Migraine ICYMI

Cluster headache is associated with a significantly increased risk for comorbid conditions, including mental disorders and other neurologic disease, leading to significant disability and absenteeism, new research shows.

Results from a Swedish register-based study also showed that patients with cluster headache had a sixfold increased risk for central nervous system disorders and a twofold increased risk for musculoskeletal disorders.

Although cluster headaches are often more prevalent in men, researchers found that multimorbidity rates were significantly higher in women. In addition, rates of external injuries were significantly higher among individuals with cluster headache than among persons without cluster headache.

“The findings very clearly indicate that cluster headache patients suffer from other health issues as well and that they are at risk of having longer periods of times when they cannot work,” said lead investigator Caroline Ran, PhD, a research specialist in the department of neuroscience at the Karolinska Institutet, Stockholm.

“It’s really important for clinicians to look at cluster headache from a broader perspective and make sure that patients are followed up so that they don’t risk ending up in a situation where they have several comorbidities,” Dr. Ran added.

The findings were published online in Neurology.
 

‘Striking’ finding

Cluster headache is one of the most severe and debilitating types of headache. It causes intense pain behind the eyes, which has been described as being worse than pain associated with childbirth or kidney stones.

Attacks can occur multiple times in a single day and can last up to 3 hours. Cluster headache is rare, occurring in about 1 in 1,000 individuals, and is more common in men. Underdiagnosis is common – especially in women.

The study drew on two Swedish population-based registries and included 3,240 patients with cluster headache aged 16-64 years and 16,200 matched control persons. The analysis covered medical visits from 2001 to 2010.

Results showed that 91.9% of participants with cluster headache had some type of multimorbidity. By comparison, 77.6% of the control group had some type of multimorbidity (odds ratio, 3.26; P < .0001).

Prior studies have shown a higher incidence of mental health and behavioral disorders among patients with cluster headache. However, when the researchers removed those conditions along with external injuries from the dataset, patients with headache were still significantly more likely to have multiple co-occurring illnesses (86.7% vs. 68.8%; OR, 2.95; P < .0001).

The most common comorbid conditions in the overall cluster headache group were diseases of the nervous system (OR, 5.9; 95% CI, 5.46 -6.42); 51.8% of the cluster headache group reported these disorders, compared with just 15.4% of the control group.

Diseases of the eye, the respiratory, gastrointestinal, and musculoskeletal systems, and connective tissue were also significantly more common among patients with cluster headache.

“For each diagnosis that we investigated, we found a higher incidence in the cluster headache group, and we thought this was a very striking finding and worth discussing in the clinical setting that these patients are at risk of general ill health,” Dr. Ran said.
 

Risky behavior?

Another novel finding was the higher rate of external injuries among the cluster headache group, compared with the control group. The finding seems to back up the theory that patients with cluster headache are more likely to engage in risky behaviors, the researchers noted.

In the cluster headache group, external injuries were reported by 47.1% of men and 41% of women, versus 34.9% and 26.0%, respectively, in the control group.

“Now we can also show that cluster headache patients have more injuries and that is totally unrelated to the biological health of the individuals, so that could also indicate higher risk taking,” Dr. Ran said.

Overall multimorbidity rates and diagnoses in each medical category except external injury were higher among women with cluster headache than men with headaches. In addition, the mean number of days on sick leave and disability pension was higher among women with cluster headache than among men with cluster headache (83.71 days vs. 52.56 days).

Overall, the mean number of sickness absence and disability pension net days in 2010 was nearly twice as high in the cluster headache group as in the control group (63.15 days vs. 34.08 days).

Removing mental and behavioral health disorders from the mix did not lower those numbers.

“Our numbers indicate that the mental health issues that are related to cluster headache might not impact their work situation as much as the other comorbidities,” Dr. Ran said.
 

Struggle is real

Commenting on the findings, Heidi Schwarz, MD, professor of clinical neurology at the University of Rochester (N.Y.) Medical Center, called the study a “valuable contribution” to the field and to the treatment of cluster headache.

“It’s a good study that addresses factors that really need to be considered as you take care of these patients,” said Dr. Schwarz, who was not involved with the research.

“The most salient features of this is that cluster headache is quite disabling, and if you add a comorbidity to it, it’s even more disabling,” she said.

Dr. Schwarz noted that cluster headache is often misdiagnosed as migraine or is overlooked altogether, especially in women. These data underscore that, although cluster headache is more common in men, it affects women too and could lead to even greater disability.

“This has a direct impact on patient quality of life, and in the end, that really should be what we’re looking to enhance,” Dr. Schwarz said. “When a patient with cluster comes in and they tell you they’re really struggling, believe them because it’s quite real.”

The findings also fill a gap in the literature and offer the kind of data that could not be collected in the United States, she noted. Sweden provides paid sick time for all workers aged 16 and older and offers a disability pension to all workers whose ability to work is temporarily or permanently inhibited because of illness or injury.

“You will never get this kind of data in the United States because this kind of data comes from two datasets that are extremely inclusive and detailed in a society, Sweden, where they have a social support system,” Dr. Schwarz said.

The study was funded by the Swedish Research Council, the Swedish Brain Foundation, and Mellby Gård, Region Stockholm, Märta Lundkvist stiftelse and Karolinska Institutet research funds. Dr. Ran and Dr. Schwarz report no relevant financial relationships.

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

Cluster headache is associated with a significantly increased risk for comorbid conditions, including mental disorders and other neurologic disease, leading to significant disability and absenteeism, new research shows.

Results from a Swedish register-based study also showed that patients with cluster headache had a sixfold increased risk for central nervous system disorders and a twofold increased risk for musculoskeletal disorders.

Although cluster headaches are often more prevalent in men, researchers found that multimorbidity rates were significantly higher in women. In addition, rates of external injuries were significantly higher among individuals with cluster headache than among persons without cluster headache.

“The findings very clearly indicate that cluster headache patients suffer from other health issues as well and that they are at risk of having longer periods of times when they cannot work,” said lead investigator Caroline Ran, PhD, a research specialist in the department of neuroscience at the Karolinska Institutet, Stockholm.

“It’s really important for clinicians to look at cluster headache from a broader perspective and make sure that patients are followed up so that they don’t risk ending up in a situation where they have several comorbidities,” Dr. Ran added.

The findings were published online in Neurology.
 

‘Striking’ finding

Cluster headache is one of the most severe and debilitating types of headache. It causes intense pain behind the eyes, which has been described as being worse than pain associated with childbirth or kidney stones.

Attacks can occur multiple times in a single day and can last up to 3 hours. Cluster headache is rare, occurring in about 1 in 1,000 individuals, and is more common in men. Underdiagnosis is common – especially in women.

The study drew on two Swedish population-based registries and included 3,240 patients with cluster headache aged 16-64 years and 16,200 matched control persons. The analysis covered medical visits from 2001 to 2010.

Results showed that 91.9% of participants with cluster headache had some type of multimorbidity. By comparison, 77.6% of the control group had some type of multimorbidity (odds ratio, 3.26; P < .0001).

Prior studies have shown a higher incidence of mental health and behavioral disorders among patients with cluster headache. However, when the researchers removed those conditions along with external injuries from the dataset, patients with headache were still significantly more likely to have multiple co-occurring illnesses (86.7% vs. 68.8%; OR, 2.95; P < .0001).

The most common comorbid conditions in the overall cluster headache group were diseases of the nervous system (OR, 5.9; 95% CI, 5.46 -6.42); 51.8% of the cluster headache group reported these disorders, compared with just 15.4% of the control group.

Diseases of the eye, the respiratory, gastrointestinal, and musculoskeletal systems, and connective tissue were also significantly more common among patients with cluster headache.

“For each diagnosis that we investigated, we found a higher incidence in the cluster headache group, and we thought this was a very striking finding and worth discussing in the clinical setting that these patients are at risk of general ill health,” Dr. Ran said.
 

Risky behavior?

Another novel finding was the higher rate of external injuries among the cluster headache group, compared with the control group. The finding seems to back up the theory that patients with cluster headache are more likely to engage in risky behaviors, the researchers noted.

In the cluster headache group, external injuries were reported by 47.1% of men and 41% of women, versus 34.9% and 26.0%, respectively, in the control group.

“Now we can also show that cluster headache patients have more injuries and that is totally unrelated to the biological health of the individuals, so that could also indicate higher risk taking,” Dr. Ran said.

Overall multimorbidity rates and diagnoses in each medical category except external injury were higher among women with cluster headache than men with headaches. In addition, the mean number of days on sick leave and disability pension was higher among women with cluster headache than among men with cluster headache (83.71 days vs. 52.56 days).

Overall, the mean number of sickness absence and disability pension net days in 2010 was nearly twice as high in the cluster headache group as in the control group (63.15 days vs. 34.08 days).

Removing mental and behavioral health disorders from the mix did not lower those numbers.

“Our numbers indicate that the mental health issues that are related to cluster headache might not impact their work situation as much as the other comorbidities,” Dr. Ran said.
 

Struggle is real

Commenting on the findings, Heidi Schwarz, MD, professor of clinical neurology at the University of Rochester (N.Y.) Medical Center, called the study a “valuable contribution” to the field and to the treatment of cluster headache.

“It’s a good study that addresses factors that really need to be considered as you take care of these patients,” said Dr. Schwarz, who was not involved with the research.

“The most salient features of this is that cluster headache is quite disabling, and if you add a comorbidity to it, it’s even more disabling,” she said.

Dr. Schwarz noted that cluster headache is often misdiagnosed as migraine or is overlooked altogether, especially in women. These data underscore that, although cluster headache is more common in men, it affects women too and could lead to even greater disability.

“This has a direct impact on patient quality of life, and in the end, that really should be what we’re looking to enhance,” Dr. Schwarz said. “When a patient with cluster comes in and they tell you they’re really struggling, believe them because it’s quite real.”

The findings also fill a gap in the literature and offer the kind of data that could not be collected in the United States, she noted. Sweden provides paid sick time for all workers aged 16 and older and offers a disability pension to all workers whose ability to work is temporarily or permanently inhibited because of illness or injury.

“You will never get this kind of data in the United States because this kind of data comes from two datasets that are extremely inclusive and detailed in a society, Sweden, where they have a social support system,” Dr. Schwarz said.

The study was funded by the Swedish Research Council, the Swedish Brain Foundation, and Mellby Gård, Region Stockholm, Märta Lundkvist stiftelse and Karolinska Institutet research funds. Dr. Ran and Dr. Schwarz report no relevant financial relationships.

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

Cluster headache is associated with a significantly increased risk for comorbid conditions, including mental disorders and other neurologic disease, leading to significant disability and absenteeism, new research shows.

Results from a Swedish register-based study also showed that patients with cluster headache had a sixfold increased risk for central nervous system disorders and a twofold increased risk for musculoskeletal disorders.

Although cluster headaches are often more prevalent in men, researchers found that multimorbidity rates were significantly higher in women. In addition, rates of external injuries were significantly higher among individuals with cluster headache than among persons without cluster headache.

“The findings very clearly indicate that cluster headache patients suffer from other health issues as well and that they are at risk of having longer periods of times when they cannot work,” said lead investigator Caroline Ran, PhD, a research specialist in the department of neuroscience at the Karolinska Institutet, Stockholm.

“It’s really important for clinicians to look at cluster headache from a broader perspective and make sure that patients are followed up so that they don’t risk ending up in a situation where they have several comorbidities,” Dr. Ran added.

The findings were published online in Neurology.
 

‘Striking’ finding

Cluster headache is one of the most severe and debilitating types of headache. It causes intense pain behind the eyes, which has been described as being worse than pain associated with childbirth or kidney stones.

Attacks can occur multiple times in a single day and can last up to 3 hours. Cluster headache is rare, occurring in about 1 in 1,000 individuals, and is more common in men. Underdiagnosis is common – especially in women.

The study drew on two Swedish population-based registries and included 3,240 patients with cluster headache aged 16-64 years and 16,200 matched control persons. The analysis covered medical visits from 2001 to 2010.

Results showed that 91.9% of participants with cluster headache had some type of multimorbidity. By comparison, 77.6% of the control group had some type of multimorbidity (odds ratio, 3.26; P < .0001).

Prior studies have shown a higher incidence of mental health and behavioral disorders among patients with cluster headache. However, when the researchers removed those conditions along with external injuries from the dataset, patients with headache were still significantly more likely to have multiple co-occurring illnesses (86.7% vs. 68.8%; OR, 2.95; P < .0001).

The most common comorbid conditions in the overall cluster headache group were diseases of the nervous system (OR, 5.9; 95% CI, 5.46 -6.42); 51.8% of the cluster headache group reported these disorders, compared with just 15.4% of the control group.

Diseases of the eye, the respiratory, gastrointestinal, and musculoskeletal systems, and connective tissue were also significantly more common among patients with cluster headache.

“For each diagnosis that we investigated, we found a higher incidence in the cluster headache group, and we thought this was a very striking finding and worth discussing in the clinical setting that these patients are at risk of general ill health,” Dr. Ran said.
 

Risky behavior?

Another novel finding was the higher rate of external injuries among the cluster headache group, compared with the control group. The finding seems to back up the theory that patients with cluster headache are more likely to engage in risky behaviors, the researchers noted.

In the cluster headache group, external injuries were reported by 47.1% of men and 41% of women, versus 34.9% and 26.0%, respectively, in the control group.

“Now we can also show that cluster headache patients have more injuries and that is totally unrelated to the biological health of the individuals, so that could also indicate higher risk taking,” Dr. Ran said.

Overall multimorbidity rates and diagnoses in each medical category except external injury were higher among women with cluster headache than men with headaches. In addition, the mean number of days on sick leave and disability pension was higher among women with cluster headache than among men with cluster headache (83.71 days vs. 52.56 days).

Overall, the mean number of sickness absence and disability pension net days in 2010 was nearly twice as high in the cluster headache group as in the control group (63.15 days vs. 34.08 days).

Removing mental and behavioral health disorders from the mix did not lower those numbers.

“Our numbers indicate that the mental health issues that are related to cluster headache might not impact their work situation as much as the other comorbidities,” Dr. Ran said.
 

Struggle is real

Commenting on the findings, Heidi Schwarz, MD, professor of clinical neurology at the University of Rochester (N.Y.) Medical Center, called the study a “valuable contribution” to the field and to the treatment of cluster headache.

“It’s a good study that addresses factors that really need to be considered as you take care of these patients,” said Dr. Schwarz, who was not involved with the research.

“The most salient features of this is that cluster headache is quite disabling, and if you add a comorbidity to it, it’s even more disabling,” she said.

Dr. Schwarz noted that cluster headache is often misdiagnosed as migraine or is overlooked altogether, especially in women. These data underscore that, although cluster headache is more common in men, it affects women too and could lead to even greater disability.

“This has a direct impact on patient quality of life, and in the end, that really should be what we’re looking to enhance,” Dr. Schwarz said. “When a patient with cluster comes in and they tell you they’re really struggling, believe them because it’s quite real.”

The findings also fill a gap in the literature and offer the kind of data that could not be collected in the United States, she noted. Sweden provides paid sick time for all workers aged 16 and older and offers a disability pension to all workers whose ability to work is temporarily or permanently inhibited because of illness or injury.

“You will never get this kind of data in the United States because this kind of data comes from two datasets that are extremely inclusive and detailed in a society, Sweden, where they have a social support system,” Dr. Schwarz said.

The study was funded by the Swedish Research Council, the Swedish Brain Foundation, and Mellby Gård, Region Stockholm, Märta Lundkvist stiftelse and Karolinska Institutet research funds. Dr. Ran and Dr. Schwarz report no relevant financial relationships.

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

Key clinical point: Migraine or severe headache is a significant risk factor for cardiovascular diseases and significantly increases the risk for angina and stroke.

Major finding: Migraine or severe headache increased the overall risk for cardiovascular diseases (adjusted odds ratio [aOR] 2.77; P = .001), angina (aOR 2.27; P = .046), and stroke (aOR 3.80; P = .006), with the increased risk for cardiovascular diseases being the most prominent among participants with migraine who were women (aOR 6.02; P < .001), aged >60 years (aOR 2.69; P = .049), or had hypertension (aOR 3.57; P < .001) or hyperlipidemia (aOR 2.74; P = .003).

Study details: This cross-sectional study evaluated 5692 participants from the US National Health and Nutrition Examination Survey (NHANES), of which 1090 had migraine or severe headache.

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

Source: Wang K et al. Association between migraine and cardiovascular disease: A cross-sectional study. Front Cardiovasc Med. 2022;9:1044465 (Nov 24). Doi: 10.3389/fcvm.2022.1044465

Key clinical point: Migraine or severe headache is a significant risk factor for cardiovascular diseases and significantly increases the risk for angina and stroke.

Major finding: Migraine or severe headache increased the overall risk for cardiovascular diseases (adjusted odds ratio [aOR] 2.77; P = .001), angina (aOR 2.27; P = .046), and stroke (aOR 3.80; P = .006), with the increased risk for cardiovascular diseases being the most prominent among participants with migraine who were women (aOR 6.02; P < .001), aged >60 years (aOR 2.69; P = .049), or had hypertension (aOR 3.57; P < .001) or hyperlipidemia (aOR 2.74; P = .003).

Study details: This cross-sectional study evaluated 5692 participants from the US National Health and Nutrition Examination Survey (NHANES), of which 1090 had migraine or severe headache.

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

Source: Wang K et al. Association between migraine and cardiovascular disease: A cross-sectional study. Front Cardiovasc Med. 2022;9:1044465 (Nov 24). Doi: 10.3389/fcvm.2022.1044465

Key clinical point: Migraine or severe headache is a significant risk factor for cardiovascular diseases and significantly increases the risk for angina and stroke.

Major finding: Migraine or severe headache increased the overall risk for cardiovascular diseases (adjusted odds ratio [aOR] 2.77; P = .001), angina (aOR 2.27; P = .046), and stroke (aOR 3.80; P = .006), with the increased risk for cardiovascular diseases being the most prominent among participants with migraine who were women (aOR 6.02; P < .001), aged >60 years (aOR 2.69; P = .049), or had hypertension (aOR 3.57; P < .001) or hyperlipidemia (aOR 2.74; P = .003).

Study details: This cross-sectional study evaluated 5692 participants from the US National Health and Nutrition Examination Survey (NHANES), of which 1090 had migraine or severe headache.

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

Source: Wang K et al. Association between migraine and cardiovascular disease: A cross-sectional study. Front Cardiovasc Med. 2022;9:1044465 (Nov 24). Doi: 10.3389/fcvm.2022.1044465

Key clinical point: The COVID-19 pandemic adversely affected psychological functioning in young US college students with migraine and increased depression and anxiety, attenuating potential improvements achieved in headache-related disability during the pandemic.

Major finding: Levels of depression, anxiety, and stress were significantly higher during vs before the COVID-19 pandemic (all P ≤ .01), whereas headache-related disability was lower (direct effect [c′] −1.6; 95% CI −3.1 to −0.1). However, anxiety (indirect effect [b] 0.3; 95% CI 0.01-0.9) and depression (b 0.7; 95% CI 0.07-1.4) mediated an increase in headache-related disability during vs before the pandemic, thereby canceling improvements achieved during the pandemic.

Study details: This cross-sectional study included 365 undergraduate students aged ≥18 years with episodic migraine with or without aura or chronic migraine who were surveyed before (n = 223) or during (n = 142) the COVID-19 pandemic.

Disclosures: This study did not receive any specific funding. TA Smitherman reported previously serving on the advisory board for Teva Pharmaceuticals (unrelated to this study).

Source: Thaxter LY and Smitherman TA. The effect of the COVID-19 pandemic on headache-related disability among young adults with migraine. Headache. 2022;62(10):1293-1301 (Nov 23). Doi: 10.1111/head.14411

Key clinical point: The COVID-19 pandemic adversely affected psychological functioning in young US college students with migraine and increased depression and anxiety, attenuating potential improvements achieved in headache-related disability during the pandemic.

Major finding: Levels of depression, anxiety, and stress were significantly higher during vs before the COVID-19 pandemic (all P ≤ .01), whereas headache-related disability was lower (direct effect [c′] −1.6; 95% CI −3.1 to −0.1). However, anxiety (indirect effect [b] 0.3; 95% CI 0.01-0.9) and depression (b 0.7; 95% CI 0.07-1.4) mediated an increase in headache-related disability during vs before the pandemic, thereby canceling improvements achieved during the pandemic.

Study details: This cross-sectional study included 365 undergraduate students aged ≥18 years with episodic migraine with or without aura or chronic migraine who were surveyed before (n = 223) or during (n = 142) the COVID-19 pandemic.

Disclosures: This study did not receive any specific funding. TA Smitherman reported previously serving on the advisory board for Teva Pharmaceuticals (unrelated to this study).

Source: Thaxter LY and Smitherman TA. The effect of the COVID-19 pandemic on headache-related disability among young adults with migraine. Headache. 2022;62(10):1293-1301 (Nov 23). Doi: 10.1111/head.14411

Key clinical point: The COVID-19 pandemic adversely affected psychological functioning in young US college students with migraine and increased depression and anxiety, attenuating potential improvements achieved in headache-related disability during the pandemic.

Major finding: Levels of depression, anxiety, and stress were significantly higher during vs before the COVID-19 pandemic (all P ≤ .01), whereas headache-related disability was lower (direct effect [c′] −1.6; 95% CI −3.1 to −0.1). However, anxiety (indirect effect [b] 0.3; 95% CI 0.01-0.9) and depression (b 0.7; 95% CI 0.07-1.4) mediated an increase in headache-related disability during vs before the pandemic, thereby canceling improvements achieved during the pandemic.

Study details: This cross-sectional study included 365 undergraduate students aged ≥18 years with episodic migraine with or without aura or chronic migraine who were surveyed before (n = 223) or during (n = 142) the COVID-19 pandemic.

Disclosures: This study did not receive any specific funding. TA Smitherman reported previously serving on the advisory board for Teva Pharmaceuticals (unrelated to this study).

Source: Thaxter LY and Smitherman TA. The effect of the COVID-19 pandemic on headache-related disability among young adults with migraine. Headache. 2022;62(10):1293-1301 (Nov 23). Doi: 10.1111/head.14411

Key clinical point: Erenumab may serve as an effective and well-tolerated therapeutic agent for migraine prophylaxis.

Major finding: Compared with placebo, 28 mg (mean difference [MD] −1.1; P = .02), 70 mg (MD −1.4; P < .001), and 140 mg (MD −1.8; P < .001) erenumab led to significant reductions in monthly migraine days at 12 weeks, with each erenumab dose being associated with a significantly higher proportion of patients achieving ≥50% reduction in migraine days (all P < .001) and similar risk for adverse events.

Study details: This was a systematic review and meta-analysis of eight randomized controlled trials including 4860 patients with migraine who received erenumab (7, 21, 28, 70, or 140 mg) or placebo.

Disclosures: This study was funded by the Jiangsu Province Key Research and Development Program, National Natural Science Foundation of China, and Natural Science Foundation of Jiangsu Province. The authors declared no conflicts of interest.

Source: Gui T, Li H et al. Different dosage regimens of erenumab for the treatment of migraine: A systematic review and meta-analysis of the efficacy and safety of randomized controlled trials. Headache. 2022;62(10):1281-1292 (Nov 14). Doi: 10.1111/head.14423

Key clinical point: Erenumab may serve as an effective and well-tolerated therapeutic agent for migraine prophylaxis.

Major finding: Compared with placebo, 28 mg (mean difference [MD] −1.1; P = .02), 70 mg (MD −1.4; P < .001), and 140 mg (MD −1.8; P < .001) erenumab led to significant reductions in monthly migraine days at 12 weeks, with each erenumab dose being associated with a significantly higher proportion of patients achieving ≥50% reduction in migraine days (all P < .001) and similar risk for adverse events.

Study details: This was a systematic review and meta-analysis of eight randomized controlled trials including 4860 patients with migraine who received erenumab (7, 21, 28, 70, or 140 mg) or placebo.

Disclosures: This study was funded by the Jiangsu Province Key Research and Development Program, National Natural Science Foundation of China, and Natural Science Foundation of Jiangsu Province. The authors declared no conflicts of interest.

Source: Gui T, Li H et al. Different dosage regimens of erenumab for the treatment of migraine: A systematic review and meta-analysis of the efficacy and safety of randomized controlled trials. Headache. 2022;62(10):1281-1292 (Nov 14). Doi: 10.1111/head.14423

Key clinical point: Erenumab may serve as an effective and well-tolerated therapeutic agent for migraine prophylaxis.

Major finding: Compared with placebo, 28 mg (mean difference [MD] −1.1; P = .02), 70 mg (MD −1.4; P < .001), and 140 mg (MD −1.8; P < .001) erenumab led to significant reductions in monthly migraine days at 12 weeks, with each erenumab dose being associated with a significantly higher proportion of patients achieving ≥50% reduction in migraine days (all P < .001) and similar risk for adverse events.

Study details: This was a systematic review and meta-analysis of eight randomized controlled trials including 4860 patients with migraine who received erenumab (7, 21, 28, 70, or 140 mg) or placebo.

Disclosures: This study was funded by the Jiangsu Province Key Research and Development Program, National Natural Science Foundation of China, and Natural Science Foundation of Jiangsu Province. The authors declared no conflicts of interest.

Source: Gui T, Li H et al. Different dosage regimens of erenumab for the treatment of migraine: A systematic review and meta-analysis of the efficacy and safety of randomized controlled trials. Headache. 2022;62(10):1281-1292 (Nov 14). Doi: 10.1111/head.14423

Key clinical point: High quality diet and higher total intake of phytochemicals and polyphenols are significantly associated with lower migraine severity in patients with episodic migraine.

Major finding: Migraine severity was negatively correlated with the intake of good quality diet (correlation coefficient [r] −0.37; P = .0003) and higher intake of phytochemicals (r −0.37; P = .0003) and phenolic components, such as flavanones (r −0.27; P = .01) and lignans (r −0.27; P = .01). The total intake of phenols and flavonoids from olive oil, oil, and fruits was also significantly negatively correlated with migraine severity (each P ≤ .04).

Study details: This questionnaire-based study included 90 patients with episodic migraine who were assessed for their migraine characteristics and dietary phytochemical and polyphenol intake.

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

Source: Bakırhan H et al. Migraine severity, disability, and duration: Is a good diet quality, high intake of phytochemicals and polyphenols important? Front Nutr. 2022;9:1041907 (Nov 21). Doi: 10.3389/fnut.2022.1041907

Key clinical point: High quality diet and higher total intake of phytochemicals and polyphenols are significantly associated with lower migraine severity in patients with episodic migraine.

Major finding: Migraine severity was negatively correlated with the intake of good quality diet (correlation coefficient [r] −0.37; P = .0003) and higher intake of phytochemicals (r −0.37; P = .0003) and phenolic components, such as flavanones (r −0.27; P = .01) and lignans (r −0.27; P = .01). The total intake of phenols and flavonoids from olive oil, oil, and fruits was also significantly negatively correlated with migraine severity (each P ≤ .04).

Study details: This questionnaire-based study included 90 patients with episodic migraine who were assessed for their migraine characteristics and dietary phytochemical and polyphenol intake.

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

Source: Bakırhan H et al. Migraine severity, disability, and duration: Is a good diet quality, high intake of phytochemicals and polyphenols important? Front Nutr. 2022;9:1041907 (Nov 21). Doi: 10.3389/fnut.2022.1041907

Key clinical point: High quality diet and higher total intake of phytochemicals and polyphenols are significantly associated with lower migraine severity in patients with episodic migraine.

Major finding: Migraine severity was negatively correlated with the intake of good quality diet (correlation coefficient [r] −0.37; P = .0003) and higher intake of phytochemicals (r −0.37; P = .0003) and phenolic components, such as flavanones (r −0.27; P = .01) and lignans (r −0.27; P = .01). The total intake of phenols and flavonoids from olive oil, oil, and fruits was also significantly negatively correlated with migraine severity (each P ≤ .04).

Study details: This questionnaire-based study included 90 patients with episodic migraine who were assessed for their migraine characteristics and dietary phytochemical and polyphenol intake.

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

Source: Bakırhan H et al. Migraine severity, disability, and duration: Is a good diet quality, high intake of phytochemicals and polyphenols important? Front Nutr. 2022;9:1041907 (Nov 21). Doi: 10.3389/fnut.2022.1041907

Key clinical point: The first two administrations of onabotulinum toxin A (onabotA) were well-tolerated in patients with chronic migraine, with adverse events (AE) being mostly mild and tolerability to onabotA not being correlated with AE or clinical response.

Major finding: The mean tolerability scores were 7.8/10 and 7.2/10 in the first and second onabotA administration sessions, respectively, with no association being observed between tolerability and AE occurrence or clinical response. The AE were mostly mild and were reported by 71.4% and 68.6% of patients after the first and second onabotA administration sessions, respectively; 49.5% of patients showed a 50% response rate between weeks 20 and 24.

Study details: This was an observational prospective cohort study including 105 patients with chronic migraine who had received onabotA for the first time.

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

Source: García-Azorín D et al. Real-world evaluation of the tolerability to onabotulinum toxin A: The RETO study. Toxins (Basel). 2022;14(12),850 (Dec 3). Doi: 10.3390/toxins14120850.

Key clinical point: The first two administrations of onabotulinum toxin A (onabotA) were well-tolerated in patients with chronic migraine, with adverse events (AE) being mostly mild and tolerability to onabotA not being correlated with AE or clinical response.

Major finding: The mean tolerability scores were 7.8/10 and 7.2/10 in the first and second onabotA administration sessions, respectively, with no association being observed between tolerability and AE occurrence or clinical response. The AE were mostly mild and were reported by 71.4% and 68.6% of patients after the first and second onabotA administration sessions, respectively; 49.5% of patients showed a 50% response rate between weeks 20 and 24.

Study details: This was an observational prospective cohort study including 105 patients with chronic migraine who had received onabotA for the first time.

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

Source: García-Azorín D et al. Real-world evaluation of the tolerability to onabotulinum toxin A: The RETO study. Toxins (Basel). 2022;14(12),850 (Dec 3). Doi: 10.3390/toxins14120850.

Key clinical point: The first two administrations of onabotulinum toxin A (onabotA) were well-tolerated in patients with chronic migraine, with adverse events (AE) being mostly mild and tolerability to onabotA not being correlated with AE or clinical response.

Major finding: The mean tolerability scores were 7.8/10 and 7.2/10 in the first and second onabotA administration sessions, respectively, with no association being observed between tolerability and AE occurrence or clinical response. The AE were mostly mild and were reported by 71.4% and 68.6% of patients after the first and second onabotA administration sessions, respectively; 49.5% of patients showed a 50% response rate between weeks 20 and 24.

Study details: This was an observational prospective cohort study including 105 patients with chronic migraine who had received onabotA for the first time.

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

Source: García-Azorín D et al. Real-world evaluation of the tolerability to onabotulinum toxin A: The RETO study. Toxins (Basel). 2022;14(12),850 (Dec 3). Doi: 10.3390/toxins14120850.

Key clinical point: Erenumab demonstrated an early onset of and superior efficacy in achieving ≥50% reduction in monthly migraine days (MMD) than topiramate in patients with migraine.

Major finding: A significantly higher proportion of patients receiving erenumab vs topiramate reported ≥50% reduction in MMD at 1 month (39.2% vs 24.0%) and during the last 3 months (60.3% vs 43.3%) of treatment (both P < .001). Reductions in MMD over last 3 months were significantly higher with erenumab vs topiramate (mean difference −1.24 days; P < .001).

Study details: This post hoc analysis of the phase 4 HER-MES trial included 776 patients with migraine who were naive to migraine prophylactics or had failed or were ill-suited for metoprolol/propranolol, amitriptyline, or flunarizine and were randomized to receive erenumab (70 or 140 mg/month) or topiramate (50-100 mg/day).

Disclosures: This study was funded by Novartis Pharma GmbH, Germany. Four authors, including the first author, declared being employees of and holding stocks in Novartis. U Reuter reported receiving grants, personal fees, and other supports from Novartis and various other sources.

Source: Ehrlich M et al. Erenumab versus topiramate: Post hoc efficacy analysis from the HER‑MES study. J Headache Pain. 2022;23:141 (Nov 15). Doi: 10.1186/s10194-022-01511-y

Key clinical point: Erenumab demonstrated an early onset of and superior efficacy in achieving ≥50% reduction in monthly migraine days (MMD) than topiramate in patients with migraine.

Major finding: A significantly higher proportion of patients receiving erenumab vs topiramate reported ≥50% reduction in MMD at 1 month (39.2% vs 24.0%) and during the last 3 months (60.3% vs 43.3%) of treatment (both P < .001). Reductions in MMD over last 3 months were significantly higher with erenumab vs topiramate (mean difference −1.24 days; P < .001).

Study details: This post hoc analysis of the phase 4 HER-MES trial included 776 patients with migraine who were naive to migraine prophylactics or had failed or were ill-suited for metoprolol/propranolol, amitriptyline, or flunarizine and were randomized to receive erenumab (70 or 140 mg/month) or topiramate (50-100 mg/day).

Disclosures: This study was funded by Novartis Pharma GmbH, Germany. Four authors, including the first author, declared being employees of and holding stocks in Novartis. U Reuter reported receiving grants, personal fees, and other supports from Novartis and various other sources.

Source: Ehrlich M et al. Erenumab versus topiramate: Post hoc efficacy analysis from the HER‑MES study. J Headache Pain. 2022;23:141 (Nov 15). Doi: 10.1186/s10194-022-01511-y

Key clinical point: Erenumab demonstrated an early onset of and superior efficacy in achieving ≥50% reduction in monthly migraine days (MMD) than topiramate in patients with migraine.

Major finding: A significantly higher proportion of patients receiving erenumab vs topiramate reported ≥50% reduction in MMD at 1 month (39.2% vs 24.0%) and during the last 3 months (60.3% vs 43.3%) of treatment (both P < .001). Reductions in MMD over last 3 months were significantly higher with erenumab vs topiramate (mean difference −1.24 days; P < .001).

Study details: This post hoc analysis of the phase 4 HER-MES trial included 776 patients with migraine who were naive to migraine prophylactics or had failed or were ill-suited for metoprolol/propranolol, amitriptyline, or flunarizine and were randomized to receive erenumab (70 or 140 mg/month) or topiramate (50-100 mg/day).

Disclosures: This study was funded by Novartis Pharma GmbH, Germany. Four authors, including the first author, declared being employees of and holding stocks in Novartis. U Reuter reported receiving grants, personal fees, and other supports from Novartis and various other sources.

Source: Ehrlich M et al. Erenumab versus topiramate: Post hoc efficacy analysis from the HER‑MES study. J Headache Pain. 2022;23:141 (Nov 15). Doi: 10.1186/s10194-022-01511-y

Key clinical point: Monthly erenumab demonstrated promising short-term clinical effectiveness in patients with difficult-to-treat chronic migraine; however, less than one-fourth of the patients sustained efficacy over 2 years.

Major finding: The monthly migraine days (MMD) reduced significantly after 6 months of erenumab treatment (mean reduction [MR] 7.5 days; P < .001), with 48% of patients achieving ≥30% reduction in MMD. At months 12 and 24, 38% and 23% of patients remained ≥30% responders, respectively.

Study details: Findings are from a 2-year real-world prospective analysis of a clinical audit including 160 patients with difficult-to-treat chronic migraine who failed an average of 8.3 preventive treatments and received monthly erenumab.

Disclosures: This study did not receive any funding. Three authors declared receiving honoraria for speaking or participation in advisory boards or funding for travel from various sources.

Source: Andreou AP et al. Two-year effectiveness of erenumab in resistant chronic migraine: a prospective real-world analysis. J Headache Pain. 2022;23:139 (Nov 4). Doi: 10.1186/s10194-022-01507-8

Key clinical point: Monthly erenumab demonstrated promising short-term clinical effectiveness in patients with difficult-to-treat chronic migraine; however, less than one-fourth of the patients sustained efficacy over 2 years.

Major finding: The monthly migraine days (MMD) reduced significantly after 6 months of erenumab treatment (mean reduction [MR] 7.5 days; P < .001), with 48% of patients achieving ≥30% reduction in MMD. At months 12 and 24, 38% and 23% of patients remained ≥30% responders, respectively.

Study details: Findings are from a 2-year real-world prospective analysis of a clinical audit including 160 patients with difficult-to-treat chronic migraine who failed an average of 8.3 preventive treatments and received monthly erenumab.

Disclosures: This study did not receive any funding. Three authors declared receiving honoraria for speaking or participation in advisory boards or funding for travel from various sources.

Source: Andreou AP et al. Two-year effectiveness of erenumab in resistant chronic migraine: a prospective real-world analysis. J Headache Pain. 2022;23:139 (Nov 4). Doi: 10.1186/s10194-022-01507-8

Key clinical point: Monthly erenumab demonstrated promising short-term clinical effectiveness in patients with difficult-to-treat chronic migraine; however, less than one-fourth of the patients sustained efficacy over 2 years.

Major finding: The monthly migraine days (MMD) reduced significantly after 6 months of erenumab treatment (mean reduction [MR] 7.5 days; P < .001), with 48% of patients achieving ≥30% reduction in MMD. At months 12 and 24, 38% and 23% of patients remained ≥30% responders, respectively.

Study details: Findings are from a 2-year real-world prospective analysis of a clinical audit including 160 patients with difficult-to-treat chronic migraine who failed an average of 8.3 preventive treatments and received monthly erenumab.

Disclosures: This study did not receive any funding. Three authors declared receiving honoraria for speaking or participation in advisory boards or funding for travel from various sources.

Source: Andreou AP et al. Two-year effectiveness of erenumab in resistant chronic migraine: a prospective real-world analysis. J Headache Pain. 2022;23:139 (Nov 4). Doi: 10.1186/s10194-022-01507-8

Key clinical point: Prior use of proton pump inhibitors (PPI) increased the risk for incident migraine with or without aura irrespective of the history and duration of use.

Major finding: Compared with non-use, past and current use of PPI increased the odds of migraine by 2.56-fold (P < .001) and 4.66-fold (P < .001), respectively, with the risk being persistent for migraine with or without aura (P < .001) and higher with PPI use for ≥30 (adjusted odds ratio [aOR] 4.41; P < .001) vs <30 (aOR 2.49; P < .001) days.

Study details: This retrospective, nested case-control study included 28,159 patients with incident migraine with or without aura and 112,636 propensity score-matched control participants.

Disclosures: This study was funded by the National Research Foundation of Korea from the Korean Ministry of Science and ICT. The authors declared no conflicts of interest.

Source: Kang HS et al. Association between migraines and prior proton pump inhibitor use: A nested case-control study using a national health screening cohort. Pharmaceuticals (Basel). 2022;15(11):1385 (Nov 10). Doi: 10.3390/ph15111385

Key clinical point: Prior use of proton pump inhibitors (PPI) increased the risk for incident migraine with or without aura irrespective of the history and duration of use.

Major finding: Compared with non-use, past and current use of PPI increased the odds of migraine by 2.56-fold (P < .001) and 4.66-fold (P < .001), respectively, with the risk being persistent for migraine with or without aura (P < .001) and higher with PPI use for ≥30 (adjusted odds ratio [aOR] 4.41; P < .001) vs <30 (aOR 2.49; P < .001) days.

Study details: This retrospective, nested case-control study included 28,159 patients with incident migraine with or without aura and 112,636 propensity score-matched control participants.

Disclosures: This study was funded by the National Research Foundation of Korea from the Korean Ministry of Science and ICT. The authors declared no conflicts of interest.

Source: Kang HS et al. Association between migraines and prior proton pump inhibitor use: A nested case-control study using a national health screening cohort. Pharmaceuticals (Basel). 2022;15(11):1385 (Nov 10). Doi: 10.3390/ph15111385

Key clinical point: Prior use of proton pump inhibitors (PPI) increased the risk for incident migraine with or without aura irrespective of the history and duration of use.

Major finding: Compared with non-use, past and current use of PPI increased the odds of migraine by 2.56-fold (P < .001) and 4.66-fold (P < .001), respectively, with the risk being persistent for migraine with or without aura (P < .001) and higher with PPI use for ≥30 (adjusted odds ratio [aOR] 4.41; P < .001) vs <30 (aOR 2.49; P < .001) days.

Study details: This retrospective, nested case-control study included 28,159 patients with incident migraine with or without aura and 112,636 propensity score-matched control participants.

Disclosures: This study was funded by the National Research Foundation of Korea from the Korean Ministry of Science and ICT. The authors declared no conflicts of interest.

Source: Kang HS et al. Association between migraines and prior proton pump inhibitor use: A nested case-control study using a national health screening cohort. Pharmaceuticals (Basel). 2022;15(11):1385 (Nov 10). Doi: 10.3390/ph15111385

Key clinical point: Alcohol intake slightly reduced the likelihood of migraine attacks 48 hours after consumption in an English-speaking cohort of patients with episodic migraine who identified themselves as mostly low-dose alcohol consumers.

Major finding: The probability of migraine attack 48 hours after consuming alcohol was 25% lower than that after no alcohol consumption (adjusted odds ratio 0.75; 95% CI 0.68-0.82); however, alcohol consumption had no significant effect on migraine probability 24 hours after consumption.

Study details: This observational prospective cohort study included 487 patients with episodic migraine who reported 5913 migraine attacks and were alcohol consumers.

Disclosures: The study was partially funded by Curelator, Inc. M Vives-Mestres and A Casanova declared receiving consulting fees and holding stock options in Curelator, Inc. N Rosen reported ties with a headache society, journals, and various other sources.

Source: Vives-Mestres M et al. Alcohol as a trigger of migraine attacks in people with migraine. Results from a large prospective cohort study in English-speaking countries. Headache. 2022;62:1329-1338. (Nov 27). Doi: 10.1111/head.14428

Key clinical point: Alcohol intake slightly reduced the likelihood of migraine attacks 48 hours after consumption in an English-speaking cohort of patients with episodic migraine who identified themselves as mostly low-dose alcohol consumers.

Major finding: The probability of migraine attack 48 hours after consuming alcohol was 25% lower than that after no alcohol consumption (adjusted odds ratio 0.75; 95% CI 0.68-0.82); however, alcohol consumption had no significant effect on migraine probability 24 hours after consumption.

Study details: This observational prospective cohort study included 487 patients with episodic migraine who reported 5913 migraine attacks and were alcohol consumers.

Disclosures: The study was partially funded by Curelator, Inc. M Vives-Mestres and A Casanova declared receiving consulting fees and holding stock options in Curelator, Inc. N Rosen reported ties with a headache society, journals, and various other sources.

Source: Vives-Mestres M et al. Alcohol as a trigger of migraine attacks in people with migraine. Results from a large prospective cohort study in English-speaking countries. Headache. 2022;62:1329-1338. (Nov 27). Doi: 10.1111/head.14428

Key clinical point: Alcohol intake slightly reduced the likelihood of migraine attacks 48 hours after consumption in an English-speaking cohort of patients with episodic migraine who identified themselves as mostly low-dose alcohol consumers.

Major finding: The probability of migraine attack 48 hours after consuming alcohol was 25% lower than that after no alcohol consumption (adjusted odds ratio 0.75; 95% CI 0.68-0.82); however, alcohol consumption had no significant effect on migraine probability 24 hours after consumption.

Study details: This observational prospective cohort study included 487 patients with episodic migraine who reported 5913 migraine attacks and were alcohol consumers.

Disclosures: The study was partially funded by Curelator, Inc. M Vives-Mestres and A Casanova declared receiving consulting fees and holding stock options in Curelator, Inc. N Rosen reported ties with a headache society, journals, and various other sources.

Source: Vives-Mestres M et al. Alcohol as a trigger of migraine attacks in people with migraine. Results from a large prospective cohort study in English-speaking countries. Headache. 2022;62:1329-1338. (Nov 27). Doi: 10.1111/head.14428