. J Clin Med. 2022;11(16):4686 (Aug 11). Doi: 10.3390/jcm11164686

Key clinical point: Treatment of perimenstrual migraine attacks with lasmiditan was associated with early and sustained freedom from migraine-related pain.

Major finding: Women who received 200 mg lasmiditan vs placebo during perimenstrual migraine attacks were more likely to report freedom from migraine-related pain (odds ratio [OR] 6.04; P < .001) and pain relief (OR 2.29; P  =  .007) at 2 hours and sustained freedom from pain at 24 hours (OR 11.67; P  =  .001).

Study details: Findings are from a post hoc analysis of the phase 2 MONONOFU and phase 3 CENTURION trials including 303 women with migraine with or without aura who had ≥1 perimenstrual migraine attacks and were randomly assigned to receive lasmiditan (50, 100, or 200 mg) or placebo.

Disclosures: This study was funded by Eli Lilly and Company. Four authors declared being employees and minor stockholders of Eli Lilly and Company. The other authors reported ties with various sources, including Eli Lilly and Company.

Source: MacGregor EA et al. Efficacy of lasmiditan for the acute treatment of perimenstrual migraine. Cephalalgia. 2022 (Aug 18). Doi: 10.1177/03331024221118929

Key clinical point: Treatment of perimenstrual migraine attacks with lasmiditan was associated with early and sustained freedom from migraine-related pain.

Major finding: Women who received 200 mg lasmiditan vs placebo during perimenstrual migraine attacks were more likely to report freedom from migraine-related pain (odds ratio [OR] 6.04; P < .001) and pain relief (OR 2.29; P  =  .007) at 2 hours and sustained freedom from pain at 24 hours (OR 11.67; P  =  .001).

Study details: Findings are from a post hoc analysis of the phase 2 MONONOFU and phase 3 CENTURION trials including 303 women with migraine with or without aura who had ≥1 perimenstrual migraine attacks and were randomly assigned to receive lasmiditan (50, 100, or 200 mg) or placebo.

Disclosures: This study was funded by Eli Lilly and Company. Four authors declared being employees and minor stockholders of Eli Lilly and Company. The other authors reported ties with various sources, including Eli Lilly and Company.

Source: MacGregor EA et al. Efficacy of lasmiditan for the acute treatment of perimenstrual migraine. Cephalalgia. 2022 (Aug 18). Doi: 10.1177/03331024221118929

Key clinical point: Treatment of perimenstrual migraine attacks with lasmiditan was associated with early and sustained freedom from migraine-related pain.

Major finding: Women who received 200 mg lasmiditan vs placebo during perimenstrual migraine attacks were more likely to report freedom from migraine-related pain (odds ratio [OR] 6.04; P < .001) and pain relief (OR 2.29; P  =  .007) at 2 hours and sustained freedom from pain at 24 hours (OR 11.67; P  =  .001).

Study details: Findings are from a post hoc analysis of the phase 2 MONONOFU and phase 3 CENTURION trials including 303 women with migraine with or without aura who had ≥1 perimenstrual migraine attacks and were randomly assigned to receive lasmiditan (50, 100, or 200 mg) or placebo.

Disclosures: This study was funded by Eli Lilly and Company. Four authors declared being employees and minor stockholders of Eli Lilly and Company. The other authors reported ties with various sources, including Eli Lilly and Company.

Source: MacGregor EA et al. Efficacy of lasmiditan for the acute treatment of perimenstrual migraine. Cephalalgia. 2022 (Aug 18). Doi: 10.1177/03331024221118929

The theme of this month's commentary is alternative outcomes measures for future migraine studies. The traditional outcomes measures, such as headache frequency measured in headache days, have long been considered gold standards when evaluating the efficacy of preventive interventions. When headache conditions are complicated by interictal pain or other symptoms, or when medication overuse adds a higher frequency or greater severity, those traditional measures are somewhat less exact and specific. Meaningful change for patients with higher frequency of attacks, near-continuous pain, or other migraine symptoms is quite different from that for those without these complications.

Ailani and colleagues reviewed post hoc data from the CONQUER trial, a prior study evaluating the safety and efficacy of galcanezumab vs placebo in patients who had previously not benefited from two to four categories of migraine preventive medication. This refractory population was initially noted to have 4.1 fewer headache days per month than patients taking placebo, but the authors now attempted to review these data with a focus on a different measure: total pain burden (TPB). They defined daily TPB as a single composite measure assessing the frequency, duration, and severity of migraine, calculated by multiplying the number of hours of migraine by the maximum daily migraine pain severity score. The monthly TPB was calculated by adding the daily pain burden over the entire month. The Migraine Disability Assessment questionnaire (MIDAS) and Migraine-Specific Quality of Life Questionnaire (MSQ) scores were also included to compare migraine-related disability and quality of life.

The patients who received galcanezumab were noted to have a significantly lower TPB, both in episodic and chronic migraine. Significantly greater reductions in monthly TPB relative to placebo were observed at each individual month as well. The change from baseline TPB was also noted to be significantly improved in the galcanezumab group compared with the placebo group. The reduction in TPB was noted even when migraine-day reductions were accounted for as part of a sensitivity analysis.

Preventive trials for migraine treatment focus primarily on migraine-day reduction, and for many patients with higher-frequency migraine, this measure does not adequately account for their disease-related disability. This unique way of looking at pain as part of a bigger picture is much more significant and meaningful for this patient population. Migraine frequency is still a very important outcomes measure, but it would be wise to add TBP or another measure that looks more globally at disease-related disability, especially when investigating preventive options in patients with chronic migraine.

When considering whether an intervention is helpful, most patients and clinicians follow the headache frequency, severity, or quality-of-life factors. As most patients will readily report, not all "headache-free days" are created equal. Although most people with migraine will experience days with absolutely no headache pain or other migraine-associated symptoms, on many days they will still have some symptoms of migraine. Lee and colleagues attempted to quantify the difference between headache-free days and crystal-clear days.

Most headache studies use the frequency of headache days as a primary or secondary outcome. This study collected data on both headache days and crystal-clear days, using data from a questionnaire-based large South Korean nationwide population study that evaluated headache and sleep. The study questions were validated for migraine and aura, and included: "How many days have you had a headache during the previous 30 days?" and "How many days have you had crystal-clear days without headache during the previous 30 days?" The data were then analyzed and compared with the widespread pain index (criteria for fibromyalgia) as well as sleep duration, sleep quality, depression and anxiety scales, and an allodynia checklist.

A little over 3000 respondents completed the surveys; 1938 had experienced headache over the past year, 170 were classified as having a diagnosis of migraine, and 50 of those were diagnosed with aura as well. Out of the patients with migraine, 97% had "unclear days." This was higher than the rate of those with non-migraine headaches (91%). Nearly all people surveyed had some crystal-clear days (99.4%).

The number of crystal-clear days per 30 days was significantly lower in participants with migraine than in those with non-migraine headache. Participants with migraine also had higher frequencies of cutaneous allodynia, anxiety, and depression. The weekly average sleep duration in participants with migraine did not significantly differ from that in participants with non-migraine headaches. The widespread pain index rate was much higher in those with migraine as well.

Most patients will definitely understand the difference between crystal-clear and unclear headache days. Many of the newer outcomes studies in migraine have started focusing on the most bothersome symptom, as headache pain is far from the only significant or disabling symptom associated with migraine. This study makes clear that further outcomes changes are necessary, and that a potentially more meaningful result in migraine studies may actually be crystal-clear days rather than simply headache-free days.

Although there are more acute options available for headache treatment, medication overuse headache remains a major complicating factor for most clinicians who treat headache. When educating patients, there is always a strong emphasis on guidelines for acute medication use. Many patients struggle with knowing when to use an acute treatment and when to alternate with a different treatment, and often they will withhold treatment completely due to fear of medication overuse. The new class of calcitonin gene-related peptide (CGRP) antagonist medications has shown some potential benefit as a preventive option for both medication overuse headache and migraine.

The prospective study by Curone and colleagues enrolled 300 patients with confirmed medication overuse headache who did not undergo withdrawal of the overused acute medication. Patients who are already taking preventive medications were excluded, as were patients with diagnoses other than chronic migraine or medication overuse. Patients were given one of the three injectable CGRP antagonist medications for prevention and were followed up at 3, 6, 9, and 12 months. The primary outcome was MIDAS score as well as monthly headache days and analgesic consumption.

Out of 303 patients, 242 (80%) showed both a ≥50% reduction of monthly headache days and ≥50% reduction in analgesic intake at 3-month follow-up visit. At 9 months, 198 (65%) were still responders. Monthly analgesic intake decreased ≥50% in 268 of 303 patients (88%) at 3 months and in 241 of 303 patients (79%) at the 6-month follow-up.

For years there has been a debate regarding whether withdrawal of an overused medication is necessary for effective treatment of medication overuse headache. Many preventive treatments are less effective when medication overuse is ongoing. The CGRP class of medications does appear to be effective even with ongoing acute medication overuse. This class of medications should definitely be considered when withdrawing an overused medication is complicated, or when a patient needs to continue to take analgesic medications for another condition.

The theme of this month's commentary is alternative outcomes measures for future migraine studies. The traditional outcomes measures, such as headache frequency measured in headache days, have long been considered gold standards when evaluating the efficacy of preventive interventions. When headache conditions are complicated by interictal pain or other symptoms, or when medication overuse adds a higher frequency or greater severity, those traditional measures are somewhat less exact and specific. Meaningful change for patients with higher frequency of attacks, near-continuous pain, or other migraine symptoms is quite different from that for those without these complications.

Ailani and colleagues reviewed post hoc data from the CONQUER trial, a prior study evaluating the safety and efficacy of galcanezumab vs placebo in patients who had previously not benefited from two to four categories of migraine preventive medication. This refractory population was initially noted to have 4.1 fewer headache days per month than patients taking placebo, but the authors now attempted to review these data with a focus on a different measure: total pain burden (TPB). They defined daily TPB as a single composite measure assessing the frequency, duration, and severity of migraine, calculated by multiplying the number of hours of migraine by the maximum daily migraine pain severity score. The monthly TPB was calculated by adding the daily pain burden over the entire month. The Migraine Disability Assessment questionnaire (MIDAS) and Migraine-Specific Quality of Life Questionnaire (MSQ) scores were also included to compare migraine-related disability and quality of life.

The patients who received galcanezumab were noted to have a significantly lower TPB, both in episodic and chronic migraine. Significantly greater reductions in monthly TPB relative to placebo were observed at each individual month as well. The change from baseline TPB was also noted to be significantly improved in the galcanezumab group compared with the placebo group. The reduction in TPB was noted even when migraine-day reductions were accounted for as part of a sensitivity analysis.

Preventive trials for migraine treatment focus primarily on migraine-day reduction, and for many patients with higher-frequency migraine, this measure does not adequately account for their disease-related disability. This unique way of looking at pain as part of a bigger picture is much more significant and meaningful for this patient population. Migraine frequency is still a very important outcomes measure, but it would be wise to add TBP or another measure that looks more globally at disease-related disability, especially when investigating preventive options in patients with chronic migraine.

When considering whether an intervention is helpful, most patients and clinicians follow the headache frequency, severity, or quality-of-life factors. As most patients will readily report, not all "headache-free days" are created equal. Although most people with migraine will experience days with absolutely no headache pain or other migraine-associated symptoms, on many days they will still have some symptoms of migraine. Lee and colleagues attempted to quantify the difference between headache-free days and crystal-clear days.

Most headache studies use the frequency of headache days as a primary or secondary outcome. This study collected data on both headache days and crystal-clear days, using data from a questionnaire-based large South Korean nationwide population study that evaluated headache and sleep. The study questions were validated for migraine and aura, and included: "How many days have you had a headache during the previous 30 days?" and "How many days have you had crystal-clear days without headache during the previous 30 days?" The data were then analyzed and compared with the widespread pain index (criteria for fibromyalgia) as well as sleep duration, sleep quality, depression and anxiety scales, and an allodynia checklist.

A little over 3000 respondents completed the surveys; 1938 had experienced headache over the past year, 170 were classified as having a diagnosis of migraine, and 50 of those were diagnosed with aura as well. Out of the patients with migraine, 97% had "unclear days." This was higher than the rate of those with non-migraine headaches (91%). Nearly all people surveyed had some crystal-clear days (99.4%).

The number of crystal-clear days per 30 days was significantly lower in participants with migraine than in those with non-migraine headache. Participants with migraine also had higher frequencies of cutaneous allodynia, anxiety, and depression. The weekly average sleep duration in participants with migraine did not significantly differ from that in participants with non-migraine headaches. The widespread pain index rate was much higher in those with migraine as well.

Most patients will definitely understand the difference between crystal-clear and unclear headache days. Many of the newer outcomes studies in migraine have started focusing on the most bothersome symptom, as headache pain is far from the only significant or disabling symptom associated with migraine. This study makes clear that further outcomes changes are necessary, and that a potentially more meaningful result in migraine studies may actually be crystal-clear days rather than simply headache-free days.

Although there are more acute options available for headache treatment, medication overuse headache remains a major complicating factor for most clinicians who treat headache. When educating patients, there is always a strong emphasis on guidelines for acute medication use. Many patients struggle with knowing when to use an acute treatment and when to alternate with a different treatment, and often they will withhold treatment completely due to fear of medication overuse. The new class of calcitonin gene-related peptide (CGRP) antagonist medications has shown some potential benefit as a preventive option for both medication overuse headache and migraine.

The prospective study by Curone and colleagues enrolled 300 patients with confirmed medication overuse headache who did not undergo withdrawal of the overused acute medication. Patients who are already taking preventive medications were excluded, as were patients with diagnoses other than chronic migraine or medication overuse. Patients were given one of the three injectable CGRP antagonist medications for prevention and were followed up at 3, 6, 9, and 12 months. The primary outcome was MIDAS score as well as monthly headache days and analgesic consumption.

Out of 303 patients, 242 (80%) showed both a ≥50% reduction of monthly headache days and ≥50% reduction in analgesic intake at 3-month follow-up visit. At 9 months, 198 (65%) were still responders. Monthly analgesic intake decreased ≥50% in 268 of 303 patients (88%) at 3 months and in 241 of 303 patients (79%) at the 6-month follow-up.

For years there has been a debate regarding whether withdrawal of an overused medication is necessary for effective treatment of medication overuse headache. Many preventive treatments are less effective when medication overuse is ongoing. The CGRP class of medications does appear to be effective even with ongoing acute medication overuse. This class of medications should definitely be considered when withdrawing an overused medication is complicated, or when a patient needs to continue to take analgesic medications for another condition.

The theme of this month's commentary is alternative outcomes measures for future migraine studies. The traditional outcomes measures, such as headache frequency measured in headache days, have long been considered gold standards when evaluating the efficacy of preventive interventions. When headache conditions are complicated by interictal pain or other symptoms, or when medication overuse adds a higher frequency or greater severity, those traditional measures are somewhat less exact and specific. Meaningful change for patients with higher frequency of attacks, near-continuous pain, or other migraine symptoms is quite different from that for those without these complications.

Ailani and colleagues reviewed post hoc data from the CONQUER trial, a prior study evaluating the safety and efficacy of galcanezumab vs placebo in patients who had previously not benefited from two to four categories of migraine preventive medication. This refractory population was initially noted to have 4.1 fewer headache days per month than patients taking placebo, but the authors now attempted to review these data with a focus on a different measure: total pain burden (TPB). They defined daily TPB as a single composite measure assessing the frequency, duration, and severity of migraine, calculated by multiplying the number of hours of migraine by the maximum daily migraine pain severity score. The monthly TPB was calculated by adding the daily pain burden over the entire month. The Migraine Disability Assessment questionnaire (MIDAS) and Migraine-Specific Quality of Life Questionnaire (MSQ) scores were also included to compare migraine-related disability and quality of life.

The patients who received galcanezumab were noted to have a significantly lower TPB, both in episodic and chronic migraine. Significantly greater reductions in monthly TPB relative to placebo were observed at each individual month as well. The change from baseline TPB was also noted to be significantly improved in the galcanezumab group compared with the placebo group. The reduction in TPB was noted even when migraine-day reductions were accounted for as part of a sensitivity analysis.

Preventive trials for migraine treatment focus primarily on migraine-day reduction, and for many patients with higher-frequency migraine, this measure does not adequately account for their disease-related disability. This unique way of looking at pain as part of a bigger picture is much more significant and meaningful for this patient population. Migraine frequency is still a very important outcomes measure, but it would be wise to add TBP or another measure that looks more globally at disease-related disability, especially when investigating preventive options in patients with chronic migraine.

When considering whether an intervention is helpful, most patients and clinicians follow the headache frequency, severity, or quality-of-life factors. As most patients will readily report, not all "headache-free days" are created equal. Although most people with migraine will experience days with absolutely no headache pain or other migraine-associated symptoms, on many days they will still have some symptoms of migraine. Lee and colleagues attempted to quantify the difference between headache-free days and crystal-clear days.

Most headache studies use the frequency of headache days as a primary or secondary outcome. This study collected data on both headache days and crystal-clear days, using data from a questionnaire-based large South Korean nationwide population study that evaluated headache and sleep. The study questions were validated for migraine and aura, and included: "How many days have you had a headache during the previous 30 days?" and "How many days have you had crystal-clear days without headache during the previous 30 days?" The data were then analyzed and compared with the widespread pain index (criteria for fibromyalgia) as well as sleep duration, sleep quality, depression and anxiety scales, and an allodynia checklist.

A little over 3000 respondents completed the surveys; 1938 had experienced headache over the past year, 170 were classified as having a diagnosis of migraine, and 50 of those were diagnosed with aura as well. Out of the patients with migraine, 97% had "unclear days." This was higher than the rate of those with non-migraine headaches (91%). Nearly all people surveyed had some crystal-clear days (99.4%).

The number of crystal-clear days per 30 days was significantly lower in participants with migraine than in those with non-migraine headache. Participants with migraine also had higher frequencies of cutaneous allodynia, anxiety, and depression. The weekly average sleep duration in participants with migraine did not significantly differ from that in participants with non-migraine headaches. The widespread pain index rate was much higher in those with migraine as well.

Most patients will definitely understand the difference between crystal-clear and unclear headache days. Many of the newer outcomes studies in migraine have started focusing on the most bothersome symptom, as headache pain is far from the only significant or disabling symptom associated with migraine. This study makes clear that further outcomes changes are necessary, and that a potentially more meaningful result in migraine studies may actually be crystal-clear days rather than simply headache-free days.

Although there are more acute options available for headache treatment, medication overuse headache remains a major complicating factor for most clinicians who treat headache. When educating patients, there is always a strong emphasis on guidelines for acute medication use. Many patients struggle with knowing when to use an acute treatment and when to alternate with a different treatment, and often they will withhold treatment completely due to fear of medication overuse. The new class of calcitonin gene-related peptide (CGRP) antagonist medications has shown some potential benefit as a preventive option for both medication overuse headache and migraine.

The prospective study by Curone and colleagues enrolled 300 patients with confirmed medication overuse headache who did not undergo withdrawal of the overused acute medication. Patients who are already taking preventive medications were excluded, as were patients with diagnoses other than chronic migraine or medication overuse. Patients were given one of the three injectable CGRP antagonist medications for prevention and were followed up at 3, 6, 9, and 12 months. The primary outcome was MIDAS score as well as monthly headache days and analgesic consumption.

Out of 303 patients, 242 (80%) showed both a ≥50% reduction of monthly headache days and ≥50% reduction in analgesic intake at 3-month follow-up visit. At 9 months, 198 (65%) were still responders. Monthly analgesic intake decreased ≥50% in 268 of 303 patients (88%) at 3 months and in 241 of 303 patients (79%) at the 6-month follow-up.

For years there has been a debate regarding whether withdrawal of an overused medication is necessary for effective treatment of medication overuse headache. Many preventive treatments are less effective when medication overuse is ongoing. The CGRP class of medications does appear to be effective even with ongoing acute medication overuse. This class of medications should definitely be considered when withdrawing an overused medication is complicated, or when a patient needs to continue to take analgesic medications for another condition.

A cell phone app that combines white noise, active game-based therapy, and counseling could help “rewire” the brain to provide relief from tinnitus symptoms, new research suggests. In a randomized controlled trial, results at 12 weeks showed patients with tinnitus reported clinically meaningful reductions in ratings of annoyance, inability to ignore, unpleasantness, and loudness after using a digital polytherapeutic app prototype that focuses on relief, relaxation, and attention-focused retraining. In addition, their improvements were significantly greater than for the control group, which received a common white noise app.

Researchers called the results “promising” for a condition that has no cure and few successful treatments. “What this therapy does is essentially rewire the brain in a way that de-emphasizes the sound of the tinnitus to a background noise that has no meaning or relevance to the listener,” lead author Grant Searchfield, PhD, associate professor of audiology at the University of Auckland, New Zealand, said in a press release.

The findings were published online in Frontiers in Neurology.
 

Worldwide problem

A recent study showed more than 740 million adults worldwide (nearly 15% of the population) have experienced at least one symptom of tinnitus – and about 120 million are severely affected. Tinnitus is the perception of a ringing, buzzing, whistling, or hissing noise in one or both ears when no external source of the sound is present. Often caused by damage to the auditory system, tinnitus can also be a symptom of a wide range of medical conditions and has been identified as a side effect of COVID-19 vaccination. In its most severe form, which is associated with hearing loss, tinnitus can also affect a patient’s mental, emotional, and social health.

For the current study, participants with tinnitus were randomly assigned to a popular app that uses white noise (control group, n = 30) or to the UpSilent app (n = 31). The UpSilent group received a smartphone app, Bluetooth bone conduction headphones, a Bluetooth neck pillow speaker for sleep, and written counseling materials. Participants in the control group received a widely available app called “White Noise” and in-ear wired headphones.
 

‘Quicker and more effective’

Both groups reported reductions in ratings of annoyance, inability to ignore, unpleasantness, and loudness at 12 weeks. But significantly more of the UpSilent group reported clinically meaningful improvement compared with the control group (65% vs. 43%, respectively; P = .049).

“Earlier trials have found white noise, goal-based counseling, goal-oriented games, and other technology-based therapies are effective for some people some of the time,” Dr. Searchfield said. “This is quicker and more effective, taking 12 weeks rather than 12 months for more individuals to gain some control,” he added.

The investigators noted that the study was not designed to determine which of the app’s functions of passive listening, active listening, or counseling contributed to symptom improvement.

The next step will be to refine the prototype and proceed to larger local and international trials with a view toward approval by the U.S. Food and Drug Administration, they reported.

The researchers hope the app will be clinically available in about 6 months.

The study was funded by Return on Science, Auckland UniServices. Dr. Searchfield is a founder and scientific officer for TrueSilence, a spinout company of the University of Auckland, and has a financial interest in TrueSilence. His coauthor has reported no relevant financial relationships.

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

A cell phone app that combines white noise, active game-based therapy, and counseling could help “rewire” the brain to provide relief from tinnitus symptoms, new research suggests. In a randomized controlled trial, results at 12 weeks showed patients with tinnitus reported clinically meaningful reductions in ratings of annoyance, inability to ignore, unpleasantness, and loudness after using a digital polytherapeutic app prototype that focuses on relief, relaxation, and attention-focused retraining. In addition, their improvements were significantly greater than for the control group, which received a common white noise app.

Researchers called the results “promising” for a condition that has no cure and few successful treatments. “What this therapy does is essentially rewire the brain in a way that de-emphasizes the sound of the tinnitus to a background noise that has no meaning or relevance to the listener,” lead author Grant Searchfield, PhD, associate professor of audiology at the University of Auckland, New Zealand, said in a press release.

The findings were published online in Frontiers in Neurology.
 

Worldwide problem

A recent study showed more than 740 million adults worldwide (nearly 15% of the population) have experienced at least one symptom of tinnitus – and about 120 million are severely affected. Tinnitus is the perception of a ringing, buzzing, whistling, or hissing noise in one or both ears when no external source of the sound is present. Often caused by damage to the auditory system, tinnitus can also be a symptom of a wide range of medical conditions and has been identified as a side effect of COVID-19 vaccination. In its most severe form, which is associated with hearing loss, tinnitus can also affect a patient’s mental, emotional, and social health.

For the current study, participants with tinnitus were randomly assigned to a popular app that uses white noise (control group, n = 30) or to the UpSilent app (n = 31). The UpSilent group received a smartphone app, Bluetooth bone conduction headphones, a Bluetooth neck pillow speaker for sleep, and written counseling materials. Participants in the control group received a widely available app called “White Noise” and in-ear wired headphones.
 

‘Quicker and more effective’

Both groups reported reductions in ratings of annoyance, inability to ignore, unpleasantness, and loudness at 12 weeks. But significantly more of the UpSilent group reported clinically meaningful improvement compared with the control group (65% vs. 43%, respectively; P = .049).

“Earlier trials have found white noise, goal-based counseling, goal-oriented games, and other technology-based therapies are effective for some people some of the time,” Dr. Searchfield said. “This is quicker and more effective, taking 12 weeks rather than 12 months for more individuals to gain some control,” he added.

The investigators noted that the study was not designed to determine which of the app’s functions of passive listening, active listening, or counseling contributed to symptom improvement.

The next step will be to refine the prototype and proceed to larger local and international trials with a view toward approval by the U.S. Food and Drug Administration, they reported.

The researchers hope the app will be clinically available in about 6 months.

The study was funded by Return on Science, Auckland UniServices. Dr. Searchfield is a founder and scientific officer for TrueSilence, a spinout company of the University of Auckland, and has a financial interest in TrueSilence. His coauthor has reported no relevant financial relationships.

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

A cell phone app that combines white noise, active game-based therapy, and counseling could help “rewire” the brain to provide relief from tinnitus symptoms, new research suggests. In a randomized controlled trial, results at 12 weeks showed patients with tinnitus reported clinically meaningful reductions in ratings of annoyance, inability to ignore, unpleasantness, and loudness after using a digital polytherapeutic app prototype that focuses on relief, relaxation, and attention-focused retraining. In addition, their improvements were significantly greater than for the control group, which received a common white noise app.

Researchers called the results “promising” for a condition that has no cure and few successful treatments. “What this therapy does is essentially rewire the brain in a way that de-emphasizes the sound of the tinnitus to a background noise that has no meaning or relevance to the listener,” lead author Grant Searchfield, PhD, associate professor of audiology at the University of Auckland, New Zealand, said in a press release.

The findings were published online in Frontiers in Neurology.
 

Worldwide problem

A recent study showed more than 740 million adults worldwide (nearly 15% of the population) have experienced at least one symptom of tinnitus – and about 120 million are severely affected. Tinnitus is the perception of a ringing, buzzing, whistling, or hissing noise in one or both ears when no external source of the sound is present. Often caused by damage to the auditory system, tinnitus can also be a symptom of a wide range of medical conditions and has been identified as a side effect of COVID-19 vaccination. In its most severe form, which is associated with hearing loss, tinnitus can also affect a patient’s mental, emotional, and social health.

For the current study, participants with tinnitus were randomly assigned to a popular app that uses white noise (control group, n = 30) or to the UpSilent app (n = 31). The UpSilent group received a smartphone app, Bluetooth bone conduction headphones, a Bluetooth neck pillow speaker for sleep, and written counseling materials. Participants in the control group received a widely available app called “White Noise” and in-ear wired headphones.
 

‘Quicker and more effective’

Both groups reported reductions in ratings of annoyance, inability to ignore, unpleasantness, and loudness at 12 weeks. But significantly more of the UpSilent group reported clinically meaningful improvement compared with the control group (65% vs. 43%, respectively; P = .049).

“Earlier trials have found white noise, goal-based counseling, goal-oriented games, and other technology-based therapies are effective for some people some of the time,” Dr. Searchfield said. “This is quicker and more effective, taking 12 weeks rather than 12 months for more individuals to gain some control,” he added.

The investigators noted that the study was not designed to determine which of the app’s functions of passive listening, active listening, or counseling contributed to symptom improvement.

The next step will be to refine the prototype and proceed to larger local and international trials with a view toward approval by the U.S. Food and Drug Administration, they reported.

The researchers hope the app will be clinically available in about 6 months.

The study was funded by Return on Science, Auckland UniServices. Dr. Searchfield is a founder and scientific officer for TrueSilence, a spinout company of the University of Auckland, and has a financial interest in TrueSilence. His coauthor has reported no relevant financial relationships.

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

Key clinical point: Monoclonal antibodies inhibiting calcitonin gene-related peptide (CGRP) effectively reduced monthly headache days, symptomatic drug consumption, and headache severity consistently over 12 months in patients with chronic migraine complicated by medication overuse headache (MOH).

Major finding: Overall, 80% of patients showed both ≥50% reduction in monthly headache days and ≥50% reduction in analgesics intake at the 3-month follow-up visit and 78.8% continued to show the improvements at the 6-month follow-up visit. The mean Migraine Impact and Disability Assessment Scale score decreased from 56.5 (range 27-63) at baseline to 13.1 (range 11-37) at 9 months, with 71% of patients being responders even at 1 year.

Study details: The data come from a prospective study of 303 patients with chronic migraine complicated by MOH who received CGRP antagonists for at least 6 months up to 1 year.

Disclosures: No source of funding was declared. The authors declared no competing interests.

Source: Curone M et al. Overview on effectiveness of erenumab, fremanezumab, and galcanezumab in reducing medication overuse headache in chronic migraine patients. Neurol Sci. 2022 (Jul 14). Doi: 10.1007/s10072-022-06265-8

Key clinical point: Monoclonal antibodies inhibiting calcitonin gene-related peptide (CGRP) effectively reduced monthly headache days, symptomatic drug consumption, and headache severity consistently over 12 months in patients with chronic migraine complicated by medication overuse headache (MOH).

Major finding: Overall, 80% of patients showed both ≥50% reduction in monthly headache days and ≥50% reduction in analgesics intake at the 3-month follow-up visit and 78.8% continued to show the improvements at the 6-month follow-up visit. The mean Migraine Impact and Disability Assessment Scale score decreased from 56.5 (range 27-63) at baseline to 13.1 (range 11-37) at 9 months, with 71% of patients being responders even at 1 year.

Study details: The data come from a prospective study of 303 patients with chronic migraine complicated by MOH who received CGRP antagonists for at least 6 months up to 1 year.

Disclosures: No source of funding was declared. The authors declared no competing interests.

Source: Curone M et al. Overview on effectiveness of erenumab, fremanezumab, and galcanezumab in reducing medication overuse headache in chronic migraine patients. Neurol Sci. 2022 (Jul 14). Doi: 10.1007/s10072-022-06265-8

Key clinical point: Monoclonal antibodies inhibiting calcitonin gene-related peptide (CGRP) effectively reduced monthly headache days, symptomatic drug consumption, and headache severity consistently over 12 months in patients with chronic migraine complicated by medication overuse headache (MOH).

Major finding: Overall, 80% of patients showed both ≥50% reduction in monthly headache days and ≥50% reduction in analgesics intake at the 3-month follow-up visit and 78.8% continued to show the improvements at the 6-month follow-up visit. The mean Migraine Impact and Disability Assessment Scale score decreased from 56.5 (range 27-63) at baseline to 13.1 (range 11-37) at 9 months, with 71% of patients being responders even at 1 year.

Study details: The data come from a prospective study of 303 patients with chronic migraine complicated by MOH who received CGRP antagonists for at least 6 months up to 1 year.

Disclosures: No source of funding was declared. The authors declared no competing interests.

Source: Curone M et al. Overview on effectiveness of erenumab, fremanezumab, and galcanezumab in reducing medication overuse headache in chronic migraine patients. Neurol Sci. 2022 (Jul 14). Doi: 10.1007/s10072-022-06265-8

Key clinical point: The occurrence of unclear days, defined as headache-free but not crystal-clear days, is prevalent in migraine, with the number of crystal-clear days being significantly lower and unclear days being significantly higher in participants with migraine vs non-migraine headache.

Major finding: Overall, 97.1% of participants had unclear days, with the number of crystal-clear days per 30 days being significantly lower (median, 20.0 vs 25.0) and the number of severe headache days (2.0 vs 1.0), days with acute medications (2.0 vs 1.0), and unclear days (4.0 vs 1.0) per 30 days being significantly higher in participants with vs without migraine headache (all P < .001).

Study details: The data come from a cross-sectional and case-control analysis of longitudinally collected data from 170 and 1768 participants with migraine and nonmigraine headaches, respectively.

Disclosures: This study was funded by the National Research Foundation of Korea. S-J Cho and MK Chu declared being site investigators of a multicenter trial or an advisory board members or receiving lecture honoraria or grants from various sources.

Source: Lee W et al. Crystal-clear days and unclear days in migraine: A population-based study. Headache. 2022;62: 818- 827 (Jul 14). Doi: 10.1111/head.14359

Key clinical point: The occurrence of unclear days, defined as headache-free but not crystal-clear days, is prevalent in migraine, with the number of crystal-clear days being significantly lower and unclear days being significantly higher in participants with migraine vs non-migraine headache.

Major finding: Overall, 97.1% of participants had unclear days, with the number of crystal-clear days per 30 days being significantly lower (median, 20.0 vs 25.0) and the number of severe headache days (2.0 vs 1.0), days with acute medications (2.0 vs 1.0), and unclear days (4.0 vs 1.0) per 30 days being significantly higher in participants with vs without migraine headache (all P < .001).

Study details: The data come from a cross-sectional and case-control analysis of longitudinally collected data from 170 and 1768 participants with migraine and nonmigraine headaches, respectively.

Disclosures: This study was funded by the National Research Foundation of Korea. S-J Cho and MK Chu declared being site investigators of a multicenter trial or an advisory board members or receiving lecture honoraria or grants from various sources.

Source: Lee W et al. Crystal-clear days and unclear days in migraine: A population-based study. Headache. 2022;62: 818- 827 (Jul 14). Doi: 10.1111/head.14359

Key clinical point: The occurrence of unclear days, defined as headache-free but not crystal-clear days, is prevalent in migraine, with the number of crystal-clear days being significantly lower and unclear days being significantly higher in participants with migraine vs non-migraine headache.

Major finding: Overall, 97.1% of participants had unclear days, with the number of crystal-clear days per 30 days being significantly lower (median, 20.0 vs 25.0) and the number of severe headache days (2.0 vs 1.0), days with acute medications (2.0 vs 1.0), and unclear days (4.0 vs 1.0) per 30 days being significantly higher in participants with vs without migraine headache (all P < .001).

Study details: The data come from a cross-sectional and case-control analysis of longitudinally collected data from 170 and 1768 participants with migraine and nonmigraine headaches, respectively.

Disclosures: This study was funded by the National Research Foundation of Korea. S-J Cho and MK Chu declared being site investigators of a multicenter trial or an advisory board members or receiving lecture honoraria or grants from various sources.

Source: Lee W et al. Crystal-clear days and unclear days in migraine: A population-based study. Headache. 2022;62: 818- 827 (Jul 14). Doi: 10.1111/head.14359

Key clinical point: Erenumab was effective and generally well tolerated over the 3 months of follow-up in a real-world population of patients with difficult-to-treat chronic migraine.

Major finding: At 3 months follow-up, the median total and severe monthly migraine days reduced significantly from 28 to 20 and from 15 to 5, respectively (both P < .0001), with 39.8%, 22.3%, and 7.8% of patients achieving at least 30%, 50%, and 75% reductions in mean monthly headache days, respectively. Overall, 43% of patients reported ≥1 adverse event, with constipation being the most common adverse event.

Study details: The data come from a prospective clinical audit of a treatment-resistant population of 103 patients with chronic migraine, high prevalence of medication overuse, and high headache burden who received 140 mg erenumab monthly for 3 months.

Disclosures: This study did not receive any funding. Some authors declared serving on advisory boards or as principal investigators for clinical trials or receiving speaker honoraria, conference sponsorship, or grants from various sources.

Source: Lowe M et al. Efficacy of erenumab and factors predicting response after 3 months in treatment resistant chronic migraine: A clinical service evaluation. J Headache Pain. 2022;23:86 (Jul 22). Doi: 10.1186/s10194-022-01456-2

Key clinical point: Erenumab was effective and generally well tolerated over the 3 months of follow-up in a real-world population of patients with difficult-to-treat chronic migraine.

Major finding: At 3 months follow-up, the median total and severe monthly migraine days reduced significantly from 28 to 20 and from 15 to 5, respectively (both P < .0001), with 39.8%, 22.3%, and 7.8% of patients achieving at least 30%, 50%, and 75% reductions in mean monthly headache days, respectively. Overall, 43% of patients reported ≥1 adverse event, with constipation being the most common adverse event.

Study details: The data come from a prospective clinical audit of a treatment-resistant population of 103 patients with chronic migraine, high prevalence of medication overuse, and high headache burden who received 140 mg erenumab monthly for 3 months.

Disclosures: This study did not receive any funding. Some authors declared serving on advisory boards or as principal investigators for clinical trials or receiving speaker honoraria, conference sponsorship, or grants from various sources.

Source: Lowe M et al. Efficacy of erenumab and factors predicting response after 3 months in treatment resistant chronic migraine: A clinical service evaluation. J Headache Pain. 2022;23:86 (Jul 22). Doi: 10.1186/s10194-022-01456-2

Key clinical point: Erenumab was effective and generally well tolerated over the 3 months of follow-up in a real-world population of patients with difficult-to-treat chronic migraine.

Major finding: At 3 months follow-up, the median total and severe monthly migraine days reduced significantly from 28 to 20 and from 15 to 5, respectively (both P < .0001), with 39.8%, 22.3%, and 7.8% of patients achieving at least 30%, 50%, and 75% reductions in mean monthly headache days, respectively. Overall, 43% of patients reported ≥1 adverse event, with constipation being the most common adverse event.

Study details: The data come from a prospective clinical audit of a treatment-resistant population of 103 patients with chronic migraine, high prevalence of medication overuse, and high headache burden who received 140 mg erenumab monthly for 3 months.

Disclosures: This study did not receive any funding. Some authors declared serving on advisory boards or as principal investigators for clinical trials or receiving speaker honoraria, conference sponsorship, or grants from various sources.

Source: Lowe M et al. Efficacy of erenumab and factors predicting response after 3 months in treatment resistant chronic migraine: A clinical service evaluation. J Headache Pain. 2022;23:86 (Jul 22). Doi: 10.1186/s10194-022-01456-2

Key clinical point: Meta-analysis demonstrated lower general cognitive and language functions in patients with migraine, along with a significant association between migraine and risk for all-cause dementia.

Major finding: General cognitive (standard mean difference [SMD] −0.40; 95% CI −0.66 to −0.15) and language (SMD −0.14; 95% CI −0.27 to −0.00) functions were lower in the group of participants with vs without migraine, and no significant between-group differences were observed for visuospatial, attention, executive, and memory functions. Moreover, migraine was significantly associated with the risk for dementia (odds ratio/relative risk 1.30; 95% CI 1.11-1.52).

Study details: Findings are from a meta-analysis of 22 studies (including 3295 patients with migraine) that assessed cognitive function and 11 studies (including 12,871 patients with dementia, 56,365 participants without dementia, 47,942 patients with migraine, and 190,024 healthy controls) that assessed the association between migraine and risk for dementia.

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

Source: Gu L et al. Association between migraine and cognitive impairment. J Headache Pain. 2022;23:88 (Jul 26). Doi: 10.1186/s10194-022-01462-4

Key clinical point: Meta-analysis demonstrated lower general cognitive and language functions in patients with migraine, along with a significant association between migraine and risk for all-cause dementia.

Major finding: General cognitive (standard mean difference [SMD] −0.40; 95% CI −0.66 to −0.15) and language (SMD −0.14; 95% CI −0.27 to −0.00) functions were lower in the group of participants with vs without migraine, and no significant between-group differences were observed for visuospatial, attention, executive, and memory functions. Moreover, migraine was significantly associated with the risk for dementia (odds ratio/relative risk 1.30; 95% CI 1.11-1.52).

Study details: Findings are from a meta-analysis of 22 studies (including 3295 patients with migraine) that assessed cognitive function and 11 studies (including 12,871 patients with dementia, 56,365 participants without dementia, 47,942 patients with migraine, and 190,024 healthy controls) that assessed the association between migraine and risk for dementia.

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

Source: Gu L et al. Association between migraine and cognitive impairment. J Headache Pain. 2022;23:88 (Jul 26). Doi: 10.1186/s10194-022-01462-4

Key clinical point: Meta-analysis demonstrated lower general cognitive and language functions in patients with migraine, along with a significant association between migraine and risk for all-cause dementia.

Major finding: General cognitive (standard mean difference [SMD] −0.40; 95% CI −0.66 to −0.15) and language (SMD −0.14; 95% CI −0.27 to −0.00) functions were lower in the group of participants with vs without migraine, and no significant between-group differences were observed for visuospatial, attention, executive, and memory functions. Moreover, migraine was significantly associated with the risk for dementia (odds ratio/relative risk 1.30; 95% CI 1.11-1.52).

Study details: Findings are from a meta-analysis of 22 studies (including 3295 patients with migraine) that assessed cognitive function and 11 studies (including 12,871 patients with dementia, 56,365 participants without dementia, 47,942 patients with migraine, and 190,024 healthy controls) that assessed the association between migraine and risk for dementia.

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

Source: Gu L et al. Association between migraine and cognitive impairment. J Headache Pain. 2022;23:88 (Jul 26). Doi: 10.1186/s10194-022-01462-4