Headache & Migraine

Migraine is a condition that particularly affects the population of reproductive-aged women. A significant amount of the literature discusses the effect of estrogen as a migraine trigger and specifically migraine with aura as a vascular risk factor. One topic that is not discussed in the literature is whether migraine could be a risk for miscarriage, also known as spontaneous abortion. The National Institutes of Health (NIH)-funded study by Crowe and colleagues looks at this risk, especially as it relates to the frequency of migraine, the use of acute migraine medications, and caffeine intake.

This was a broad study, including nearly 2000 patients with migraine, and was a continuation of a prior ongoing NIH-funded epidemiologic study. The initial study enrolled nearly 8000 participants, all of whom were women aged 21-45 years, were in a pregnancy planning stage, and were followed for up to 12 months or until a reported pregnancy. Questionnaires were given preconception, as well as early in pregnancy (defined as 8-9 weeks' gestation), and late in pregnancy (defined as 32 weeks' gestation).

During this study 19% of pregnancies ended in spontaneous abortion. A history of migraine preconception was not associated with spontaneous abortion risk on the basis of hazard ratios. There was a slight risk in those taking some migraine medication daily, either prophylactic or analgesic. Frequency of migraine itself was not noted as a risk for spontaneous abortion.

It is necessary that this important study be followed by further investigations looking at specific medication classes and their potential risk for spontaneous abortion. Migraine itself does not appear to be a risk for miscarriage; however, there remains the possibility that some preventive or acute medications may elevate this risk. At the current moment, there is not enough information to draw a conclusion. All clinicians who treat people with migraine, particularly women who are in their reproductive years, should continue to have conversations regarding pregnancy planning and the adjustment of both preventive and acute medications prior to conception.

Neck pain is a common comorbidity of both chronic and acute migraine, and botulinum toxin is a US Food and Drug Administration–approved treatment both for chronic migraine and certain painful neck conditions, including cervical dystonia. Migraine itself can be a disabling condition; when migraine is combined with other painful comorbidities the likelihood of disability becomes increased significantly. The standard PREEMPT protocol for botulinum toxin injection in chronic migraine of 155 units includes a number of injections in the trapezius and cervical paraspinal muscles. Many clinicians will give additional injections into these muscles and other areas around the neck, specifically targeting areas of neck and shoulder spasm and tenderness. Onan and colleagues investigated the quality of life and disability scores of patients who received these additional injections.

This was an open study, in which participants were given an additional 30 units of botulinum toxin into the general neck areas in a follow-the-pain protocol. The authors, used as a primary outcome, the reduction in the Migraine Disability Assessment (MIDAS) and Neck Disability Index (NDI) scores at 4 weeks and 3 months. The secondary outcome was the Headache Impact Test (HIT-6) score. An objective assessment of neck mobility or a quantification of trigger points were not calculated.

All scores, both the primary and secondary outcomes, were significantly decreased, and quality of life was also noted to be significantly improved with these additional injections. Most clinicians receive a 200-unit vial of botulinum toxin for each of their chronic migraine protocol injections. There is a growing body of evidence to argue that the additional units of botulinum toxin significantly improve outcomes, both regarding headache and neck pain. This study argues for delivering these additional injections of botulinum toxin, especially when neck pain is more prominent.

Much has been written about diet triggers and migraine recently. There has been some evidence for specific diet changes, ie, the addition of foods or nutrients that can be helpful or preventive for migraine. There is some evidence for the addition of omega-3 fatty acids. Huang and He investigated the effect of a high fiber diet on migraine frequency and severity.

This was a cross-sectional study involving data collected from the NIH/Centers for Disease Control and Prevention–sponsored National Health and Nutrition Examination Survey trial from 1999 to 2004. In the studied population, severe headache and migraine was present in approximately 20%, and dietary fiber intake was delineated on the basis of whether it was more than or less than 100 g/d. This study assessed dietary intake of fiber, via a 24-hour dietary recall that was conducted by trained interviewers during two interviews conducted over the course of 2 years.

A total of 12,000 participants were included in the study. There was a significant decrease in migraine severity between those with a higher and lower dietary fiber intake. The incidence of severe headache or migraine, as defined by frequency and severity, decreased in participants who had a dietary fiber intake > 100 g/d. The authors found that for every 10 g/d increase in dietary fiber intake, the prevalence of severe headache or migraine decreased by approximately 11%.

Although much has been written about the association between diet and migraine, most of the literature focuses on the avoidance of specific dietary triggers. A different consideration now exists, one that will likely increase compliance with dietary recommendations. Specifically, people treating patients with migraine can make recommendations regarding dietary changes that focus on adding specific healthy foods or other changes that can actually be associated with improving migraine frequency long-term. Recommending healthy fats, such as omega-3 fatty acids, and high fiber should be done for nearly all patients with migraine.

Migraine is a condition that particularly affects the population of reproductive-aged women. A significant amount of the literature discusses the effect of estrogen as a migraine trigger and specifically migraine with aura as a vascular risk factor. One topic that is not discussed in the literature is whether migraine could be a risk for miscarriage, also known as spontaneous abortion. The National Institutes of Health (NIH)-funded study by Crowe and colleagues looks at this risk, especially as it relates to the frequency of migraine, the use of acute migraine medications, and caffeine intake.

This was a broad study, including nearly 2000 patients with migraine, and was a continuation of a prior ongoing NIH-funded epidemiologic study. The initial study enrolled nearly 8000 participants, all of whom were women aged 21-45 years, were in a pregnancy planning stage, and were followed for up to 12 months or until a reported pregnancy. Questionnaires were given preconception, as well as early in pregnancy (defined as 8-9 weeks' gestation), and late in pregnancy (defined as 32 weeks' gestation).

During this study 19% of pregnancies ended in spontaneous abortion. A history of migraine preconception was not associated with spontaneous abortion risk on the basis of hazard ratios. There was a slight risk in those taking some migraine medication daily, either prophylactic or analgesic. Frequency of migraine itself was not noted as a risk for spontaneous abortion.

It is necessary that this important study be followed by further investigations looking at specific medication classes and their potential risk for spontaneous abortion. Migraine itself does not appear to be a risk for miscarriage; however, there remains the possibility that some preventive or acute medications may elevate this risk. At the current moment, there is not enough information to draw a conclusion. All clinicians who treat people with migraine, particularly women who are in their reproductive years, should continue to have conversations regarding pregnancy planning and the adjustment of both preventive and acute medications prior to conception.

Neck pain is a common comorbidity of both chronic and acute migraine, and botulinum toxin is a US Food and Drug Administration–approved treatment both for chronic migraine and certain painful neck conditions, including cervical dystonia. Migraine itself can be a disabling condition; when migraine is combined with other painful comorbidities the likelihood of disability becomes increased significantly. The standard PREEMPT protocol for botulinum toxin injection in chronic migraine of 155 units includes a number of injections in the trapezius and cervical paraspinal muscles. Many clinicians will give additional injections into these muscles and other areas around the neck, specifically targeting areas of neck and shoulder spasm and tenderness. Onan and colleagues investigated the quality of life and disability scores of patients who received these additional injections.

This was an open study, in which participants were given an additional 30 units of botulinum toxin into the general neck areas in a follow-the-pain protocol. The authors, used as a primary outcome, the reduction in the Migraine Disability Assessment (MIDAS) and Neck Disability Index (NDI) scores at 4 weeks and 3 months. The secondary outcome was the Headache Impact Test (HIT-6) score. An objective assessment of neck mobility or a quantification of trigger points were not calculated.

All scores, both the primary and secondary outcomes, were significantly decreased, and quality of life was also noted to be significantly improved with these additional injections. Most clinicians receive a 200-unit vial of botulinum toxin for each of their chronic migraine protocol injections. There is a growing body of evidence to argue that the additional units of botulinum toxin significantly improve outcomes, both regarding headache and neck pain. This study argues for delivering these additional injections of botulinum toxin, especially when neck pain is more prominent.

Much has been written about diet triggers and migraine recently. There has been some evidence for specific diet changes, ie, the addition of foods or nutrients that can be helpful or preventive for migraine. There is some evidence for the addition of omega-3 fatty acids. Huang and He investigated the effect of a high fiber diet on migraine frequency and severity.

This was a cross-sectional study involving data collected from the NIH/Centers for Disease Control and Prevention–sponsored National Health and Nutrition Examination Survey trial from 1999 to 2004. In the studied population, severe headache and migraine was present in approximately 20%, and dietary fiber intake was delineated on the basis of whether it was more than or less than 100 g/d. This study assessed dietary intake of fiber, via a 24-hour dietary recall that was conducted by trained interviewers during two interviews conducted over the course of 2 years.

A total of 12,000 participants were included in the study. There was a significant decrease in migraine severity between those with a higher and lower dietary fiber intake. The incidence of severe headache or migraine, as defined by frequency and severity, decreased in participants who had a dietary fiber intake > 100 g/d. The authors found that for every 10 g/d increase in dietary fiber intake, the prevalence of severe headache or migraine decreased by approximately 11%.

Although much has been written about the association between diet and migraine, most of the literature focuses on the avoidance of specific dietary triggers. A different consideration now exists, one that will likely increase compliance with dietary recommendations. Specifically, people treating patients with migraine can make recommendations regarding dietary changes that focus on adding specific healthy foods or other changes that can actually be associated with improving migraine frequency long-term. Recommending healthy fats, such as omega-3 fatty acids, and high fiber should be done for nearly all patients with migraine.

Migraine is a condition that particularly affects the population of reproductive-aged women. A significant amount of the literature discusses the effect of estrogen as a migraine trigger and specifically migraine with aura as a vascular risk factor. One topic that is not discussed in the literature is whether migraine could be a risk for miscarriage, also known as spontaneous abortion. The National Institutes of Health (NIH)-funded study by Crowe and colleagues looks at this risk, especially as it relates to the frequency of migraine, the use of acute migraine medications, and caffeine intake.

This was a broad study, including nearly 2000 patients with migraine, and was a continuation of a prior ongoing NIH-funded epidemiologic study. The initial study enrolled nearly 8000 participants, all of whom were women aged 21-45 years, were in a pregnancy planning stage, and were followed for up to 12 months or until a reported pregnancy. Questionnaires were given preconception, as well as early in pregnancy (defined as 8-9 weeks' gestation), and late in pregnancy (defined as 32 weeks' gestation).

During this study 19% of pregnancies ended in spontaneous abortion. A history of migraine preconception was not associated with spontaneous abortion risk on the basis of hazard ratios. There was a slight risk in those taking some migraine medication daily, either prophylactic or analgesic. Frequency of migraine itself was not noted as a risk for spontaneous abortion.

It is necessary that this important study be followed by further investigations looking at specific medication classes and their potential risk for spontaneous abortion. Migraine itself does not appear to be a risk for miscarriage; however, there remains the possibility that some preventive or acute medications may elevate this risk. At the current moment, there is not enough information to draw a conclusion. All clinicians who treat people with migraine, particularly women who are in their reproductive years, should continue to have conversations regarding pregnancy planning and the adjustment of both preventive and acute medications prior to conception.

Neck pain is a common comorbidity of both chronic and acute migraine, and botulinum toxin is a US Food and Drug Administration–approved treatment both for chronic migraine and certain painful neck conditions, including cervical dystonia. Migraine itself can be a disabling condition; when migraine is combined with other painful comorbidities the likelihood of disability becomes increased significantly. The standard PREEMPT protocol for botulinum toxin injection in chronic migraine of 155 units includes a number of injections in the trapezius and cervical paraspinal muscles. Many clinicians will give additional injections into these muscles and other areas around the neck, specifically targeting areas of neck and shoulder spasm and tenderness. Onan and colleagues investigated the quality of life and disability scores of patients who received these additional injections.

This was an open study, in which participants were given an additional 30 units of botulinum toxin into the general neck areas in a follow-the-pain protocol. The authors, used as a primary outcome, the reduction in the Migraine Disability Assessment (MIDAS) and Neck Disability Index (NDI) scores at 4 weeks and 3 months. The secondary outcome was the Headache Impact Test (HIT-6) score. An objective assessment of neck mobility or a quantification of trigger points were not calculated.

All scores, both the primary and secondary outcomes, were significantly decreased, and quality of life was also noted to be significantly improved with these additional injections. Most clinicians receive a 200-unit vial of botulinum toxin for each of their chronic migraine protocol injections. There is a growing body of evidence to argue that the additional units of botulinum toxin significantly improve outcomes, both regarding headache and neck pain. This study argues for delivering these additional injections of botulinum toxin, especially when neck pain is more prominent.

Much has been written about diet triggers and migraine recently. There has been some evidence for specific diet changes, ie, the addition of foods or nutrients that can be helpful or preventive for migraine. There is some evidence for the addition of omega-3 fatty acids. Huang and He investigated the effect of a high fiber diet on migraine frequency and severity.

This was a cross-sectional study involving data collected from the NIH/Centers for Disease Control and Prevention–sponsored National Health and Nutrition Examination Survey trial from 1999 to 2004. In the studied population, severe headache and migraine was present in approximately 20%, and dietary fiber intake was delineated on the basis of whether it was more than or less than 100 g/d. This study assessed dietary intake of fiber, via a 24-hour dietary recall that was conducted by trained interviewers during two interviews conducted over the course of 2 years.

A total of 12,000 participants were included in the study. There was a significant decrease in migraine severity between those with a higher and lower dietary fiber intake. The incidence of severe headache or migraine, as defined by frequency and severity, decreased in participants who had a dietary fiber intake > 100 g/d. The authors found that for every 10 g/d increase in dietary fiber intake, the prevalence of severe headache or migraine decreased by approximately 11%.

Although much has been written about the association between diet and migraine, most of the literature focuses on the avoidance of specific dietary triggers. A different consideration now exists, one that will likely increase compliance with dietary recommendations. Specifically, people treating patients with migraine can make recommendations regarding dietary changes that focus on adding specific healthy foods or other changes that can actually be associated with improving migraine frequency long-term. Recommending healthy fats, such as omega-3 fatty acids, and high fiber should be done for nearly all patients with migraine.

Key clinical point: Increased intake of dietary fiber seemed protective against migraine or severe headache in a large population of US adults.

Major finding: Risk for migraine or severe headache was 26% lower among patients in the highest (22.10-95.50 g/day) vs lowest (0.0-7.79 g/day) quintile of dietary fiber intake (adjusted odds ratio 0.74; P  =  .0029).

Study details: This cross-sectional study included 12,710 participants from the US National Health and Nutrition Examination Survey, of which 2527 experienced migraine or severe headache.

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

Source: Huang H and He K. The association between dietary fiber intake and severe headaches or migraine in US adults. Front Nutr. 2023;9:1044066  (Jan 4). Doi: 10.3389/fnut.2022.1044066

Key clinical point: Increased intake of dietary fiber seemed protective against migraine or severe headache in a large population of US adults.

Major finding: Risk for migraine or severe headache was 26% lower among patients in the highest (22.10-95.50 g/day) vs lowest (0.0-7.79 g/day) quintile of dietary fiber intake (adjusted odds ratio 0.74; P  =  .0029).

Study details: This cross-sectional study included 12,710 participants from the US National Health and Nutrition Examination Survey, of which 2527 experienced migraine or severe headache.

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

Source: Huang H and He K. The association between dietary fiber intake and severe headaches or migraine in US adults. Front Nutr. 2023;9:1044066  (Jan 4). Doi: 10.3389/fnut.2022.1044066

Key clinical point: Increased intake of dietary fiber seemed protective against migraine or severe headache in a large population of US adults.

Major finding: Risk for migraine or severe headache was 26% lower among patients in the highest (22.10-95.50 g/day) vs lowest (0.0-7.79 g/day) quintile of dietary fiber intake (adjusted odds ratio 0.74; P  =  .0029).

Study details: This cross-sectional study included 12,710 participants from the US National Health and Nutrition Examination Survey, of which 2527 experienced migraine or severe headache.

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

Source: Huang H and He K. The association between dietary fiber intake and severe headaches or migraine in US adults. Front Nutr. 2023;9:1044066  (Jan 4). Doi: 10.3389/fnut.2022.1044066

Key clinical point: Index vein served as a good biomarker for migraine aura with a high diagnostic specificity and sensitivity in the emergency setting in patients with acute neurological deficit.

Major finding: Prevalence of index vein was more frequent in patients with migraine aura (17%) vs those with stroke (2%)/epileptic seizure (4%) or control participants (1%; P < .001). Index vein was highly specific to migraine aura (specificity 97%; 95% CI 95%-99%), with an ability to diagnose migraine aura with 94% sensitivity (95% CI 87.4%-97.8%) and 73.5% specificity (95% CI 66.8%-79.5%) at a cut-off of 4 points.

Study details: This retrospective case-control study included 400 patients who presented to the emergency department with an acute neurological deficit, underwent brain magnetic resonance imaging, and were discharged with a diagnosis of migraine aura/ischemic stroke/epileptic seizure or none of these (control participants).

Disclosures: This study did not receive any specific funding. Two authors declared serving as part-time employees at Zynnon or as a consultant, speaker, or advisory board member for various sources.

Source: Scutelnic A et al. The “index vein” as a sign for migraine aura in the emergency setting. Cephalalgia. 2023 (Jan 9). Doi: 10.1177/033310242211320

Key clinical point: Index vein served as a good biomarker for migraine aura with a high diagnostic specificity and sensitivity in the emergency setting in patients with acute neurological deficit.

Major finding: Prevalence of index vein was more frequent in patients with migraine aura (17%) vs those with stroke (2%)/epileptic seizure (4%) or control participants (1%; P < .001). Index vein was highly specific to migraine aura (specificity 97%; 95% CI 95%-99%), with an ability to diagnose migraine aura with 94% sensitivity (95% CI 87.4%-97.8%) and 73.5% specificity (95% CI 66.8%-79.5%) at a cut-off of 4 points.

Study details: This retrospective case-control study included 400 patients who presented to the emergency department with an acute neurological deficit, underwent brain magnetic resonance imaging, and were discharged with a diagnosis of migraine aura/ischemic stroke/epileptic seizure or none of these (control participants).

Disclosures: This study did not receive any specific funding. Two authors declared serving as part-time employees at Zynnon or as a consultant, speaker, or advisory board member for various sources.

Source: Scutelnic A et al. The “index vein” as a sign for migraine aura in the emergency setting. Cephalalgia. 2023 (Jan 9). Doi: 10.1177/033310242211320

Key clinical point: Index vein served as a good biomarker for migraine aura with a high diagnostic specificity and sensitivity in the emergency setting in patients with acute neurological deficit.

Major finding: Prevalence of index vein was more frequent in patients with migraine aura (17%) vs those with stroke (2%)/epileptic seizure (4%) or control participants (1%; P < .001). Index vein was highly specific to migraine aura (specificity 97%; 95% CI 95%-99%), with an ability to diagnose migraine aura with 94% sensitivity (95% CI 87.4%-97.8%) and 73.5% specificity (95% CI 66.8%-79.5%) at a cut-off of 4 points.

Study details: This retrospective case-control study included 400 patients who presented to the emergency department with an acute neurological deficit, underwent brain magnetic resonance imaging, and were discharged with a diagnosis of migraine aura/ischemic stroke/epileptic seizure or none of these (control participants).

Disclosures: This study did not receive any specific funding. Two authors declared serving as part-time employees at Zynnon or as a consultant, speaker, or advisory board member for various sources.

Source: Scutelnic A et al. The “index vein” as a sign for migraine aura in the emergency setting. Cephalalgia. 2023 (Jan 9). Doi: 10.1177/033310242211320

Key clinical point: American adults with higher dietary zinc intake were at a lower risk for migraine, demonstrating an inverse association between dietary zinc intake and migraine.

Major finding: The risk for migraine was significantly lower among participants in the highest (≥15.8 mg/day) vs lowest (≤5.9 mg/day) quintile of dietary zinc intake (adjusted odds ratio [aOR] 0.70; P  =  .029) and remained low among participants with dietary zinc intake of at least 6.0-8.4 mg/day (aOR 0.73; P  =  .004).

Study details: This cross-sectional study included 11,088 adults with or without migraine from the US National Health and Nutrition Examination Survey (1999-2004).

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

Source: Liu H et al. Dietary zinc intake and migraine in adults: A cross-sectional analysis of the National Health and Nutrition Examination Survey 1999-2004. Headache. 2023 (Jan 1). Doi: 10.1111/head.14431

Key clinical point: American adults with higher dietary zinc intake were at a lower risk for migraine, demonstrating an inverse association between dietary zinc intake and migraine.

Major finding: The risk for migraine was significantly lower among participants in the highest (≥15.8 mg/day) vs lowest (≤5.9 mg/day) quintile of dietary zinc intake (adjusted odds ratio [aOR] 0.70; P  =  .029) and remained low among participants with dietary zinc intake of at least 6.0-8.4 mg/day (aOR 0.73; P  =  .004).

Study details: This cross-sectional study included 11,088 adults with or without migraine from the US National Health and Nutrition Examination Survey (1999-2004).

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

Source: Liu H et al. Dietary zinc intake and migraine in adults: A cross-sectional analysis of the National Health and Nutrition Examination Survey 1999-2004. Headache. 2023 (Jan 1). Doi: 10.1111/head.14431

Key clinical point: American adults with higher dietary zinc intake were at a lower risk for migraine, demonstrating an inverse association between dietary zinc intake and migraine.

Major finding: The risk for migraine was significantly lower among participants in the highest (≥15.8 mg/day) vs lowest (≤5.9 mg/day) quintile of dietary zinc intake (adjusted odds ratio [aOR] 0.70; P  =  .029) and remained low among participants with dietary zinc intake of at least 6.0-8.4 mg/day (aOR 0.73; P  =  .004).

Study details: This cross-sectional study included 11,088 adults with or without migraine from the US National Health and Nutrition Examination Survey (1999-2004).

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

Source: Liu H et al. Dietary zinc intake and migraine in adults: A cross-sectional analysis of the National Health and Nutrition Examination Survey 1999-2004. Headache. 2023 (Jan 1). Doi: 10.1111/head.14431

Key clinical point: Eptinezumab vs placebo demonstrated significantly greater and sustained improvements in patient-reported overall health, quality of life, and most bothersome symptoms in patients with migraine and 2-4 preventive treatment failures.

Major finding: At week 12, 100 and 300 mg eptinezumab vs placebo led to significantly greater improvements in EQ-5D-5L visual analog scale scores (difference from placebo [Δ] 5.1; P < .001, and Δ 7.5; P < .0001, respectively), 6-item Headache Impact Test total scores (Δ −3.8 and −5.4, respectively; both P < .0001), Migraine-Specific Quality of Life Questionnaire scores (both P < .0001), and patient-identified most bothersome symptoms (both P < .0001), with effects sustained until week 24.

Study details: Findings are from the phase 3b DELIVER trial including 890 adults with episodic/chronic migraine and 2-4 prior preventive treatment failures who were randomly assigned to receive eptinezumab (100/300 mg) or placebo.

Disclosures: The clinical trial and publication was funded by H. Lundbeck A/S. Five authors declared being employees of H. Lundbeck A/S. Three authors reported ties with various sources.

Source: Goadsby PJ et al. Eptinezumab improved patient-reported outcomes and quality of life in patients with migraine and prior preventive treatment failures. Eur J Neurol. 2022 (Dec 30). Doi: 10.1111/ene.15670

Key clinical point: Eptinezumab vs placebo demonstrated significantly greater and sustained improvements in patient-reported overall health, quality of life, and most bothersome symptoms in patients with migraine and 2-4 preventive treatment failures.

Major finding: At week 12, 100 and 300 mg eptinezumab vs placebo led to significantly greater improvements in EQ-5D-5L visual analog scale scores (difference from placebo [Δ] 5.1; P < .001, and Δ 7.5; P < .0001, respectively), 6-item Headache Impact Test total scores (Δ −3.8 and −5.4, respectively; both P < .0001), Migraine-Specific Quality of Life Questionnaire scores (both P < .0001), and patient-identified most bothersome symptoms (both P < .0001), with effects sustained until week 24.

Study details: Findings are from the phase 3b DELIVER trial including 890 adults with episodic/chronic migraine and 2-4 prior preventive treatment failures who were randomly assigned to receive eptinezumab (100/300 mg) or placebo.

Disclosures: The clinical trial and publication was funded by H. Lundbeck A/S. Five authors declared being employees of H. Lundbeck A/S. Three authors reported ties with various sources.

Source: Goadsby PJ et al. Eptinezumab improved patient-reported outcomes and quality of life in patients with migraine and prior preventive treatment failures. Eur J Neurol. 2022 (Dec 30). Doi: 10.1111/ene.15670

Key clinical point: Eptinezumab vs placebo demonstrated significantly greater and sustained improvements in patient-reported overall health, quality of life, and most bothersome symptoms in patients with migraine and 2-4 preventive treatment failures.

Major finding: At week 12, 100 and 300 mg eptinezumab vs placebo led to significantly greater improvements in EQ-5D-5L visual analog scale scores (difference from placebo [Δ] 5.1; P < .001, and Δ 7.5; P < .0001, respectively), 6-item Headache Impact Test total scores (Δ −3.8 and −5.4, respectively; both P < .0001), Migraine-Specific Quality of Life Questionnaire scores (both P < .0001), and patient-identified most bothersome symptoms (both P < .0001), with effects sustained until week 24.

Study details: Findings are from the phase 3b DELIVER trial including 890 adults with episodic/chronic migraine and 2-4 prior preventive treatment failures who were randomly assigned to receive eptinezumab (100/300 mg) or placebo.

Disclosures: The clinical trial and publication was funded by H. Lundbeck A/S. Five authors declared being employees of H. Lundbeck A/S. Three authors reported ties with various sources.

Source: Goadsby PJ et al. Eptinezumab improved patient-reported outcomes and quality of life in patients with migraine and prior preventive treatment failures. Eur J Neurol. 2022 (Dec 30). Doi: 10.1111/ene.15670

Key clinical point: Single session of onabotulinumtoxinA effectively reduced neck and migraine-related disability and pain intensity over 3 months in patients with chronic migraine.

Major finding: OnabotulinumtoxinA significantly reduced Neck Disability Index scores (median −16.5 points; P < .001) and Migraine Disability Assessment scores (median −28 points; P < .001) after 4 weeks. The neck pain intensity and migraine headache intensity reduced by almost half (both P < .001) and the median number of monthly headache days reduced from 20 to 6 days (P < .001) after 3 months of onabotulinumtoxinA treatment.

Study details: This retrospective study included 134 patients with chronic migraine who received one session of onabotulinumtoxinA treatment.

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

Source: Onan D et al. OnabotulinumtoxinA treatment in chronic migraine: Investigation of its effects on disability, headache and neck pain intensity. Toxins (Basel). 2022;15(1):29 (Dec 30). Doi: 10.3390/toxins15010029

Key clinical point: Single session of onabotulinumtoxinA effectively reduced neck and migraine-related disability and pain intensity over 3 months in patients with chronic migraine.

Major finding: OnabotulinumtoxinA significantly reduced Neck Disability Index scores (median −16.5 points; P < .001) and Migraine Disability Assessment scores (median −28 points; P < .001) after 4 weeks. The neck pain intensity and migraine headache intensity reduced by almost half (both P < .001) and the median number of monthly headache days reduced from 20 to 6 days (P < .001) after 3 months of onabotulinumtoxinA treatment.

Study details: This retrospective study included 134 patients with chronic migraine who received one session of onabotulinumtoxinA treatment.

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

Source: Onan D et al. OnabotulinumtoxinA treatment in chronic migraine: Investigation of its effects on disability, headache and neck pain intensity. Toxins (Basel). 2022;15(1):29 (Dec 30). Doi: 10.3390/toxins15010029

Key clinical point: Single session of onabotulinumtoxinA effectively reduced neck and migraine-related disability and pain intensity over 3 months in patients with chronic migraine.

Major finding: OnabotulinumtoxinA significantly reduced Neck Disability Index scores (median −16.5 points; P < .001) and Migraine Disability Assessment scores (median −28 points; P < .001) after 4 weeks. The neck pain intensity and migraine headache intensity reduced by almost half (both P < .001) and the median number of monthly headache days reduced from 20 to 6 days (P < .001) after 3 months of onabotulinumtoxinA treatment.

Study details: This retrospective study included 134 patients with chronic migraine who received one session of onabotulinumtoxinA treatment.

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

Source: Onan D et al. OnabotulinumtoxinA treatment in chronic migraine: Investigation of its effects on disability, headache and neck pain intensity. Toxins (Basel). 2022;15(1):29 (Dec 30). Doi: 10.3390/toxins15010029

Key clinical point: The safety and tolerability of once-daily atogepant observed over 40 weeks in this extension trial aligns with profiles from the pivotal phase 3 trials with no new safety signals identified in patients with episodic migraine.

Major finding: Nearly 63% of patients reported treatment-emergent adverse events, most being mild or moderate, with upper respiratory tract infection (5.5%) and urinary tract infection (5.3%) being most frequent. Treatment discontinuation rates due to lack of efficacy (0.6%) or adverse events (3.6%) were low. No deaths were reported.

Study details: Findings are from the 309-OLEX trial, an open-label extension of phase 3 ADVANCE trial, including 685 patients with episodic migraine with or without aura who received 60 mg atogepant once daily for 40 weeks.

Disclosures: This study was supported by AbbVie Inc. (formerly Allergan). Five authors declared being full-time or former employees of or holding stock or stock options in AbbVie. Several authors reported ties with various sources, including AbbVie.

Source: Klein BC et al. Safety and tolerability results of atogepant for the preventive treatment of episodic migraine from a 40-week, open-label multicenter extension of the phase 3 ADVANCE trial. Cephalalgia. 2023 (Jan 9). Doi: 10.1177/03331024221128250

Key clinical point: The safety and tolerability of once-daily atogepant observed over 40 weeks in this extension trial aligns with profiles from the pivotal phase 3 trials with no new safety signals identified in patients with episodic migraine.

Major finding: Nearly 63% of patients reported treatment-emergent adverse events, most being mild or moderate, with upper respiratory tract infection (5.5%) and urinary tract infection (5.3%) being most frequent. Treatment discontinuation rates due to lack of efficacy (0.6%) or adverse events (3.6%) were low. No deaths were reported.

Study details: Findings are from the 309-OLEX trial, an open-label extension of phase 3 ADVANCE trial, including 685 patients with episodic migraine with or without aura who received 60 mg atogepant once daily for 40 weeks.

Disclosures: This study was supported by AbbVie Inc. (formerly Allergan). Five authors declared being full-time or former employees of or holding stock or stock options in AbbVie. Several authors reported ties with various sources, including AbbVie.

Source: Klein BC et al. Safety and tolerability results of atogepant for the preventive treatment of episodic migraine from a 40-week, open-label multicenter extension of the phase 3 ADVANCE trial. Cephalalgia. 2023 (Jan 9). Doi: 10.1177/03331024221128250

Key clinical point: The safety and tolerability of once-daily atogepant observed over 40 weeks in this extension trial aligns with profiles from the pivotal phase 3 trials with no new safety signals identified in patients with episodic migraine.

Major finding: Nearly 63% of patients reported treatment-emergent adverse events, most being mild or moderate, with upper respiratory tract infection (5.5%) and urinary tract infection (5.3%) being most frequent. Treatment discontinuation rates due to lack of efficacy (0.6%) or adverse events (3.6%) were low. No deaths were reported.

Study details: Findings are from the 309-OLEX trial, an open-label extension of phase 3 ADVANCE trial, including 685 patients with episodic migraine with or without aura who received 60 mg atogepant once daily for 40 weeks.

Disclosures: This study was supported by AbbVie Inc. (formerly Allergan). Five authors declared being full-time or former employees of or holding stock or stock options in AbbVie. Several authors reported ties with various sources, including AbbVie.

Source: Klein BC et al. Safety and tolerability results of atogepant for the preventive treatment of episodic migraine from a 40-week, open-label multicenter extension of the phase 3 ADVANCE trial. Cephalalgia. 2023 (Jan 9). Doi: 10.1177/03331024221128250

Key clinical point: A preconception history of migraine showed no significant association with the risk for spontaneous abortion (SAB); however, routine use of medication, suggesting more severe migraine, may confer a greater SAB risk.

Major finding: Preconception migraine history did not increase the risk for SAB (adjusted hazard ratio [aHR] 1.03; 95% CI 0.91-1.16), but daily migraine medication use (aHR 1.38; 95% CI 0.81-2.35), use of prescription migraine prophylaxis medication (aHR 1.43; 95% CI 0.72-2.84), or analgesic/caffeine medication use (aHR 1.42; 95% CI 0.99-2.04) showed a modest but non-significant association with SAB risk.

Study details: This study evaluated 7890 participants from an ongoing prospective study who conceived during follow-up and had or did not have a preconception diagnosis of migraine or migraine medication use, of which 1537 experienced SAB.

Disclosures: This study was funded by the National Institute of Child Health and Human Development, US National Institutes of Health. The authors declared no conflicts of interest.

Source: Crowe HM et al. Pre‑pregnancy migraine diagnosis, medication use, and spontaneous abortion: A prospective cohort study. J Headache Pain. 2022;23:162 (Dec 20). Doi: 10.1186/s10194-022-01533-6

Key clinical point: A preconception history of migraine showed no significant association with the risk for spontaneous abortion (SAB); however, routine use of medication, suggesting more severe migraine, may confer a greater SAB risk.

Major finding: Preconception migraine history did not increase the risk for SAB (adjusted hazard ratio [aHR] 1.03; 95% CI 0.91-1.16), but daily migraine medication use (aHR 1.38; 95% CI 0.81-2.35), use of prescription migraine prophylaxis medication (aHR 1.43; 95% CI 0.72-2.84), or analgesic/caffeine medication use (aHR 1.42; 95% CI 0.99-2.04) showed a modest but non-significant association with SAB risk.

Study details: This study evaluated 7890 participants from an ongoing prospective study who conceived during follow-up and had or did not have a preconception diagnosis of migraine or migraine medication use, of which 1537 experienced SAB.

Disclosures: This study was funded by the National Institute of Child Health and Human Development, US National Institutes of Health. The authors declared no conflicts of interest.

Source: Crowe HM et al. Pre‑pregnancy migraine diagnosis, medication use, and spontaneous abortion: A prospective cohort study. J Headache Pain. 2022;23:162 (Dec 20). Doi: 10.1186/s10194-022-01533-6

Key clinical point: A preconception history of migraine showed no significant association with the risk for spontaneous abortion (SAB); however, routine use of medication, suggesting more severe migraine, may confer a greater SAB risk.

Major finding: Preconception migraine history did not increase the risk for SAB (adjusted hazard ratio [aHR] 1.03; 95% CI 0.91-1.16), but daily migraine medication use (aHR 1.38; 95% CI 0.81-2.35), use of prescription migraine prophylaxis medication (aHR 1.43; 95% CI 0.72-2.84), or analgesic/caffeine medication use (aHR 1.42; 95% CI 0.99-2.04) showed a modest but non-significant association with SAB risk.

Study details: This study evaluated 7890 participants from an ongoing prospective study who conceived during follow-up and had or did not have a preconception diagnosis of migraine or migraine medication use, of which 1537 experienced SAB.

Disclosures: This study was funded by the National Institute of Child Health and Human Development, US National Institutes of Health. The authors declared no conflicts of interest.

Source: Crowe HM et al. Pre‑pregnancy migraine diagnosis, medication use, and spontaneous abortion: A prospective cohort study. J Headache Pain. 2022;23:162 (Dec 20). Doi: 10.1186/s10194-022-01533-6

Key clinical point: A brief group education and supportive self-management program had no beneficial effects on clinically relevant outcomes in patients with chronic migraine or chronic tension type headache and episodic migraine, with or without medication overuse headache.

Major finding: At 12 months, Headache Impact Test scores (adjusted mean difference [AMD] −0.3; P  =  .56), number of headache days (AMD 0.2; P  =  .234), duration of headache (estimated difference [ED] 0.4; P  =  .361), and headache severity (ED 0.2; P  =  .163) were not significantly different between patients who received self-management intervention vs usual care.

Study details: The data come from CHESS, a randomized controlled trial, including 727 participants with chronic migraine or chronic tension type headache and episodic migraine, with or without medication overuse headache, who received self-management intervention or usual care.

Disclosures: This study was funded by the UK National Institute for Health Research Programme Grants for Applied Research program. Several authors reported receiving grants, personal fees, or honoraria from various sources or owning patent.

Source: Underwood M et al. A supportive self-management program for people with chronic headaches and migraine: A randomized controlled trial and economic evaluation. Neurology. 2022 (Dec 16). Doi: 10.1212/WNL.0000000000201518

Key clinical point: A brief group education and supportive self-management program had no beneficial effects on clinically relevant outcomes in patients with chronic migraine or chronic tension type headache and episodic migraine, with or without medication overuse headache.

Major finding: At 12 months, Headache Impact Test scores (adjusted mean difference [AMD] −0.3; P  =  .56), number of headache days (AMD 0.2; P  =  .234), duration of headache (estimated difference [ED] 0.4; P  =  .361), and headache severity (ED 0.2; P  =  .163) were not significantly different between patients who received self-management intervention vs usual care.

Study details: The data come from CHESS, a randomized controlled trial, including 727 participants with chronic migraine or chronic tension type headache and episodic migraine, with or without medication overuse headache, who received self-management intervention or usual care.

Disclosures: This study was funded by the UK National Institute for Health Research Programme Grants for Applied Research program. Several authors reported receiving grants, personal fees, or honoraria from various sources or owning patent.

Source: Underwood M et al. A supportive self-management program for people with chronic headaches and migraine: A randomized controlled trial and economic evaluation. Neurology. 2022 (Dec 16). Doi: 10.1212/WNL.0000000000201518

Key clinical point: A brief group education and supportive self-management program had no beneficial effects on clinically relevant outcomes in patients with chronic migraine or chronic tension type headache and episodic migraine, with or without medication overuse headache.

Major finding: At 12 months, Headache Impact Test scores (adjusted mean difference [AMD] −0.3; P  =  .56), number of headache days (AMD 0.2; P  =  .234), duration of headache (estimated difference [ED] 0.4; P  =  .361), and headache severity (ED 0.2; P  =  .163) were not significantly different between patients who received self-management intervention vs usual care.

Study details: The data come from CHESS, a randomized controlled trial, including 727 participants with chronic migraine or chronic tension type headache and episodic migraine, with or without medication overuse headache, who received self-management intervention or usual care.

Disclosures: This study was funded by the UK National Institute for Health Research Programme Grants for Applied Research program. Several authors reported receiving grants, personal fees, or honoraria from various sources or owning patent.

Source: Underwood M et al. A supportive self-management program for people with chronic headaches and migraine: A randomized controlled trial and economic evaluation. Neurology. 2022 (Dec 16). Doi: 10.1212/WNL.0000000000201518

Key clinical point: Erenumab and onabotulinumtoxinA (onabotA) dual therapy appeared less effective than erenumab alone in patients with chronic migraine.

Major finding: After 12 weeks, patients who were taking onabotA while initiating erenumab and maintained it as dual therapy (WBT) vs those who received erenumab alone (NoBT) had a lower reduction in mean monthly headache days (MHD; 4.7 vs 8.21 days; P  =  .009) and lower mean percentage improvement in MHD (21.7% vs 35.0%; P  =  .001), with a similar trend being observed among patients who were on onabotA while initiating erenumab but discontinued onabotA (WoBT).

Study details: This retrospective cohort study included 187 patients with chronic migraine who received WBT (n = 73), WoBT (n = 44), or NoBT (n = 70).

Disclosures: This study did not receive any specific funding. A Jaimes and J Rodríguez-Vico declared receiving honoraria or speaking fees from AbbVie and other sources.

Source: Jaimes A et al. Dual therapy with Erenumab and onabotulinumtoxinA: No synergistic effect in chronic migraine: A retrospective cohort study. Pain Pract. 2022 (Dec 12). Doi: 10.1111/papr.13196

Key clinical point: Erenumab and onabotulinumtoxinA (onabotA) dual therapy appeared less effective than erenumab alone in patients with chronic migraine.

Major finding: After 12 weeks, patients who were taking onabotA while initiating erenumab and maintained it as dual therapy (WBT) vs those who received erenumab alone (NoBT) had a lower reduction in mean monthly headache days (MHD; 4.7 vs 8.21 days; P  =  .009) and lower mean percentage improvement in MHD (21.7% vs 35.0%; P  =  .001), with a similar trend being observed among patients who were on onabotA while initiating erenumab but discontinued onabotA (WoBT).

Study details: This retrospective cohort study included 187 patients with chronic migraine who received WBT (n = 73), WoBT (n = 44), or NoBT (n = 70).

Disclosures: This study did not receive any specific funding. A Jaimes and J Rodríguez-Vico declared receiving honoraria or speaking fees from AbbVie and other sources.

Source: Jaimes A et al. Dual therapy with Erenumab and onabotulinumtoxinA: No synergistic effect in chronic migraine: A retrospective cohort study. Pain Pract. 2022 (Dec 12). Doi: 10.1111/papr.13196

Key clinical point: Erenumab and onabotulinumtoxinA (onabotA) dual therapy appeared less effective than erenumab alone in patients with chronic migraine.

Major finding: After 12 weeks, patients who were taking onabotA while initiating erenumab and maintained it as dual therapy (WBT) vs those who received erenumab alone (NoBT) had a lower reduction in mean monthly headache days (MHD; 4.7 vs 8.21 days; P  =  .009) and lower mean percentage improvement in MHD (21.7% vs 35.0%; P  =  .001), with a similar trend being observed among patients who were on onabotA while initiating erenumab but discontinued onabotA (WoBT).

Study details: This retrospective cohort study included 187 patients with chronic migraine who received WBT (n = 73), WoBT (n = 44), or NoBT (n = 70).

Disclosures: This study did not receive any specific funding. A Jaimes and J Rodríguez-Vico declared receiving honoraria or speaking fees from AbbVie and other sources.

Source: Jaimes A et al. Dual therapy with Erenumab and onabotulinumtoxinA: No synergistic effect in chronic migraine: A retrospective cohort study. Pain Pract. 2022 (Dec 12). Doi: 10.1111/papr.13196