Article

Key clinical point: Habitual intake of caffeinated beverages may not increase headache frequency, duration, or intensity in patients with episodic migraine, contrary to popular belief.

Major finding: Compared with patients having episodic migraine who did not habitually consume caffeinated beverages, those who consumed 1-2 servings per day reported 0.3 (95% CI −2.0 to 2.5) more headache days per month, whereas those who consumed 3-4 servings per day reported 1.3 (95% CI −4.5 to 1.9) fewer headache days per month. Moreover, the headache duration and intensity did not differ across levels of caffeinated beverage intake.

Study details: This prospective cohort study evaluated the association between habitual caffeinated beverages intake and headache outcomes among 97 patients with episodic migraine (age ≥ 18 years).

Disclosures: This study was funded by US National Institute of Neurological Disorders and Stroke, the American Sleep Medicine Foundation, Harvard Catalyst—The Harvard Clinical and Translational Science Center. Suzanne M. Bertisch declared serving as a consultant for Idorsia and ResMed. The other authors declared no conflicts of interest.

Source: Mittleman MR, Mostofsky E, Vgontzas A, Bertisch SM. Habitual caffeinated beverage consumption and headaches among adults with episodic migraine: A prospective cohort study. Headache. 2024 (Feb 6). doi: 10.1111/head.14673 Source

Key clinical point: Habitual intake of caffeinated beverages may not increase headache frequency, duration, or intensity in patients with episodic migraine, contrary to popular belief.

Major finding: Compared with patients having episodic migraine who did not habitually consume caffeinated beverages, those who consumed 1-2 servings per day reported 0.3 (95% CI −2.0 to 2.5) more headache days per month, whereas those who consumed 3-4 servings per day reported 1.3 (95% CI −4.5 to 1.9) fewer headache days per month. Moreover, the headache duration and intensity did not differ across levels of caffeinated beverage intake.

Study details: This prospective cohort study evaluated the association between habitual caffeinated beverages intake and headache outcomes among 97 patients with episodic migraine (age ≥ 18 years).

Disclosures: This study was funded by US National Institute of Neurological Disorders and Stroke, the American Sleep Medicine Foundation, Harvard Catalyst—The Harvard Clinical and Translational Science Center. Suzanne M. Bertisch declared serving as a consultant for Idorsia and ResMed. The other authors declared no conflicts of interest.

Source: Mittleman MR, Mostofsky E, Vgontzas A, Bertisch SM. Habitual caffeinated beverage consumption and headaches among adults with episodic migraine: A prospective cohort study. Headache. 2024 (Feb 6). doi: 10.1111/head.14673 Source

Key clinical point: Habitual intake of caffeinated beverages may not increase headache frequency, duration, or intensity in patients with episodic migraine, contrary to popular belief.

Major finding: Compared with patients having episodic migraine who did not habitually consume caffeinated beverages, those who consumed 1-2 servings per day reported 0.3 (95% CI −2.0 to 2.5) more headache days per month, whereas those who consumed 3-4 servings per day reported 1.3 (95% CI −4.5 to 1.9) fewer headache days per month. Moreover, the headache duration and intensity did not differ across levels of caffeinated beverage intake.

Study details: This prospective cohort study evaluated the association between habitual caffeinated beverages intake and headache outcomes among 97 patients with episodic migraine (age ≥ 18 years).

Disclosures: This study was funded by US National Institute of Neurological Disorders and Stroke, the American Sleep Medicine Foundation, Harvard Catalyst—The Harvard Clinical and Translational Science Center. Suzanne M. Bertisch declared serving as a consultant for Idorsia and ResMed. The other authors declared no conflicts of interest.

Source: Mittleman MR, Mostofsky E, Vgontzas A, Bertisch SM. Habitual caffeinated beverage consumption and headaches among adults with episodic migraine: A prospective cohort study. Headache. 2024 (Feb 6). doi: 10.1111/head.14673 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were more effective than onabotulinumtoxinA (BoNT-A) in reducing monthly headache days (MHD) in patients with chronic migraine (CM), although the safety profile of both treatments was comparable.

Major finding: Anti-CGRP mAb vs BoNT-A led to a significantly greater reduction in MHD at 6 months (adjusted mean difference ‒7.1; P < .001) and 12 months(adjusted mean difference ‒6.2; P < .001). Both treatments had favorable and comparable safety profiles.

Study details: Findings are from an observational, retrospective, multicenter, cohort study including 183 patients with CM who had at least two oral preventive treatment failures and received anti-CGRP mAb (n = 86) and BoNT-A (n = 97).

Disclosures: This study was supported by Italian Ministry of Health. Four authors declared receiving consultancy and advisory fees, travel grants, honoraria, or personal fees for participating in advisory boards, speaker panels, or clinical investigation studies from various sources.

Source: Grazzi L, Giossi R, Montisano DA et al. Real-world effectiveness of anti-CGRP monoclonal antibodies compared to onabotulinumtoxinA (RAMO) in chronic migraine: A retrospective, observational, multicenter, cohort study. J Headache Pain. 2024;25:14. doi: 10.1186/s10194-024-01721-6 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were more effective than onabotulinumtoxinA (BoNT-A) in reducing monthly headache days (MHD) in patients with chronic migraine (CM), although the safety profile of both treatments was comparable.

Major finding: Anti-CGRP mAb vs BoNT-A led to a significantly greater reduction in MHD at 6 months (adjusted mean difference ‒7.1; P < .001) and 12 months(adjusted mean difference ‒6.2; P < .001). Both treatments had favorable and comparable safety profiles.

Study details: Findings are from an observational, retrospective, multicenter, cohort study including 183 patients with CM who had at least two oral preventive treatment failures and received anti-CGRP mAb (n = 86) and BoNT-A (n = 97).

Disclosures: This study was supported by Italian Ministry of Health. Four authors declared receiving consultancy and advisory fees, travel grants, honoraria, or personal fees for participating in advisory boards, speaker panels, or clinical investigation studies from various sources.

Source: Grazzi L, Giossi R, Montisano DA et al. Real-world effectiveness of anti-CGRP monoclonal antibodies compared to onabotulinumtoxinA (RAMO) in chronic migraine: A retrospective, observational, multicenter, cohort study. J Headache Pain. 2024;25:14. doi: 10.1186/s10194-024-01721-6 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were more effective than onabotulinumtoxinA (BoNT-A) in reducing monthly headache days (MHD) in patients with chronic migraine (CM), although the safety profile of both treatments was comparable.

Major finding: Anti-CGRP mAb vs BoNT-A led to a significantly greater reduction in MHD at 6 months (adjusted mean difference ‒7.1; P < .001) and 12 months(adjusted mean difference ‒6.2; P < .001). Both treatments had favorable and comparable safety profiles.

Study details: Findings are from an observational, retrospective, multicenter, cohort study including 183 patients with CM who had at least two oral preventive treatment failures and received anti-CGRP mAb (n = 86) and BoNT-A (n = 97).

Disclosures: This study was supported by Italian Ministry of Health. Four authors declared receiving consultancy and advisory fees, travel grants, honoraria, or personal fees for participating in advisory boards, speaker panels, or clinical investigation studies from various sources.

Source: Grazzi L, Giossi R, Montisano DA et al. Real-world effectiveness of anti-CGRP monoclonal antibodies compared to onabotulinumtoxinA (RAMO) in chronic migraine: A retrospective, observational, multicenter, cohort study. J Headache Pain. 2024;25:14. doi: 10.1186/s10194-024-01721-6 Source

and migraine or its subtypes, and vice versa.

Major finding: Genetic predispositions to AR were not casually associated with a higher risk for migraine (odds ratio [OR] 0.816; P = .394), both with aura (OR 0.690; P = .384) and without aura (OR 1.022; P = .954). Reciprocally, genetic predispositions to migraine or its subtypes showed no casual association with AR.

Study details: This two-sample Mendelian randomization analysis included 25,486 patients with AR and 87,907 control individuals without AR along with 3541 patients with migraine with aura, 3215 patients with migraine without aura, and 176,107 controls individuals without migraine.

Disclosures: This study was supported by grants from the National Natural Science Foundation of China and the Fundamental Research Funds for the Central Universities. The authors declared no conflicts of interest.

Source: Lv H, Liu K, Xie Y et al. No causal association between allergic rhinitis and migraine: A Mendelian randomization study. Eur J Med Res. 2024;29:78. doi: 10.1186/s40001-024-01682-1 Source

and migraine or its subtypes, and vice versa.

Major finding: Genetic predispositions to AR were not casually associated with a higher risk for migraine (odds ratio [OR] 0.816; P = .394), both with aura (OR 0.690; P = .384) and without aura (OR 1.022; P = .954). Reciprocally, genetic predispositions to migraine or its subtypes showed no casual association with AR.

Study details: This two-sample Mendelian randomization analysis included 25,486 patients with AR and 87,907 control individuals without AR along with 3541 patients with migraine with aura, 3215 patients with migraine without aura, and 176,107 controls individuals without migraine.

Disclosures: This study was supported by grants from the National Natural Science Foundation of China and the Fundamental Research Funds for the Central Universities. The authors declared no conflicts of interest.

Source: Lv H, Liu K, Xie Y et al. No causal association between allergic rhinitis and migraine: A Mendelian randomization study. Eur J Med Res. 2024;29:78. doi: 10.1186/s40001-024-01682-1 Source

and migraine or its subtypes, and vice versa.

Major finding: Genetic predispositions to AR were not casually associated with a higher risk for migraine (odds ratio [OR] 0.816; P = .394), both with aura (OR 0.690; P = .384) and without aura (OR 1.022; P = .954). Reciprocally, genetic predispositions to migraine or its subtypes showed no casual association with AR.

Study details: This two-sample Mendelian randomization analysis included 25,486 patients with AR and 87,907 control individuals without AR along with 3541 patients with migraine with aura, 3215 patients with migraine without aura, and 176,107 controls individuals without migraine.

Disclosures: This study was supported by grants from the National Natural Science Foundation of China and the Fundamental Research Funds for the Central Universities. The authors declared no conflicts of interest.

Source: Lv H, Liu K, Xie Y et al. No causal association between allergic rhinitis and migraine: A Mendelian randomization study. Eur J Med Res. 2024;29:78. doi: 10.1186/s40001-024-01682-1 Source

Key clinical point: Resuming anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) therapy was beneficial in patients with migraine who had responded to this treatment previously but relapsed upon discontinuation.

Major finding: The median monthly headache days (MHD) improved from 16 in the month before antibody reintroduction to 8 after 3 months of treatment re-introduction. The majority of patients achieved 30% reduction in MHD (75.3%) and monthly migraine days (80.8%) during the second treatment period with anti-CGRP mAb.

Study details: This observational prospective analytical multicentric study included 360 patients with migraine who had shown prior response to anti-CGRP mAb, with clinical worsening after withdrawal and were re-introduced anti-CGRP mAb therapy.

Disclosures: This study was funded by the Instituto de Salud Carlos III, European Union, and  Fondo Europeo de Desarrollo Regional (FEDER) funds. Several authors declared receiving speaker honoraria, payments or honoraria for lectures, or research support or grants from various sources.

Source: Romero Del Rincón C, Gonzalez-Martinez A, Quintas S et al. RE-START: Exploring the effectiveness of anti-calcitonin gene-related peptide resumption after discontinuation in migraine. Eur J Neurol. 2024 (Jan 25). doi: 10.1111/ene.16203 Source

Key clinical point: Resuming anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) therapy was beneficial in patients with migraine who had responded to this treatment previously but relapsed upon discontinuation.

Major finding: The median monthly headache days (MHD) improved from 16 in the month before antibody reintroduction to 8 after 3 months of treatment re-introduction. The majority of patients achieved 30% reduction in MHD (75.3%) and monthly migraine days (80.8%) during the second treatment period with anti-CGRP mAb.

Study details: This observational prospective analytical multicentric study included 360 patients with migraine who had shown prior response to anti-CGRP mAb, with clinical worsening after withdrawal and were re-introduced anti-CGRP mAb therapy.

Disclosures: This study was funded by the Instituto de Salud Carlos III, European Union, and  Fondo Europeo de Desarrollo Regional (FEDER) funds. Several authors declared receiving speaker honoraria, payments or honoraria for lectures, or research support or grants from various sources.

Source: Romero Del Rincón C, Gonzalez-Martinez A, Quintas S et al. RE-START: Exploring the effectiveness of anti-calcitonin gene-related peptide resumption after discontinuation in migraine. Eur J Neurol. 2024 (Jan 25). doi: 10.1111/ene.16203 Source

Key clinical point: Resuming anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) therapy was beneficial in patients with migraine who had responded to this treatment previously but relapsed upon discontinuation.

Major finding: The median monthly headache days (MHD) improved from 16 in the month before antibody reintroduction to 8 after 3 months of treatment re-introduction. The majority of patients achieved 30% reduction in MHD (75.3%) and monthly migraine days (80.8%) during the second treatment period with anti-CGRP mAb.

Study details: This observational prospective analytical multicentric study included 360 patients with migraine who had shown prior response to anti-CGRP mAb, with clinical worsening after withdrawal and were re-introduced anti-CGRP mAb therapy.

Disclosures: This study was funded by the Instituto de Salud Carlos III, European Union, and  Fondo Europeo de Desarrollo Regional (FEDER) funds. Several authors declared receiving speaker honoraria, payments or honoraria for lectures, or research support or grants from various sources.

Source: Romero Del Rincón C, Gonzalez-Martinez A, Quintas S et al. RE-START: Exploring the effectiveness of anti-calcitonin gene-related peptide resumption after discontinuation in migraine. Eur J Neurol. 2024 (Jan 25). doi: 10.1111/ene.16203 Source

Key clinical point: Body mass index (BMI) was positively correlated with an increased risk for severe headache or migraine, with the association being further increased in patients with diabetes and high BMI.

Major finding: BMI was positively associated with a higher risk for migraine (adjusted odds ratio [aOR] 1.02; P < .001), with participants in the highest (≥30.0 kg/m²) vs lowest (<25.0 kg/m²) BMI groups reporting an increased risk for migraine (aOR 1.30; P = .0022). The positive association between BMI and migraine was further strengthened in patients with diabetes, who had BMI ≥ 29.71 kg/m² (aOR 1.30; P = . 003).

Study details: This cross-sectional study included 10,074 participants, of whom 2004 had migraine and 1020 had diabetes.

Disclosures: This work was supported by the National Natural Science Foundation of China and Jiangxi Province, Jiangxi Provincial Department of Education Science and Technology Program Project, and Jiangxi Province Postgraduate Innovation Special Fund. The authors declared no competing interests.

Source: Tian S, Cheng Z, Zheng H et al. Interaction between diabetes and body mass index on severe headache or migraine in adults: A cross-sectional study. BMC Geriatr. 2024;24:76. doi: 10.1186/s12877-024-04657-3 Source

Key clinical point: Body mass index (BMI) was positively correlated with an increased risk for severe headache or migraine, with the association being further increased in patients with diabetes and high BMI.

Major finding: BMI was positively associated with a higher risk for migraine (adjusted odds ratio [aOR] 1.02; P < .001), with participants in the highest (≥30.0 kg/m²) vs lowest (<25.0 kg/m²) BMI groups reporting an increased risk for migraine (aOR 1.30; P = .0022). The positive association between BMI and migraine was further strengthened in patients with diabetes, who had BMI ≥ 29.71 kg/m² (aOR 1.30; P = . 003).

Study details: This cross-sectional study included 10,074 participants, of whom 2004 had migraine and 1020 had diabetes.

Disclosures: This work was supported by the National Natural Science Foundation of China and Jiangxi Province, Jiangxi Provincial Department of Education Science and Technology Program Project, and Jiangxi Province Postgraduate Innovation Special Fund. The authors declared no competing interests.

Source: Tian S, Cheng Z, Zheng H et al. Interaction between diabetes and body mass index on severe headache or migraine in adults: A cross-sectional study. BMC Geriatr. 2024;24:76. doi: 10.1186/s12877-024-04657-3 Source

Key clinical point: Body mass index (BMI) was positively correlated with an increased risk for severe headache or migraine, with the association being further increased in patients with diabetes and high BMI.

Major finding: BMI was positively associated with a higher risk for migraine (adjusted odds ratio [aOR] 1.02; P < .001), with participants in the highest (≥30.0 kg/m²) vs lowest (<25.0 kg/m²) BMI groups reporting an increased risk for migraine (aOR 1.30; P = .0022). The positive association between BMI and migraine was further strengthened in patients with diabetes, who had BMI ≥ 29.71 kg/m² (aOR 1.30; P = . 003).

Study details: This cross-sectional study included 10,074 participants, of whom 2004 had migraine and 1020 had diabetes.

Disclosures: This work was supported by the National Natural Science Foundation of China and Jiangxi Province, Jiangxi Provincial Department of Education Science and Technology Program Project, and Jiangxi Province Postgraduate Innovation Special Fund. The authors declared no competing interests.

Source: Tian S, Cheng Z, Zheng H et al. Interaction between diabetes and body mass index on severe headache or migraine in adults: A cross-sectional study. BMC Geriatr. 2024;24:76. doi: 10.1186/s12877-024-04657-3 Source

Key clinical point: Eptinezumab vs placebo led to a greater reduction in migraine frequency and an improvement in migraine response in patients with migraine, irrespective of the type of prior treatment failure.

Major finding: Across weeks 1-12, patients receiving eptinezumab vs placebo experienced greater reductions in monthly migraine days (MMD) from baseline in all subgroups, with even greater improvements at weeks 13-24 (all P < .0001). Migraine responder rates (≥50% reduction in MMD) were also higher with eptinezumab vs placebo and increased following a second infusion (all P < .0001).

Study details: Findings are from a post hoc analysis of the DELIVER trial that included 890 patients with migraine who were randomly assigned to receive either 100 mg or 300 mg eptinezumab or placebo.

Disclosures: The study was sponsored and funded by H. Lundbeck A/S. Several authors declared receiving personal fees, research support, or research funding from various sources. Four authors declared being full-time employees of or holding stocks in Lundbeck or one of its subsidiary companies.

Source: Pozo-Rosich P, Ashina M, Tepper SJ et al. Eptinezumab demonstrated efficacy regardless of prior preventive migraine treatment failure type: Post hoc analyses of the DELIVER study. Neurol Ther. 2024 (Jan 18). doi: 10.1007/s40120-023-00575-5  Source

Key clinical point: Eptinezumab vs placebo led to a greater reduction in migraine frequency and an improvement in migraine response in patients with migraine, irrespective of the type of prior treatment failure.

Major finding: Across weeks 1-12, patients receiving eptinezumab vs placebo experienced greater reductions in monthly migraine days (MMD) from baseline in all subgroups, with even greater improvements at weeks 13-24 (all P < .0001). Migraine responder rates (≥50% reduction in MMD) were also higher with eptinezumab vs placebo and increased following a second infusion (all P < .0001).

Study details: Findings are from a post hoc analysis of the DELIVER trial that included 890 patients with migraine who were randomly assigned to receive either 100 mg or 300 mg eptinezumab or placebo.

Disclosures: The study was sponsored and funded by H. Lundbeck A/S. Several authors declared receiving personal fees, research support, or research funding from various sources. Four authors declared being full-time employees of or holding stocks in Lundbeck or one of its subsidiary companies.

Source: Pozo-Rosich P, Ashina M, Tepper SJ et al. Eptinezumab demonstrated efficacy regardless of prior preventive migraine treatment failure type: Post hoc analyses of the DELIVER study. Neurol Ther. 2024 (Jan 18). doi: 10.1007/s40120-023-00575-5  Source

Key clinical point: Eptinezumab vs placebo led to a greater reduction in migraine frequency and an improvement in migraine response in patients with migraine, irrespective of the type of prior treatment failure.

Major finding: Across weeks 1-12, patients receiving eptinezumab vs placebo experienced greater reductions in monthly migraine days (MMD) from baseline in all subgroups, with even greater improvements at weeks 13-24 (all P < .0001). Migraine responder rates (≥50% reduction in MMD) were also higher with eptinezumab vs placebo and increased following a second infusion (all P < .0001).

Study details: Findings are from a post hoc analysis of the DELIVER trial that included 890 patients with migraine who were randomly assigned to receive either 100 mg or 300 mg eptinezumab or placebo.

Disclosures: The study was sponsored and funded by H. Lundbeck A/S. Several authors declared receiving personal fees, research support, or research funding from various sources. Four authors declared being full-time employees of or holding stocks in Lundbeck or one of its subsidiary companies.

Source: Pozo-Rosich P, Ashina M, Tepper SJ et al. Eptinezumab demonstrated efficacy regardless of prior preventive migraine treatment failure type: Post hoc analyses of the DELIVER study. Neurol Ther. 2024 (Jan 18). doi: 10.1007/s40120-023-00575-5  Source

Key clinical point: Patients diagnosed with migraine should be monitored for the potential onset of inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC); particularly, men with migraine may require increased monitoring for the development of UC.

Major finding: Patients with migraine had a higher risk for IBD (adjusted hazard ratio [aHR] 1.31; P < .0001), CD (aHR 1.58; P = .0002), and UC (aHR 1.26; P = .0004) than those without migraine. Presence of migraine increased the risk for UC more prominently in men (aHR 1.43; 95% CI 1.20-1.71) than in women (aHR 1.12; 95% CI 0.94-1.34; P_interaction = .042).

Study details: The data come from a nationwide population-based cohort study that included 10,131,193 individuals who had undergone a national health examination conducted by the Korean National Health Insurance Service in 2009, of which 281,144 patients had migraine.

Disclosures: This study did not disclose the funding source. The authors declared no competing interests.

Source: Lee CH, Han K, Lee HJ et al. Migraine is associated with the development of adult patients with inflammatory bowel disease: A nationwide, population-based study. Sci Rep. 2024;14:1157 (Jan 12).  doi: 10.1038/s41598-024-51455-3  Source.

Key clinical point: Patients diagnosed with migraine should be monitored for the potential onset of inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC); particularly, men with migraine may require increased monitoring for the development of UC.

Major finding: Patients with migraine had a higher risk for IBD (adjusted hazard ratio [aHR] 1.31; P < .0001), CD (aHR 1.58; P = .0002), and UC (aHR 1.26; P = .0004) than those without migraine. Presence of migraine increased the risk for UC more prominently in men (aHR 1.43; 95% CI 1.20-1.71) than in women (aHR 1.12; 95% CI 0.94-1.34; P_interaction = .042).

Study details: The data come from a nationwide population-based cohort study that included 10,131,193 individuals who had undergone a national health examination conducted by the Korean National Health Insurance Service in 2009, of which 281,144 patients had migraine.

Disclosures: This study did not disclose the funding source. The authors declared no competing interests.

Source: Lee CH, Han K, Lee HJ et al. Migraine is associated with the development of adult patients with inflammatory bowel disease: A nationwide, population-based study. Sci Rep. 2024;14:1157 (Jan 12).  doi: 10.1038/s41598-024-51455-3  Source.

Key clinical point: Patients diagnosed with migraine should be monitored for the potential onset of inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC); particularly, men with migraine may require increased monitoring for the development of UC.

Major finding: Patients with migraine had a higher risk for IBD (adjusted hazard ratio [aHR] 1.31; P < .0001), CD (aHR 1.58; P = .0002), and UC (aHR 1.26; P = .0004) than those without migraine. Presence of migraine increased the risk for UC more prominently in men (aHR 1.43; 95% CI 1.20-1.71) than in women (aHR 1.12; 95% CI 0.94-1.34; P_interaction = .042).

Study details: The data come from a nationwide population-based cohort study that included 10,131,193 individuals who had undergone a national health examination conducted by the Korean National Health Insurance Service in 2009, of which 281,144 patients had migraine.

Disclosures: This study did not disclose the funding source. The authors declared no competing interests.

Source: Lee CH, Han K, Lee HJ et al. Migraine is associated with the development of adult patients with inflammatory bowel disease: A nationwide, population-based study. Sci Rep. 2024;14:1157 (Jan 12).  doi: 10.1038/s41598-024-51455-3  Source.

Key clinical point: Patients with chronic migraine may be informed that they should not expect a consistent wearing-off effect when being treated with erenumab or fremanezumab as anxiety regarding attacks toward the end of the month may potentially trigger further migraine episodes.

Major finding: Overall, 62% of patients treated with erenumab and fremanezumab achieved a consistent ≥30% reduction in migraine days over 2 consecutive months (≥30% responders), with no consistent wearing-off effect (ie, an increase of ≥2 weekly migraine days from week 2 to 4 over 2 consecutive treatment months) in the erenumab (P = .194) and fremanezumab (P = .581) groups. Among ≥30% responders, there was no significant wearing-off effect from week 2 to 4 over 2 consecutive months (1.43 vs 1.52 days; P = .573).

Study details: This single-center, real-world, observational study included 100 patients with chronic migraine (age ≥ 18 years) who received either erenumab (n = 60) or fremanezumab (n = 40).

Disclosures: This study was supported by Lundbeck Foundation. Two authors declared receiving personal fees or honoraria from or serving on advisory boards for various sources.

Source: Florescu AM, Lannov LV, Younis S et al. No wearing-off effect of erenumab or fremanezumab for chronic migraine prevention: A single-center, real-world, observational study. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231222 Source.

Key clinical point: Patients with chronic migraine may be informed that they should not expect a consistent wearing-off effect when being treated with erenumab or fremanezumab as anxiety regarding attacks toward the end of the month may potentially trigger further migraine episodes.

Major finding: Overall, 62% of patients treated with erenumab and fremanezumab achieved a consistent ≥30% reduction in migraine days over 2 consecutive months (≥30% responders), with no consistent wearing-off effect (ie, an increase of ≥2 weekly migraine days from week 2 to 4 over 2 consecutive treatment months) in the erenumab (P = .194) and fremanezumab (P = .581) groups. Among ≥30% responders, there was no significant wearing-off effect from week 2 to 4 over 2 consecutive months (1.43 vs 1.52 days; P = .573).

Study details: This single-center, real-world, observational study included 100 patients with chronic migraine (age ≥ 18 years) who received either erenumab (n = 60) or fremanezumab (n = 40).

Disclosures: This study was supported by Lundbeck Foundation. Two authors declared receiving personal fees or honoraria from or serving on advisory boards for various sources.

Source: Florescu AM, Lannov LV, Younis S et al. No wearing-off effect of erenumab or fremanezumab for chronic migraine prevention: A single-center, real-world, observational study. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231222 Source.

Key clinical point: Patients with chronic migraine may be informed that they should not expect a consistent wearing-off effect when being treated with erenumab or fremanezumab as anxiety regarding attacks toward the end of the month may potentially trigger further migraine episodes.

Major finding: Overall, 62% of patients treated with erenumab and fremanezumab achieved a consistent ≥30% reduction in migraine days over 2 consecutive months (≥30% responders), with no consistent wearing-off effect (ie, an increase of ≥2 weekly migraine days from week 2 to 4 over 2 consecutive treatment months) in the erenumab (P = .194) and fremanezumab (P = .581) groups. Among ≥30% responders, there was no significant wearing-off effect from week 2 to 4 over 2 consecutive months (1.43 vs 1.52 days; P = .573).

Study details: This single-center, real-world, observational study included 100 patients with chronic migraine (age ≥ 18 years) who received either erenumab (n = 60) or fremanezumab (n = 40).

Disclosures: This study was supported by Lundbeck Foundation. Two authors declared receiving personal fees or honoraria from or serving on advisory boards for various sources.

Source: Florescu AM, Lannov LV, Younis S et al. No wearing-off effect of erenumab or fremanezumab for chronic migraine prevention: A single-center, real-world, observational study. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231222 Source.

Key clinical point: Women who had menarche at older age had a lower risk for migraine, whereas those who used oral contraceptives and those who had children had a higher risk for migraine.

Major finding: Older age at menarche decreased migraine risk (adjusted hazard ratio [aHR] 0.96; 95% CI 0.95-0.98), whereas oral contraceptive use (aHR 1.12; 95% CI 1.06-1.18) and having children (aHR 1.37; 95% CI 1.29-1.46) increased migraine risk.

Study details: This study evaluated the data of 62,959 women (age 30-70 years) from the Norwegian Women and Cancer Study, of whom 15,635 (24.8%) had migraine.

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

Source: Bugge NS, Grøtta Vetvik K, Alstadhaug KB, Braaten T et al. Cumulative exposure to estrogen may increase the risk of migraine in women. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231225 Source.

Key clinical point: Women who had menarche at older age had a lower risk for migraine, whereas those who used oral contraceptives and those who had children had a higher risk for migraine.

Major finding: Older age at menarche decreased migraine risk (adjusted hazard ratio [aHR] 0.96; 95% CI 0.95-0.98), whereas oral contraceptive use (aHR 1.12; 95% CI 1.06-1.18) and having children (aHR 1.37; 95% CI 1.29-1.46) increased migraine risk.

Study details: This study evaluated the data of 62,959 women (age 30-70 years) from the Norwegian Women and Cancer Study, of whom 15,635 (24.8%) had migraine.

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

Source: Bugge NS, Grøtta Vetvik K, Alstadhaug KB, Braaten T et al. Cumulative exposure to estrogen may increase the risk of migraine in women. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231225 Source.

Key clinical point: Women who had menarche at older age had a lower risk for migraine, whereas those who used oral contraceptives and those who had children had a higher risk for migraine.

Major finding: Older age at menarche decreased migraine risk (adjusted hazard ratio [aHR] 0.96; 95% CI 0.95-0.98), whereas oral contraceptive use (aHR 1.12; 95% CI 1.06-1.18) and having children (aHR 1.37; 95% CI 1.29-1.46) increased migraine risk.

Study details: This study evaluated the data of 62,959 women (age 30-70 years) from the Norwegian Women and Cancer Study, of whom 15,635 (24.8%) had migraine.

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

Source: Bugge NS, Grøtta Vetvik K, Alstadhaug KB, Braaten T et al. Cumulative exposure to estrogen may increase the risk of migraine in women. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231225 Source.

Dermatologists in training are exposed to many different clinical scenarios—from the quick 15-minute encounter to diagnose a case of atopic dermatitis to hours of digging through a medical record to identify a culprit medication in a hospitalized patient with a life-threatening cutaneous drug reaction. Amidst the day-to-day clinical work that we do, there inevitably are interactions we have with patients that are less than ideal. These challenging encounters—whether they be subtle microaggressions that unfortunately enter the workplace or blatant quarrels between providers and patients that leave both parties dissatisfied—are notable contributors to physician stress levels and can lead to burnout.^1,2 However, there are positive lessons to be learned from these challenging patient encounters if we manage to withstand them. When we start to understand the factors contributing to difficult clinical encounters, we can begin to develop and apply effective communication tools to productively navigate these experiences.

Defining the Difficult Patient

In 2017, the Global Burden of Disease study revealed that skin disease is the fourth leading cause of nonfatal disease burden worldwide.³ Based on this statistic, it is easy to see how some patients may experience frustration associated with their condition and subsequently displace their discontent on the physician. In one study, nearly 1 of every 6 (16.7%) outpatient encounters was considered difficult by physicians.⁴ Family medicine physicians defined the difficult patient as one who is violent, demanding, aggressive, and rude.⁵ Others in primary care specialties have considered difficult patients to have characteristics that include mental health problems, more than 5 somatic symptoms, and abrasive personalities.^4,6

Situational and Physician-Centered Factors in Difficult Patient Encounters

In our medical system, the narrative often is focused on the patient, for better or worse—the patient was difficult, thereby making the encounter difficult. However, it is important to remember that difficult encounters can be attributed to several different factors, including those related to the physician, the clinical situation, or both. For example, dermatology residents juggle their clinical duties; academic work including studying, teaching, and/or research; and systemic and personal pressures at all times, whether they are cognizant of it or not. For better or worse, by virtue of being human, residents bring these factors with them to each clinical encounter. The delicate balance of these components can have a considerable impact on our delivery of good health care. This is particularly relevant in dermatology, where residents are subject to limited time during visits, work culture among clinic staff that is out of our control, and prominent complex social issues (for those of us practicing in medically underserved areas). Poor communication skills, underlying bias toward specific health conditions, limited knowledge as a trainee, and our own personal stressors also may play large roles in perceiving a clinical encounter as difficult during dermatology residency.⁷

Strategies to Mitigate Difficult Encounters

As a resident, if you make a statement that sparks a negative response from the patient, acknowledge their negative emotion, try to offer help, or rephrase the original statement to quickly dispel the tension. Validating a patient’s emotions and helping them embrace uncertainty can go a long way in the therapeutic relationship, especially in dermatology where so many of our diseases are chronic and without a definite cure.⁸ Additionally, it is important to apply strategies to redirect and de-escalate the situation during emotionally charged conversations, such as active listening, validating and empathizing with emotions, exploring alternative solutions, and providing closure to the conversation. Consensus recommendations for managing challenging encounters established by the American Academy of Family Physicians in 2013 include setting boundaries or modifying schedules, as needed, to handle difficult encounters; employing empathetic listening skills and a nonjudgmental attitude to facilitate trust and adherence to treatment; and assessing for underlying psychological illnesses with referral for appropriate diagnosis and treatment. Finally, the CALMER method—catalyst for change, alter thoughts to change feelings, listen and then make a diagnosis, make an agreement, education and follow-up, reach out and discuss feelings—is another approach that may be useful.⁷ In dermatology, this approach may not only dissipate unwanted tension but also make progress toward a therapeutic relationship. We cannot control the patient’s behavior in a visit, but we need to keep in mind that we are in control of our own reactions to said behavior.⁹ After first acknowledging this, we can then guide patients to take steps toward overcoming the issue. Within the time restrictions of a dermatology clinic visit, residents may use this approach to quickly feel more in control of a distressing situation and remain calm to better care for the patient.

Final Thoughts

Difficult patient encounters are impossible to avoid in any field of medicine, and dermatology is no exception. It will only benefit residents to recognize the multiple factors impacting a challenging encounter now and learn or enhance conflict resolution and communication skills to navigate these dissatisfying and uncomfortable situations, as they are inevitable in our careers.

Dermatologists in training are exposed to many different clinical scenarios—from the quick 15-minute encounter to diagnose a case of atopic dermatitis to hours of digging through a medical record to identify a culprit medication in a hospitalized patient with a life-threatening cutaneous drug reaction. Amidst the day-to-day clinical work that we do, there inevitably are interactions we have with patients that are less than ideal. These challenging encounters—whether they be subtle microaggressions that unfortunately enter the workplace or blatant quarrels between providers and patients that leave both parties dissatisfied—are notable contributors to physician stress levels and can lead to burnout.^1,2 However, there are positive lessons to be learned from these challenging patient encounters if we manage to withstand them. When we start to understand the factors contributing to difficult clinical encounters, we can begin to develop and apply effective communication tools to productively navigate these experiences.

Defining the Difficult Patient

In 2017, the Global Burden of Disease study revealed that skin disease is the fourth leading cause of nonfatal disease burden worldwide.³ Based on this statistic, it is easy to see how some patients may experience frustration associated with their condition and subsequently displace their discontent on the physician. In one study, nearly 1 of every 6 (16.7%) outpatient encounters was considered difficult by physicians.⁴ Family medicine physicians defined the difficult patient as one who is violent, demanding, aggressive, and rude.⁵ Others in primary care specialties have considered difficult patients to have characteristics that include mental health problems, more than 5 somatic symptoms, and abrasive personalities.^4,6

Situational and Physician-Centered Factors in Difficult Patient Encounters

In our medical system, the narrative often is focused on the patient, for better or worse—the patient was difficult, thereby making the encounter difficult. However, it is important to remember that difficult encounters can be attributed to several different factors, including those related to the physician, the clinical situation, or both. For example, dermatology residents juggle their clinical duties; academic work including studying, teaching, and/or research; and systemic and personal pressures at all times, whether they are cognizant of it or not. For better or worse, by virtue of being human, residents bring these factors with them to each clinical encounter. The delicate balance of these components can have a considerable impact on our delivery of good health care. This is particularly relevant in dermatology, where residents are subject to limited time during visits, work culture among clinic staff that is out of our control, and prominent complex social issues (for those of us practicing in medically underserved areas). Poor communication skills, underlying bias toward specific health conditions, limited knowledge as a trainee, and our own personal stressors also may play large roles in perceiving a clinical encounter as difficult during dermatology residency.⁷

Strategies to Mitigate Difficult Encounters

As a resident, if you make a statement that sparks a negative response from the patient, acknowledge their negative emotion, try to offer help, or rephrase the original statement to quickly dispel the tension. Validating a patient’s emotions and helping them embrace uncertainty can go a long way in the therapeutic relationship, especially in dermatology where so many of our diseases are chronic and without a definite cure.⁸ Additionally, it is important to apply strategies to redirect and de-escalate the situation during emotionally charged conversations, such as active listening, validating and empathizing with emotions, exploring alternative solutions, and providing closure to the conversation. Consensus recommendations for managing challenging encounters established by the American Academy of Family Physicians in 2013 include setting boundaries or modifying schedules, as needed, to handle difficult encounters; employing empathetic listening skills and a nonjudgmental attitude to facilitate trust and adherence to treatment; and assessing for underlying psychological illnesses with referral for appropriate diagnosis and treatment. Finally, the CALMER method—catalyst for change, alter thoughts to change feelings, listen and then make a diagnosis, make an agreement, education and follow-up, reach out and discuss feelings—is another approach that may be useful.⁷ In dermatology, this approach may not only dissipate unwanted tension but also make progress toward a therapeutic relationship. We cannot control the patient’s behavior in a visit, but we need to keep in mind that we are in control of our own reactions to said behavior.⁹ After first acknowledging this, we can then guide patients to take steps toward overcoming the issue. Within the time restrictions of a dermatology clinic visit, residents may use this approach to quickly feel more in control of a distressing situation and remain calm to better care for the patient.

Final Thoughts

Difficult patient encounters are impossible to avoid in any field of medicine, and dermatology is no exception. It will only benefit residents to recognize the multiple factors impacting a challenging encounter now and learn or enhance conflict resolution and communication skills to navigate these dissatisfying and uncomfortable situations, as they are inevitable in our careers.

Dermatologists in training are exposed to many different clinical scenarios—from the quick 15-minute encounter to diagnose a case of atopic dermatitis to hours of digging through a medical record to identify a culprit medication in a hospitalized patient with a life-threatening cutaneous drug reaction. Amidst the day-to-day clinical work that we do, there inevitably are interactions we have with patients that are less than ideal. These challenging encounters—whether they be subtle microaggressions that unfortunately enter the workplace or blatant quarrels between providers and patients that leave both parties dissatisfied—are notable contributors to physician stress levels and can lead to burnout.^1,2 However, there are positive lessons to be learned from these challenging patient encounters if we manage to withstand them. When we start to understand the factors contributing to difficult clinical encounters, we can begin to develop and apply effective communication tools to productively navigate these experiences.

Defining the Difficult Patient

In 2017, the Global Burden of Disease study revealed that skin disease is the fourth leading cause of nonfatal disease burden worldwide.³ Based on this statistic, it is easy to see how some patients may experience frustration associated with their condition and subsequently displace their discontent on the physician. In one study, nearly 1 of every 6 (16.7%) outpatient encounters was considered difficult by physicians.⁴ Family medicine physicians defined the difficult patient as one who is violent, demanding, aggressive, and rude.⁵ Others in primary care specialties have considered difficult patients to have characteristics that include mental health problems, more than 5 somatic symptoms, and abrasive personalities.^4,6

Situational and Physician-Centered Factors in Difficult Patient Encounters

In our medical system, the narrative often is focused on the patient, for better or worse—the patient was difficult, thereby making the encounter difficult. However, it is important to remember that difficult encounters can be attributed to several different factors, including those related to the physician, the clinical situation, or both. For example, dermatology residents juggle their clinical duties; academic work including studying, teaching, and/or research; and systemic and personal pressures at all times, whether they are cognizant of it or not. For better or worse, by virtue of being human, residents bring these factors with them to each clinical encounter. The delicate balance of these components can have a considerable impact on our delivery of good health care. This is particularly relevant in dermatology, where residents are subject to limited time during visits, work culture among clinic staff that is out of our control, and prominent complex social issues (for those of us practicing in medically underserved areas). Poor communication skills, underlying bias toward specific health conditions, limited knowledge as a trainee, and our own personal stressors also may play large roles in perceiving a clinical encounter as difficult during dermatology residency.⁷

Strategies to Mitigate Difficult Encounters

As a resident, if you make a statement that sparks a negative response from the patient, acknowledge their negative emotion, try to offer help, or rephrase the original statement to quickly dispel the tension. Validating a patient’s emotions and helping them embrace uncertainty can go a long way in the therapeutic relationship, especially in dermatology where so many of our diseases are chronic and without a definite cure.⁸ Additionally, it is important to apply strategies to redirect and de-escalate the situation during emotionally charged conversations, such as active listening, validating and empathizing with emotions, exploring alternative solutions, and providing closure to the conversation. Consensus recommendations for managing challenging encounters established by the American Academy of Family Physicians in 2013 include setting boundaries or modifying schedules, as needed, to handle difficult encounters; employing empathetic listening skills and a nonjudgmental attitude to facilitate trust and adherence to treatment; and assessing for underlying psychological illnesses with referral for appropriate diagnosis and treatment. Finally, the CALMER method—catalyst for change, alter thoughts to change feelings, listen and then make a diagnosis, make an agreement, education and follow-up, reach out and discuss feelings—is another approach that may be useful.⁷ In dermatology, this approach may not only dissipate unwanted tension but also make progress toward a therapeutic relationship. We cannot control the patient’s behavior in a visit, but we need to keep in mind that we are in control of our own reactions to said behavior.⁹ After first acknowledging this, we can then guide patients to take steps toward overcoming the issue. Within the time restrictions of a dermatology clinic visit, residents may use this approach to quickly feel more in control of a distressing situation and remain calm to better care for the patient.

Final Thoughts

Difficult patient encounters are impossible to avoid in any field of medicine, and dermatology is no exception. It will only benefit residents to recognize the multiple factors impacting a challenging encounter now and learn or enhance conflict resolution and communication skills to navigate these dissatisfying and uncomfortable situations, as they are inevitable in our careers.