Headache & Migraine

MOH involves many of the same features as migraine headaches: photophobia, nausea, vomiting, and sleep disturbances.¹ Additionally, patients with migraine and comorbid MOH are at a higher risk for anxiety, depression, and emotional stress. MOH is difficult to treat, and symptom relapse after treatment is common. Results of a retrospective analysis published in July 2024 in The Journal of Headache and Facial Pain confirmed the effectiveness of calcitonin gene-related peptide (CGRP) antibody treatment in a real-world setting among migraine patients who had MOH. The study included a total of 291 patients who had been treated with either erenumab, fremanezumab, or galcanezumab. The majority of patients experienced a significant decline in monthly headache days, monthly migraine days, and monthly acute medication intake at 1 year. The researchers found that only 15.4% of the patients who initially met the criterion of chronic migraine with MOH relapsed, meeting the criterion for chronic migraine/MOH at the end of the 1-year follow-up period.

Lifestyle factors, such as diet, should be addressed when discussing migraine therapy with patients. Dietary factors, including a low–glycemic index diet, have been associated with promising results in migraine control. Results of a 10,359-patient cross-sectional study published in 2023 in the journal Nutrition confirmed that the inflammatory potential of patients' diet is associated with severe headache or migraine in US adults.²A more recent study, published in Frontiers in Nutrition in July 2024, examined dietary vitamin C intake of 13,445 individuals, of whom 20.42% had a severe headache or migraine. Vitamin C is a naturally occurring antioxidant and is also anti-inflammatory, found in foods such as citrus fruit, mangoes, strawberries, broccoli, and peppers. A subgroup analysis showed a significant association between vitamin C intake and severe headaches or migraines, with a reduced risk for severe headaches or migraines associated with an increased consumption of vitamin C. The authors noted that "each 1 mg/day increase in dietary vitamin C intake was significantly associated with a 6% lower risk for severe headache or migraine." Real-life application of this result for patients can involve encouraging patients to swap processed, low-nutrient foods in favor of fresh, nutrient-dense foods.

When treating migraine patients who are also parents, it is crucial to be persistent in searching for effective therapies to treat migraine and to treat or prevent MOH. According to a study published in 2018 in Headache, adolescents reported that parental migraine affected these factors in their lives: loss of parental support, reverse caregiving, emotional experience, interference with school, and missed activities and events.³ According to the authors of a more recent study, published in July 2024 in the Annals of General Psychiatry, parental migraine was significantly associated with an increased risk for attention-deficit/hyperactivity disorder, bipolar disorder, and depressive disorder among offspring of parents with migraine when compared with offspring of parents without migraine. The study authors noted that these outcomes could be the result of multiple factors, including psychosocial interactions, the burden of migraine on the family, and hereditary genetic traits. Nevertheless, even for offspring who may have a predisposition to these conditions because of genetic factors, effective treatment of parental migraine can relieve the day-to-day burden on the family, potentially reducing the effect of parental migraine on children. Parents who have migraine can become better equipped to provide attention to their children when their migraine symptoms are effectively treated. Furthermore, parents who have experienced improvement of their own migraine symptoms can offer hope and support if their children experience migraines, as migraine can be hereditary.

Additional References

1. Göçmez Yılmaz G, Ghouri R, et al. Complicated form of medication overuse headache is severe version of chronic migraine. J Clin Med. 2024;13(13):3696. doi: 10.3390/jcm13133696 Source

2. Liu H, Wang D, Wu F, et al. Association between inflammatory potential of diet and self-reported severe headache or migraine: A cross-sectional study of the National Health and Nutrition Examination Survey. Nutrition. 2023;113:112098. doi: 10.1016/j.nut.2023.112098 Source

3. Buse DC, Powers SW, Gelfand AA, et al. Adolescent perspectives on the burden of a parent's migraine: Results from the CaMEO Study. Headache. 2018;58(4):512-524. doi: 10.1111/head.13254 Source

MOH involves many of the same features as migraine headaches: photophobia, nausea, vomiting, and sleep disturbances.¹ Additionally, patients with migraine and comorbid MOH are at a higher risk for anxiety, depression, and emotional stress. MOH is difficult to treat, and symptom relapse after treatment is common. Results of a retrospective analysis published in July 2024 in The Journal of Headache and Facial Pain confirmed the effectiveness of calcitonin gene-related peptide (CGRP) antibody treatment in a real-world setting among migraine patients who had MOH. The study included a total of 291 patients who had been treated with either erenumab, fremanezumab, or galcanezumab. The majority of patients experienced a significant decline in monthly headache days, monthly migraine days, and monthly acute medication intake at 1 year. The researchers found that only 15.4% of the patients who initially met the criterion of chronic migraine with MOH relapsed, meeting the criterion for chronic migraine/MOH at the end of the 1-year follow-up period.

Lifestyle factors, such as diet, should be addressed when discussing migraine therapy with patients. Dietary factors, including a low–glycemic index diet, have been associated with promising results in migraine control. Results of a 10,359-patient cross-sectional study published in 2023 in the journal Nutrition confirmed that the inflammatory potential of patients' diet is associated with severe headache or migraine in US adults.²A more recent study, published in Frontiers in Nutrition in July 2024, examined dietary vitamin C intake of 13,445 individuals, of whom 20.42% had a severe headache or migraine. Vitamin C is a naturally occurring antioxidant and is also anti-inflammatory, found in foods such as citrus fruit, mangoes, strawberries, broccoli, and peppers. A subgroup analysis showed a significant association between vitamin C intake and severe headaches or migraines, with a reduced risk for severe headaches or migraines associated with an increased consumption of vitamin C. The authors noted that "each 1 mg/day increase in dietary vitamin C intake was significantly associated with a 6% lower risk for severe headache or migraine." Real-life application of this result for patients can involve encouraging patients to swap processed, low-nutrient foods in favor of fresh, nutrient-dense foods.

When treating migraine patients who are also parents, it is crucial to be persistent in searching for effective therapies to treat migraine and to treat or prevent MOH. According to a study published in 2018 in Headache, adolescents reported that parental migraine affected these factors in their lives: loss of parental support, reverse caregiving, emotional experience, interference with school, and missed activities and events.³ According to the authors of a more recent study, published in July 2024 in the Annals of General Psychiatry, parental migraine was significantly associated with an increased risk for attention-deficit/hyperactivity disorder, bipolar disorder, and depressive disorder among offspring of parents with migraine when compared with offspring of parents without migraine. The study authors noted that these outcomes could be the result of multiple factors, including psychosocial interactions, the burden of migraine on the family, and hereditary genetic traits. Nevertheless, even for offspring who may have a predisposition to these conditions because of genetic factors, effective treatment of parental migraine can relieve the day-to-day burden on the family, potentially reducing the effect of parental migraine on children. Parents who have migraine can become better equipped to provide attention to their children when their migraine symptoms are effectively treated. Furthermore, parents who have experienced improvement of their own migraine symptoms can offer hope and support if their children experience migraines, as migraine can be hereditary.

Additional References

1. Göçmez Yılmaz G, Ghouri R, et al. Complicated form of medication overuse headache is severe version of chronic migraine. J Clin Med. 2024;13(13):3696. doi: 10.3390/jcm13133696 Source

2. Liu H, Wang D, Wu F, et al. Association between inflammatory potential of diet and self-reported severe headache or migraine: A cross-sectional study of the National Health and Nutrition Examination Survey. Nutrition. 2023;113:112098. doi: 10.1016/j.nut.2023.112098 Source

3. Buse DC, Powers SW, Gelfand AA, et al. Adolescent perspectives on the burden of a parent's migraine: Results from the CaMEO Study. Headache. 2018;58(4):512-524. doi: 10.1111/head.13254 Source

MOH involves many of the same features as migraine headaches: photophobia, nausea, vomiting, and sleep disturbances.¹ Additionally, patients with migraine and comorbid MOH are at a higher risk for anxiety, depression, and emotional stress. MOH is difficult to treat, and symptom relapse after treatment is common. Results of a retrospective analysis published in July 2024 in The Journal of Headache and Facial Pain confirmed the effectiveness of calcitonin gene-related peptide (CGRP) antibody treatment in a real-world setting among migraine patients who had MOH. The study included a total of 291 patients who had been treated with either erenumab, fremanezumab, or galcanezumab. The majority of patients experienced a significant decline in monthly headache days, monthly migraine days, and monthly acute medication intake at 1 year. The researchers found that only 15.4% of the patients who initially met the criterion of chronic migraine with MOH relapsed, meeting the criterion for chronic migraine/MOH at the end of the 1-year follow-up period.

Lifestyle factors, such as diet, should be addressed when discussing migraine therapy with patients. Dietary factors, including a low–glycemic index diet, have been associated with promising results in migraine control. Results of a 10,359-patient cross-sectional study published in 2023 in the journal Nutrition confirmed that the inflammatory potential of patients' diet is associated with severe headache or migraine in US adults.²A more recent study, published in Frontiers in Nutrition in July 2024, examined dietary vitamin C intake of 13,445 individuals, of whom 20.42% had a severe headache or migraine. Vitamin C is a naturally occurring antioxidant and is also anti-inflammatory, found in foods such as citrus fruit, mangoes, strawberries, broccoli, and peppers. A subgroup analysis showed a significant association between vitamin C intake and severe headaches or migraines, with a reduced risk for severe headaches or migraines associated with an increased consumption of vitamin C. The authors noted that "each 1 mg/day increase in dietary vitamin C intake was significantly associated with a 6% lower risk for severe headache or migraine." Real-life application of this result for patients can involve encouraging patients to swap processed, low-nutrient foods in favor of fresh, nutrient-dense foods.

When treating migraine patients who are also parents, it is crucial to be persistent in searching for effective therapies to treat migraine and to treat or prevent MOH. According to a study published in 2018 in Headache, adolescents reported that parental migraine affected these factors in their lives: loss of parental support, reverse caregiving, emotional experience, interference with school, and missed activities and events.³ According to the authors of a more recent study, published in July 2024 in the Annals of General Psychiatry, parental migraine was significantly associated with an increased risk for attention-deficit/hyperactivity disorder, bipolar disorder, and depressive disorder among offspring of parents with migraine when compared with offspring of parents without migraine. The study authors noted that these outcomes could be the result of multiple factors, including psychosocial interactions, the burden of migraine on the family, and hereditary genetic traits. Nevertheless, even for offspring who may have a predisposition to these conditions because of genetic factors, effective treatment of parental migraine can relieve the day-to-day burden on the family, potentially reducing the effect of parental migraine on children. Parents who have migraine can become better equipped to provide attention to their children when their migraine symptoms are effectively treated. Furthermore, parents who have experienced improvement of their own migraine symptoms can offer hope and support if their children experience migraines, as migraine can be hereditary.

Additional References

1. Göçmez Yılmaz G, Ghouri R, et al. Complicated form of medication overuse headache is severe version of chronic migraine. J Clin Med. 2024;13(13):3696. doi: 10.3390/jcm13133696 Source

2. Liu H, Wang D, Wu F, et al. Association between inflammatory potential of diet and self-reported severe headache or migraine: A cross-sectional study of the National Health and Nutrition Examination Survey. Nutrition. 2023;113:112098. doi: 10.1016/j.nut.2023.112098 Source

3. Buse DC, Powers SW, Gelfand AA, et al. Adolescent perspectives on the burden of a parent's migraine: Results from the CaMEO Study. Headache. 2018;58(4):512-524. doi: 10.1111/head.13254 Source

Key clinical point: Parental migraine was associated with an increased risk for major mental disorders in the offspring, including attention deficit/hyperactivity disorder (ADHD), bipolar disorder, and depressive disorder.

Major finding: Offspring of parents with vs without migraine had a significantly higher risk for ADHD (hazard ratio [HR] 1.37; 95% CI 1.25-1.50), bipolar disorder (HR 1.35; 95% CI 1.06-1.71), and depressive disorder (HR 1.33; 95% CI 1.21-1.47). Sub-analyses revealed that only maternal migraine was a significant risk factor for these disorders.

Study details: This study used data from the Taiwan National Health Insurance Research Database and included 22,747 offspring of parents with migraine and 227,470 matched offspring of parents without migraine.

Disclosures: This study was supported by grants from the Taipei Veterans General Hospital, Yen Tjing Ling Medical Foundation, and Ministry of Science and Technology, Taiwan. The authors declared no conflicts of interest.

Source: Li D-J, Tsai S-J, Chen T-J, et al. Risk of major mental disorders in the offspring of parents with migraine. Ann Gen Psychiatry. 2024;23:23 (Jun 22). Doi: 10.1186/s12991-024-00508-y Source

Key clinical point: Parental migraine was associated with an increased risk for major mental disorders in the offspring, including attention deficit/hyperactivity disorder (ADHD), bipolar disorder, and depressive disorder.

Major finding: Offspring of parents with vs without migraine had a significantly higher risk for ADHD (hazard ratio [HR] 1.37; 95% CI 1.25-1.50), bipolar disorder (HR 1.35; 95% CI 1.06-1.71), and depressive disorder (HR 1.33; 95% CI 1.21-1.47). Sub-analyses revealed that only maternal migraine was a significant risk factor for these disorders.

Study details: This study used data from the Taiwan National Health Insurance Research Database and included 22,747 offspring of parents with migraine and 227,470 matched offspring of parents without migraine.

Disclosures: This study was supported by grants from the Taipei Veterans General Hospital, Yen Tjing Ling Medical Foundation, and Ministry of Science and Technology, Taiwan. The authors declared no conflicts of interest.

Source: Li D-J, Tsai S-J, Chen T-J, et al. Risk of major mental disorders in the offspring of parents with migraine. Ann Gen Psychiatry. 2024;23:23 (Jun 22). Doi: 10.1186/s12991-024-00508-y Source

Key clinical point: Parental migraine was associated with an increased risk for major mental disorders in the offspring, including attention deficit/hyperactivity disorder (ADHD), bipolar disorder, and depressive disorder.

Major finding: Offspring of parents with vs without migraine had a significantly higher risk for ADHD (hazard ratio [HR] 1.37; 95% CI 1.25-1.50), bipolar disorder (HR 1.35; 95% CI 1.06-1.71), and depressive disorder (HR 1.33; 95% CI 1.21-1.47). Sub-analyses revealed that only maternal migraine was a significant risk factor for these disorders.

Study details: This study used data from the Taiwan National Health Insurance Research Database and included 22,747 offspring of parents with migraine and 227,470 matched offspring of parents without migraine.

Disclosures: This study was supported by grants from the Taipei Veterans General Hospital, Yen Tjing Ling Medical Foundation, and Ministry of Science and Technology, Taiwan. The authors declared no conflicts of interest.

Source: Li D-J, Tsai S-J, Chen T-J, et al. Risk of major mental disorders in the offspring of parents with migraine. Ann Gen Psychiatry. 2024;23:23 (Jun 22). Doi: 10.1186/s12991-024-00508-y Source

Key clinical point: Dietary vitamin C intake was negatively associated with the risk for severe headache or migraine.

Major finding: Each 1 mg/day increase in dietary vitamin C intake was significantly associated with a 6% lower risk for severe headache or migraine (adjusted odd ratio [aOR] 0.94; P = .0007). This inverse association between dietary vitamin C intake and severe headache or migraine risk was significant in women (aOR 0.90; 95% CI 0.87-0.85) but not in men.

Study details: This cross-sectional study included 13,445 participants from the National Health and Nutrition Examination Survey, of whom 2745 (20.42%) had severe headache or migraine.

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

Source: Zheng Y, Jin J, Wei C, Huang C. Association of dietary vitamin C consumption with severe headache or migraine among adults: A cross-sectional study of NHANES 1999–2004. Front Nutr. 2024;11:fnut.2024.1412031 (Jun 18). Doi: 10.3389/fnut.2024.1412031 Source

Key clinical point: Dietary vitamin C intake was negatively associated with the risk for severe headache or migraine.

Major finding: Each 1 mg/day increase in dietary vitamin C intake was significantly associated with a 6% lower risk for severe headache or migraine (adjusted odd ratio [aOR] 0.94; P = .0007). This inverse association between dietary vitamin C intake and severe headache or migraine risk was significant in women (aOR 0.90; 95% CI 0.87-0.85) but not in men.

Study details: This cross-sectional study included 13,445 participants from the National Health and Nutrition Examination Survey, of whom 2745 (20.42%) had severe headache or migraine.

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

Source: Zheng Y, Jin J, Wei C, Huang C. Association of dietary vitamin C consumption with severe headache or migraine among adults: A cross-sectional study of NHANES 1999–2004. Front Nutr. 2024;11:fnut.2024.1412031 (Jun 18). Doi: 10.3389/fnut.2024.1412031 Source

Key clinical point: Dietary vitamin C intake was negatively associated with the risk for severe headache or migraine.

Major finding: Each 1 mg/day increase in dietary vitamin C intake was significantly associated with a 6% lower risk for severe headache or migraine (adjusted odd ratio [aOR] 0.94; P = .0007). This inverse association between dietary vitamin C intake and severe headache or migraine risk was significant in women (aOR 0.90; 95% CI 0.87-0.85) but not in men.

Study details: This cross-sectional study included 13,445 participants from the National Health and Nutrition Examination Survey, of whom 2745 (20.42%) had severe headache or migraine.

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

Source: Zheng Y, Jin J, Wei C, Huang C. Association of dietary vitamin C consumption with severe headache or migraine among adults: A cross-sectional study of NHANES 1999–2004. Front Nutr. 2024;11:fnut.2024.1412031 (Jun 18). Doi: 10.3389/fnut.2024.1412031 Source

Key clinical point: Prophylactic migraine therapy with calcitonin gene-related peptide (CGRP) antibodies showed sustained benefits in patients with migraine and medication overuse headache (MOH) or medication overuse (MO) for up to a year.

Major findings: All patients, including those with episodic migraine (EM) with MO, EM without MO, chronic migraine (CM) with MOH, or CM without MOH, had significant reductions in monthly headache days, monthly migraine days, and acute medication days at the last observation timepoint within the first year of CGRP therapy from baseline (all P < .0001). Relapse rates were lower (15.4%) in patients with CM with MOH after successful initiation of CGRP treatment.

Study details: This retrospective real-world analysis included 112 patients with EM (35 with MO and 77 without MO) and 179 patients with CM (109 with MOH and 70 without MOH).

Disclosures: This study was funded by Projekt DEAL. Some authors declared receiving travel fees, honoraria, or scientific support from or serving as consultants or advisors for various sources.

Source: Scheffler A, Basten J, Menzel L, et al. Persistent effectiveness of CGRP antibody therapy in migraine and comorbid medication overuse or medication overuse headache - a retrospective real-world analysis. J Headache Pain. 2024;25:109 (Jul 4). Doi: 10.1186/s10194-024-01813-3 Source

Key clinical point: Prophylactic migraine therapy with calcitonin gene-related peptide (CGRP) antibodies showed sustained benefits in patients with migraine and medication overuse headache (MOH) or medication overuse (MO) for up to a year.

Major findings: All patients, including those with episodic migraine (EM) with MO, EM without MO, chronic migraine (CM) with MOH, or CM without MOH, had significant reductions in monthly headache days, monthly migraine days, and acute medication days at the last observation timepoint within the first year of CGRP therapy from baseline (all P < .0001). Relapse rates were lower (15.4%) in patients with CM with MOH after successful initiation of CGRP treatment.

Study details: This retrospective real-world analysis included 112 patients with EM (35 with MO and 77 without MO) and 179 patients with CM (109 with MOH and 70 without MOH).

Disclosures: This study was funded by Projekt DEAL. Some authors declared receiving travel fees, honoraria, or scientific support from or serving as consultants or advisors for various sources.

Source: Scheffler A, Basten J, Menzel L, et al. Persistent effectiveness of CGRP antibody therapy in migraine and comorbid medication overuse or medication overuse headache - a retrospective real-world analysis. J Headache Pain. 2024;25:109 (Jul 4). Doi: 10.1186/s10194-024-01813-3 Source

Key clinical point: Prophylactic migraine therapy with calcitonin gene-related peptide (CGRP) antibodies showed sustained benefits in patients with migraine and medication overuse headache (MOH) or medication overuse (MO) for up to a year.

Major findings: All patients, including those with episodic migraine (EM) with MO, EM without MO, chronic migraine (CM) with MOH, or CM without MOH, had significant reductions in monthly headache days, monthly migraine days, and acute medication days at the last observation timepoint within the first year of CGRP therapy from baseline (all P < .0001). Relapse rates were lower (15.4%) in patients with CM with MOH after successful initiation of CGRP treatment.

Study details: This retrospective real-world analysis included 112 patients with EM (35 with MO and 77 without MO) and 179 patients with CM (109 with MOH and 70 without MOH).

Disclosures: This study was funded by Projekt DEAL. Some authors declared receiving travel fees, honoraria, or scientific support from or serving as consultants or advisors for various sources.

Source: Scheffler A, Basten J, Menzel L, et al. Persistent effectiveness of CGRP antibody therapy in migraine and comorbid medication overuse or medication overuse headache - a retrospective real-world analysis. J Headache Pain. 2024;25:109 (Jul 4). Doi: 10.1186/s10194-024-01813-3 Source

Key clinical point: Patients with migraine who experienced neck pain with headache (NPWH) had a higher prevalence of disability, depression, anxiety, and allodynia, as well as a lower quality of life, greater work productivity losses, and poorer acute treatment optimization than those without NPWH.

Major findings: Patients with vs without NPWH showed a higher prevalence of moderate to severe disability (47.7% vs 28.9%), depression (40.2% vs 28.2%), anxiety (41.2% vs 29.2%), allodynia (54.0% vs 36.6%), and poor acute treatment optimization (61.1% vs 53.3%; P < .001 for all). They also had lower quality of life scores (60.0 vs 68.6) and higher work productivity loss scores (50.0 vs 30.0; P < .001 for both).

Study details: This analysis of the Chronic Migraine Epidemiology and Outcomes – International study included 14, 492 patients with migraine, of whom 9896 (68.3%) had NPWH.

Disclosures: This study was funded by Allergan (now AbbVie). One author declared being an employee or a stockholder of AbbVie. Several authors declared having ties with various sources, including AbbVie.

Source: Matharu M, Katsarava Z, Buse DC, et al. Characterizing neck pain during headache among people with migraine: Multicountry results from the Chronic Migraine Epidemiology and Outcomes – International (CaMEO-I) cross-sectional study. Headache. 2024;64:750-763 (Jun 22). Doi: 10.1111/head.14753 Source

Key clinical point: Patients with migraine who experienced neck pain with headache (NPWH) had a higher prevalence of disability, depression, anxiety, and allodynia, as well as a lower quality of life, greater work productivity losses, and poorer acute treatment optimization than those without NPWH.

Major findings: Patients with vs without NPWH showed a higher prevalence of moderate to severe disability (47.7% vs 28.9%), depression (40.2% vs 28.2%), anxiety (41.2% vs 29.2%), allodynia (54.0% vs 36.6%), and poor acute treatment optimization (61.1% vs 53.3%; P < .001 for all). They also had lower quality of life scores (60.0 vs 68.6) and higher work productivity loss scores (50.0 vs 30.0; P < .001 for both).

Study details: This analysis of the Chronic Migraine Epidemiology and Outcomes – International study included 14, 492 patients with migraine, of whom 9896 (68.3%) had NPWH.

Disclosures: This study was funded by Allergan (now AbbVie). One author declared being an employee or a stockholder of AbbVie. Several authors declared having ties with various sources, including AbbVie.

Source: Matharu M, Katsarava Z, Buse DC, et al. Characterizing neck pain during headache among people with migraine: Multicountry results from the Chronic Migraine Epidemiology and Outcomes – International (CaMEO-I) cross-sectional study. Headache. 2024;64:750-763 (Jun 22). Doi: 10.1111/head.14753 Source

Key clinical point: Patients with migraine who experienced neck pain with headache (NPWH) had a higher prevalence of disability, depression, anxiety, and allodynia, as well as a lower quality of life, greater work productivity losses, and poorer acute treatment optimization than those without NPWH.

Major findings: Patients with vs without NPWH showed a higher prevalence of moderate to severe disability (47.7% vs 28.9%), depression (40.2% vs 28.2%), anxiety (41.2% vs 29.2%), allodynia (54.0% vs 36.6%), and poor acute treatment optimization (61.1% vs 53.3%; P < .001 for all). They also had lower quality of life scores (60.0 vs 68.6) and higher work productivity loss scores (50.0 vs 30.0; P < .001 for both).

Study details: This analysis of the Chronic Migraine Epidemiology and Outcomes – International study included 14, 492 patients with migraine, of whom 9896 (68.3%) had NPWH.

Disclosures: This study was funded by Allergan (now AbbVie). One author declared being an employee or a stockholder of AbbVie. Several authors declared having ties with various sources, including AbbVie.

Source: Matharu M, Katsarava Z, Buse DC, et al. Characterizing neck pain during headache among people with migraine: Multicountry results from the Chronic Migraine Epidemiology and Outcomes – International (CaMEO-I) cross-sectional study. Headache. 2024;64:750-763 (Jun 22). Doi: 10.1111/head.14753 Source

Key clinical point: Patients with inflammatory bowel disease (IBD) and chronic migraine (CM) had higher serum levels of alpha-calcitonin gene-related peptide (CGRP) than patients with only IBD.

Major findings: The alpha-CGRP levels were significantly higher in patients with IBD (56.9 vs 37.2 pg/mL; P = .003) or CM (53.0 vs 37.2 pg/mL; P = .019) than healthy control participants without a history of IBD and CM. The levels of this peptide in the serum were further increased in patients with IBD and concomitant migraine compared with those with only IBD (70.9 vs 53.7 pg/mL; P = .046).

Study details: This cross-sectional study compared the serum CGRP levels in 96 patients with IBD, 50 patients with CM, and 50 healthy control participants without a history of IBD and CM.

Disclosures: This study was funded by Instituto de Salud Carlos III, Spain. The authors declared no conflicts of interest.

Source: Pascual-Mato M, Gárate G, González-Quintanilla V, et al. Differences in circulating alpha-calcitonin gene-related peptide levels in inflammatory bowel disease and its relation to migraine comorbidity: A cross-sectional study. Headache. 2024;64:849-858 (Jun 24). Doi: 10.1111/head.14768 Source

Key clinical point: Patients with inflammatory bowel disease (IBD) and chronic migraine (CM) had higher serum levels of alpha-calcitonin gene-related peptide (CGRP) than patients with only IBD.

Major findings: The alpha-CGRP levels were significantly higher in patients with IBD (56.9 vs 37.2 pg/mL; P = .003) or CM (53.0 vs 37.2 pg/mL; P = .019) than healthy control participants without a history of IBD and CM. The levels of this peptide in the serum were further increased in patients with IBD and concomitant migraine compared with those with only IBD (70.9 vs 53.7 pg/mL; P = .046).

Study details: This cross-sectional study compared the serum CGRP levels in 96 patients with IBD, 50 patients with CM, and 50 healthy control participants without a history of IBD and CM.

Disclosures: This study was funded by Instituto de Salud Carlos III, Spain. The authors declared no conflicts of interest.

Source: Pascual-Mato M, Gárate G, González-Quintanilla V, et al. Differences in circulating alpha-calcitonin gene-related peptide levels in inflammatory bowel disease and its relation to migraine comorbidity: A cross-sectional study. Headache. 2024;64:849-858 (Jun 24). Doi: 10.1111/head.14768 Source

Key clinical point: Patients with inflammatory bowel disease (IBD) and chronic migraine (CM) had higher serum levels of alpha-calcitonin gene-related peptide (CGRP) than patients with only IBD.

Major findings: The alpha-CGRP levels were significantly higher in patients with IBD (56.9 vs 37.2 pg/mL; P = .003) or CM (53.0 vs 37.2 pg/mL; P = .019) than healthy control participants without a history of IBD and CM. The levels of this peptide in the serum were further increased in patients with IBD and concomitant migraine compared with those with only IBD (70.9 vs 53.7 pg/mL; P = .046).

Study details: This cross-sectional study compared the serum CGRP levels in 96 patients with IBD, 50 patients with CM, and 50 healthy control participants without a history of IBD and CM.

Disclosures: This study was funded by Instituto de Salud Carlos III, Spain. The authors declared no conflicts of interest.

Source: Pascual-Mato M, Gárate G, González-Quintanilla V, et al. Differences in circulating alpha-calcitonin gene-related peptide levels in inflammatory bowel disease and its relation to migraine comorbidity: A cross-sectional study. Headache. 2024;64:849-858 (Jun 24). Doi: 10.1111/head.14768 Source

Key clinical point: Long-term eptinezumab treatment showed benefits in patients with chronic migraine (CM) who had concomitant medication-overuse headache (MOH).

Major findings: After eptinezumab treatment, the average number of headache days per 3 months reduced from 15.8 days (mean 47.5 headache days/month) at baseline to 3.8 days (mean 11.3 headache days/month) at 104 weeks, along with reductions observed in the Migraine Disability Assessment (mean change −51.9 points) and 6-item Headache Impact Test (mean change −9.7 points) scores. More than half (57.1%) the patients showed an improvement in their patient-identified most bothersome symptom at as early as 4 weeks.

Study details: This post hoc analysis of the PREVAIL study included 49 patients with CM and concomitant MOH.

Disclosures: This publication was supported by H. Lundbeck A/S, Copenhagen, Denmark. Two authors declared being employees of H. Lundbeck A/S. The other authors declared having ties with various sources, including H. Lundbeck A/S.

Source: Blumenfeld A, Kudrow D, McAllister P, et al. Long-term effectiveness of eptinezumab in the treatment of patients with chronic migraine and medication-overuse headache. Headache. 2024;64:738-749 (Jun 24). Doi: 10.1111/head.14767 Source

Key clinical point: Long-term eptinezumab treatment showed benefits in patients with chronic migraine (CM) who had concomitant medication-overuse headache (MOH).

Major findings: After eptinezumab treatment, the average number of headache days per 3 months reduced from 15.8 days (mean 47.5 headache days/month) at baseline to 3.8 days (mean 11.3 headache days/month) at 104 weeks, along with reductions observed in the Migraine Disability Assessment (mean change −51.9 points) and 6-item Headache Impact Test (mean change −9.7 points) scores. More than half (57.1%) the patients showed an improvement in their patient-identified most bothersome symptom at as early as 4 weeks.

Study details: This post hoc analysis of the PREVAIL study included 49 patients with CM and concomitant MOH.

Disclosures: This publication was supported by H. Lundbeck A/S, Copenhagen, Denmark. Two authors declared being employees of H. Lundbeck A/S. The other authors declared having ties with various sources, including H. Lundbeck A/S.

Source: Blumenfeld A, Kudrow D, McAllister P, et al. Long-term effectiveness of eptinezumab in the treatment of patients with chronic migraine and medication-overuse headache. Headache. 2024;64:738-749 (Jun 24). Doi: 10.1111/head.14767 Source

Key clinical point: Long-term eptinezumab treatment showed benefits in patients with chronic migraine (CM) who had concomitant medication-overuse headache (MOH).

Major findings: After eptinezumab treatment, the average number of headache days per 3 months reduced from 15.8 days (mean 47.5 headache days/month) at baseline to 3.8 days (mean 11.3 headache days/month) at 104 weeks, along with reductions observed in the Migraine Disability Assessment (mean change −51.9 points) and 6-item Headache Impact Test (mean change −9.7 points) scores. More than half (57.1%) the patients showed an improvement in their patient-identified most bothersome symptom at as early as 4 weeks.

Study details: This post hoc analysis of the PREVAIL study included 49 patients with CM and concomitant MOH.

Disclosures: This publication was supported by H. Lundbeck A/S, Copenhagen, Denmark. Two authors declared being employees of H. Lundbeck A/S. The other authors declared having ties with various sources, including H. Lundbeck A/S.

Source: Blumenfeld A, Kudrow D, McAllister P, et al. Long-term effectiveness of eptinezumab in the treatment of patients with chronic migraine and medication-overuse headache. Headache. 2024;64:738-749 (Jun 24). Doi: 10.1111/head.14767 Source

Key clinical point: Calcitonin gene-related peptide (CGRP)–induced migraine attacks did not affect therapeutic response to erenumab in patients with migraine.

Major finding: Overall, a similar proportion of patients who experienced vs did not experience CGRP-induced migraine attacks had a ≥50% reduction in monthly migraine days during weeks 13-24 following erenumab treatment (61% vs 52%; odds ratio [OR] 1.42; P = .498). No significant differences were seen between the two patient groups that achieved a ≥50% reduction in monthly migraine or headache days of moderate to severe intensity (OR 1.25; P = .625).

Study details: This interim analysis of the REFORM study included 124 patients with migraine who received CGRP infusion on a single experimental day and subsequently a 24-week treatment with erenumab.

Disclosures: This study was funded by Novartis Pharma and the Lundbeck Foundation. Two authors declared being employees of or holding shares in Novartis Pharma AG. Several authors declared receiving personal fees from various sources, including Novartis, outside of the submitted work. One author is an associate editor for Cephalalgia.

Source: Al-Khazali HM, Ashina H, Christensen RH, et al. Hypersensitivity to CGRP as a predictive biomarker of migraine prevention with erenumab. Cephalalgia. 2024;44(6):3331024241258734 (Jun 11). Doi: 10.1177/03331024241258734 Source

Key clinical point: Calcitonin gene-related peptide (CGRP)–induced migraine attacks did not affect therapeutic response to erenumab in patients with migraine.

Major finding: Overall, a similar proportion of patients who experienced vs did not experience CGRP-induced migraine attacks had a ≥50% reduction in monthly migraine days during weeks 13-24 following erenumab treatment (61% vs 52%; odds ratio [OR] 1.42; P = .498). No significant differences were seen between the two patient groups that achieved a ≥50% reduction in monthly migraine or headache days of moderate to severe intensity (OR 1.25; P = .625).

Study details: This interim analysis of the REFORM study included 124 patients with migraine who received CGRP infusion on a single experimental day and subsequently a 24-week treatment with erenumab.

Disclosures: This study was funded by Novartis Pharma and the Lundbeck Foundation. Two authors declared being employees of or holding shares in Novartis Pharma AG. Several authors declared receiving personal fees from various sources, including Novartis, outside of the submitted work. One author is an associate editor for Cephalalgia.

Source: Al-Khazali HM, Ashina H, Christensen RH, et al. Hypersensitivity to CGRP as a predictive biomarker of migraine prevention with erenumab. Cephalalgia. 2024;44(6):3331024241258734 (Jun 11). Doi: 10.1177/03331024241258734 Source

Key clinical point: Calcitonin gene-related peptide (CGRP)–induced migraine attacks did not affect therapeutic response to erenumab in patients with migraine.

Major finding: Overall, a similar proportion of patients who experienced vs did not experience CGRP-induced migraine attacks had a ≥50% reduction in monthly migraine days during weeks 13-24 following erenumab treatment (61% vs 52%; odds ratio [OR] 1.42; P = .498). No significant differences were seen between the two patient groups that achieved a ≥50% reduction in monthly migraine or headache days of moderate to severe intensity (OR 1.25; P = .625).

Study details: This interim analysis of the REFORM study included 124 patients with migraine who received CGRP infusion on a single experimental day and subsequently a 24-week treatment with erenumab.

Disclosures: This study was funded by Novartis Pharma and the Lundbeck Foundation. Two authors declared being employees of or holding shares in Novartis Pharma AG. Several authors declared receiving personal fees from various sources, including Novartis, outside of the submitted work. One author is an associate editor for Cephalalgia.

Source: Al-Khazali HM, Ashina H, Christensen RH, et al. Hypersensitivity to CGRP as a predictive biomarker of migraine prevention with erenumab. Cephalalgia. 2024;44(6):3331024241258734 (Jun 11). Doi: 10.1177/03331024241258734 Source

Key clinical point: In patients with episodic migraine (EM) or chronic migraine (CM), erenumab treatment interruption was associated with increased monthly migraine days (MMD) and worsening of migraine disability; these effects ameliorated on treatment restart.

Major finding: After erenumab treatment interruption for 3 months, the number of monthly migraine days (MMD) increased from 6.1 to 10.9 days for patients with EM and from 11.4 to 16.8 days for patients with CM; the modified Migraine Disability Assessment scores (mMIDAS) also worsened during this period. Both MMD and mMIDAS scores improved upon restarting treatment.

Study details: This interim analysis of the 24-month, multicentric, non-interventional observational study included 172 patients with CM or EM who received erenumab and underwent treatment interruptions on average 11.2 months after initiation, with interruptions lasting for a mean duration of 4 months.

Disclosures: This study was funded by Novartis Pharma Schweiz AG. Four authors declared being full-time employees of Novartis Pharma Schweiz AG, and others declared having ties with various sources, including Novartis.

Source: Gantenbein AR, Bonvin C, Kamm CP, et al. Implications of therapy interruption on monthly migraine days and modified migraine disability assessment in patients treated with erenumab for chronic and episodic migraine: SQUARE study interim results. J Neurol. 2024 (Jun 13). Doi: 10.1007/s00415-024-12470-6 Source

Key clinical point: In patients with episodic migraine (EM) or chronic migraine (CM), erenumab treatment interruption was associated with increased monthly migraine days (MMD) and worsening of migraine disability; these effects ameliorated on treatment restart.

Major finding: After erenumab treatment interruption for 3 months, the number of monthly migraine days (MMD) increased from 6.1 to 10.9 days for patients with EM and from 11.4 to 16.8 days for patients with CM; the modified Migraine Disability Assessment scores (mMIDAS) also worsened during this period. Both MMD and mMIDAS scores improved upon restarting treatment.

Study details: This interim analysis of the 24-month, multicentric, non-interventional observational study included 172 patients with CM or EM who received erenumab and underwent treatment interruptions on average 11.2 months after initiation, with interruptions lasting for a mean duration of 4 months.

Disclosures: This study was funded by Novartis Pharma Schweiz AG. Four authors declared being full-time employees of Novartis Pharma Schweiz AG, and others declared having ties with various sources, including Novartis.

Source: Gantenbein AR, Bonvin C, Kamm CP, et al. Implications of therapy interruption on monthly migraine days and modified migraine disability assessment in patients treated with erenumab for chronic and episodic migraine: SQUARE study interim results. J Neurol. 2024 (Jun 13). Doi: 10.1007/s00415-024-12470-6 Source

Key clinical point: In patients with episodic migraine (EM) or chronic migraine (CM), erenumab treatment interruption was associated with increased monthly migraine days (MMD) and worsening of migraine disability; these effects ameliorated on treatment restart.

Major finding: After erenumab treatment interruption for 3 months, the number of monthly migraine days (MMD) increased from 6.1 to 10.9 days for patients with EM and from 11.4 to 16.8 days for patients with CM; the modified Migraine Disability Assessment scores (mMIDAS) also worsened during this period. Both MMD and mMIDAS scores improved upon restarting treatment.

Study details: This interim analysis of the 24-month, multicentric, non-interventional observational study included 172 patients with CM or EM who received erenumab and underwent treatment interruptions on average 11.2 months after initiation, with interruptions lasting for a mean duration of 4 months.

Disclosures: This study was funded by Novartis Pharma Schweiz AG. Four authors declared being full-time employees of Novartis Pharma Schweiz AG, and others declared having ties with various sources, including Novartis.

Source: Gantenbein AR, Bonvin C, Kamm CP, et al. Implications of therapy interruption on monthly migraine days and modified migraine disability assessment in patients treated with erenumab for chronic and episodic migraine: SQUARE study interim results. J Neurol. 2024 (Jun 13). Doi: 10.1007/s00415-024-12470-6 Source

Key clinical point: Patients with migraine, migraine with aura (MA), or migraine without aura (MO) faced a significantly higher risk for retinal vascular occlusion.

Major findings: Compared with control individuals without migraine, those with migraine (adjusted hazard ratio [aHR] 1.69; 95% CI 1.57-1.83), MA (aHR 1.77; 95% CI 1.58-1.98), or MO (aHR 1.92; 95% CI 1.64-2.25; P < .001 for all) had a significantly higher risk for retinal vascular occlusion. The risk was, however, reduced in the migraine population that received nonsteroidal anti-inflammatory drugs (aHR 0.19; 95% CI 0.16-0.22), propranolol (aHR 0.73; 95% CI 0.62-0.86), or flunarizine (aHR 0.84; 95% CI 0.76-0.93; P < .001 for all).

Study details: This population-based retrospective cohort study included 628,760 patients with migraine and 628,760 control individuals without migraine.

Disclosures: This study was supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial Center, China Medical University Hospital, and National Science and Technology Council. The authors declared no conflicts of interest.

Source: Ho K-Y, Lin C-D, Hsu T-J, et al. Increased risks of retinal vascular occlusion in patients with migraine and the protective effects of migraine treatment: A population-based retrospective cohort study. Sci Rep. 2024;14:15429 (Jul 4). Doi: 10.1038/s41598-024-66363-9 Source

Key clinical point: Patients with migraine, migraine with aura (MA), or migraine without aura (MO) faced a significantly higher risk for retinal vascular occlusion.

Major findings: Compared with control individuals without migraine, those with migraine (adjusted hazard ratio [aHR] 1.69; 95% CI 1.57-1.83), MA (aHR 1.77; 95% CI 1.58-1.98), or MO (aHR 1.92; 95% CI 1.64-2.25; P < .001 for all) had a significantly higher risk for retinal vascular occlusion. The risk was, however, reduced in the migraine population that received nonsteroidal anti-inflammatory drugs (aHR 0.19; 95% CI 0.16-0.22), propranolol (aHR 0.73; 95% CI 0.62-0.86), or flunarizine (aHR 0.84; 95% CI 0.76-0.93; P < .001 for all).

Study details: This population-based retrospective cohort study included 628,760 patients with migraine and 628,760 control individuals without migraine.

Disclosures: This study was supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial Center, China Medical University Hospital, and National Science and Technology Council. The authors declared no conflicts of interest.

Source: Ho K-Y, Lin C-D, Hsu T-J, et al. Increased risks of retinal vascular occlusion in patients with migraine and the protective effects of migraine treatment: A population-based retrospective cohort study. Sci Rep. 2024;14:15429 (Jul 4). Doi: 10.1038/s41598-024-66363-9 Source

Key clinical point: Patients with migraine, migraine with aura (MA), or migraine without aura (MO) faced a significantly higher risk for retinal vascular occlusion.

Major findings: Compared with control individuals without migraine, those with migraine (adjusted hazard ratio [aHR] 1.69; 95% CI 1.57-1.83), MA (aHR 1.77; 95% CI 1.58-1.98), or MO (aHR 1.92; 95% CI 1.64-2.25; P < .001 for all) had a significantly higher risk for retinal vascular occlusion. The risk was, however, reduced in the migraine population that received nonsteroidal anti-inflammatory drugs (aHR 0.19; 95% CI 0.16-0.22), propranolol (aHR 0.73; 95% CI 0.62-0.86), or flunarizine (aHR 0.84; 95% CI 0.76-0.93; P < .001 for all).

Study details: This population-based retrospective cohort study included 628,760 patients with migraine and 628,760 control individuals without migraine.

Disclosures: This study was supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial Center, China Medical University Hospital, and National Science and Technology Council. The authors declared no conflicts of interest.

Source: Ho K-Y, Lin C-D, Hsu T-J, et al. Increased risks of retinal vascular occlusion in patients with migraine and the protective effects of migraine treatment: A population-based retrospective cohort study. Sci Rep. 2024;14:15429 (Jul 4). Doi: 10.1038/s41598-024-66363-9 Source