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Eptinezumab Shows Promise For Treatment-refractory Migraine
Key clinical point: Switching to intravenous eptinezumab may benefit patients with treatment-refractory migraine who have previously failed subcutaneous calcitonin gene-related peptide-receptor (CGRP-R) monoclonal antibodies (mAbs).
Major findings: At 12 and 24 weeks of eptinezumab treatment, 23.1% and 29.7% of patients had ≥30% reduction in monthly migraine days, whereas 15.4% and 21.4% had ≥30% reduction in monthly headache days, respectively. At 21-24 weeks, 38.5% and 52.4% of patients showed significant reductions in the Headache Impact Test and Migraine Disability Assessment scores, respectively. No adverse events were reported during the 24-week treatment period.
Study details: This monocentric retrospective longitudinal cohort study included 41 patients with migraine unresponsive to ≥1 subcutaneous CGRP mAb, who received an initial 100 mg dose of intravenous eptinezumab, followed by 100 or 300 mg after 12 weeks.
Disclosure: This study was supported by the Lundbeck Foundation. Several authors declared receiving personal fees from various sources.
Source: Triller P, Blessing VN, Overeem LH, et al. Efficacy of eptinezumab in non-responders to subcutaneous monoclonal antibodies against CGRP and the CGRP receptor: A retrospective cohort study. Cephalalgia. Published online October 29, 2024. Source
Key clinical point: Switching to intravenous eptinezumab may benefit patients with treatment-refractory migraine who have previously failed subcutaneous calcitonin gene-related peptide-receptor (CGRP-R) monoclonal antibodies (mAbs).
Major findings: At 12 and 24 weeks of eptinezumab treatment, 23.1% and 29.7% of patients had ≥30% reduction in monthly migraine days, whereas 15.4% and 21.4% had ≥30% reduction in monthly headache days, respectively. At 21-24 weeks, 38.5% and 52.4% of patients showed significant reductions in the Headache Impact Test and Migraine Disability Assessment scores, respectively. No adverse events were reported during the 24-week treatment period.
Study details: This monocentric retrospective longitudinal cohort study included 41 patients with migraine unresponsive to ≥1 subcutaneous CGRP mAb, who received an initial 100 mg dose of intravenous eptinezumab, followed by 100 or 300 mg after 12 weeks.
Disclosure: This study was supported by the Lundbeck Foundation. Several authors declared receiving personal fees from various sources.
Source: Triller P, Blessing VN, Overeem LH, et al. Efficacy of eptinezumab in non-responders to subcutaneous monoclonal antibodies against CGRP and the CGRP receptor: A retrospective cohort study. Cephalalgia. Published online October 29, 2024. Source
Key clinical point: Switching to intravenous eptinezumab may benefit patients with treatment-refractory migraine who have previously failed subcutaneous calcitonin gene-related peptide-receptor (CGRP-R) monoclonal antibodies (mAbs).
Major findings: At 12 and 24 weeks of eptinezumab treatment, 23.1% and 29.7% of patients had ≥30% reduction in monthly migraine days, whereas 15.4% and 21.4% had ≥30% reduction in monthly headache days, respectively. At 21-24 weeks, 38.5% and 52.4% of patients showed significant reductions in the Headache Impact Test and Migraine Disability Assessment scores, respectively. No adverse events were reported during the 24-week treatment period.
Study details: This monocentric retrospective longitudinal cohort study included 41 patients with migraine unresponsive to ≥1 subcutaneous CGRP mAb, who received an initial 100 mg dose of intravenous eptinezumab, followed by 100 or 300 mg after 12 weeks.
Disclosure: This study was supported by the Lundbeck Foundation. Several authors declared receiving personal fees from various sources.
Source: Triller P, Blessing VN, Overeem LH, et al. Efficacy of eptinezumab in non-responders to subcutaneous monoclonal antibodies against CGRP and the CGRP receptor: A retrospective cohort study. Cephalalgia. Published online October 29, 2024. Source
Elevated Waist-to-Height Ratio Linked to Increased Migraine Incidence in Young Adults
Key clinical point: An increased waist-to-height ratio (WHtR), indicating central obesity, was associated with an increased incidence of migraine, particularly in individuals aged <60 years.
Major findings: Each unit increase in WHtR was associated with a 70% increase in the incidence of migraines (odds ratio [OR], 1.70; 95% CI, 1.04-2.78). Individuals in the highest WHtR quartile (WHtR values, 0.64-1.01) had a 13% greater incidence of migraines than those in the lowest quartile (WHtR values, 0.35-0.52; OR, 1.13; 95% CI, 0.99-1.28). For individuals aged <60 years, each unit increase in WHtR was associated with an 82% increased risk for migraine (P < .01); however, WHtR was negatively associated with migraine risk among those aged ≥60 years.
Study details: This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey, including 13,344 participants, of whom 2764 had migraines. Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.
Source: Jin J, Zheng Y, Gao T, Lin X, Li S, Huang C. Associations between the waist-to-height ratio index and migraine: A cross-section study of the NHANES 1999–2004. PLoS ONE. Published online October 23, 2024. Source
Key clinical point: An increased waist-to-height ratio (WHtR), indicating central obesity, was associated with an increased incidence of migraine, particularly in individuals aged <60 years.
Major findings: Each unit increase in WHtR was associated with a 70% increase in the incidence of migraines (odds ratio [OR], 1.70; 95% CI, 1.04-2.78). Individuals in the highest WHtR quartile (WHtR values, 0.64-1.01) had a 13% greater incidence of migraines than those in the lowest quartile (WHtR values, 0.35-0.52; OR, 1.13; 95% CI, 0.99-1.28). For individuals aged <60 years, each unit increase in WHtR was associated with an 82% increased risk for migraine (P < .01); however, WHtR was negatively associated with migraine risk among those aged ≥60 years.
Study details: This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey, including 13,344 participants, of whom 2764 had migraines. Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.
Source: Jin J, Zheng Y, Gao T, Lin X, Li S, Huang C. Associations between the waist-to-height ratio index and migraine: A cross-section study of the NHANES 1999–2004. PLoS ONE. Published online October 23, 2024. Source
Key clinical point: An increased waist-to-height ratio (WHtR), indicating central obesity, was associated with an increased incidence of migraine, particularly in individuals aged <60 years.
Major findings: Each unit increase in WHtR was associated with a 70% increase in the incidence of migraines (odds ratio [OR], 1.70; 95% CI, 1.04-2.78). Individuals in the highest WHtR quartile (WHtR values, 0.64-1.01) had a 13% greater incidence of migraines than those in the lowest quartile (WHtR values, 0.35-0.52; OR, 1.13; 95% CI, 0.99-1.28). For individuals aged <60 years, each unit increase in WHtR was associated with an 82% increased risk for migraine (P < .01); however, WHtR was negatively associated with migraine risk among those aged ≥60 years.
Study details: This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey, including 13,344 participants, of whom 2764 had migraines. Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.
Source: Jin J, Zheng Y, Gao T, Lin X, Li S, Huang C. Associations between the waist-to-height ratio index and migraine: A cross-section study of the NHANES 1999–2004. PLoS ONE. Published online October 23, 2024. Source
Pharmacologic Treatment of Chronic Migraine: A Revolution in Progress
Pharmacologic Treatment of Chronic Migraine: A Revolution in Progress
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In assessing chronic medical disorders that adversely affect quality of life, including disorders such as malaria, acquired immunodeficiency syndrome, and sickle cell anemia, the World Health Organization has ranked migraine as the number 1 disorder for women. The diagnosis of chronic migraine (CM) implies an established history of migraine, including 15 or more days of headache per month. This clinical variant accounts for a disproportionate share of the public health burden generally imposed by migraine. One of the great paradoxes of migraine is that, despite this outsized burden, as few as 5% of the millions of Americans with CM seek medical attention, are diagnosed accurately, and receive appropriate therapy.
Why is this? The answer lies in part with the relatively recent formal recognition of CM as a distinct primary headache disorder. Not until the 2006 revision of the International Classification of Headache Disorders were widely accepted diagnostic criteria for CM available. Without such criteria in place, meaningful clinical research (and therapeutic research in particular) is impossible. As recently as 2009, we consequently lacked any evidence-based therapies for suppression of CM. In what may be a therapeutic revolution unrivaled in almost any other area of clinical medicine, within 15 years we have identified and introduced into general clinical practice no fewer than 6 new evidence-based therapies for suppression of CM that are safe, generally well tolerated, and effective. Those therapies are onabotulinumtoxin A, an orally administered atogepant, the 3 subcutaneously self-administered anti–calcitonin gene-related peptide (CGRP) monoclonal antibodies (erenumab, galcanezumab, and fremanezumab), and the intravenously administered anti-CGRP monoclonal antibody eptinenzumab. A seventh and older therapy, topiramate, could be included in that group, except tolerability issues reduce its utility.
As we presently lack adequate active vs active comparator trials, at this point there is no “best” among these 6 CM therapies. Each is effective in reducing migraine burden substantially in a large proportion of patients. In many cases, the onset of the positive treatment response is gratifyingly rapid. Are they disease-modifying therapies (DMTs) that, in addition to suppressing symptoms, can alter the disorder’s biologic underpinnings and its long-term course? Put another way, does their benefit extend beyond the period of time the patient is actively on treatment? Given their relative newness, the answer is unknown. However, preliminary evidence suggests that onabotulinumtoxin A may qualify as a DMT. The US Food and Drug Administration indicated onabotulinumtoxin A for CM in 2010, and it is the first of the group introduced into clinical practice.
Complicating clinical use of these 6 therapies for suppression of CM have been various proscriptions emanating from the health care insurance industry. Chief among these has been the oft-encountered mandate that, for 1 of these 6 evidence-based treatments to be authorized for coverage, the patient with CM first must fail an “adequate” trial of multiple older, generic, and less costly therapies commonly used for prophylaxis in episodic migraine. But, with the exception of frequently difficult-to-tolerate topiramate, these therapies have no meaningful evidence base for use in CM. Furthermore, some limited evidence suggests that the efficacy of the evidence-based treatments may be less robust in patients whose CM has been longstanding. Therefore, spending many months prescribing a succession of therapies lacking an evidence base seems counterproductive and contrary to the patient’s best interests, when evidence-based therapies are available. In addition, the higher cost of evidence-based therapies may be offset by their reduction in the direct medical costs that result from clinical improvement.
The American Headache Society (AHS) recently published a position statement recommending that the CGRP-targeting medications─both the small molecule gepants and the large molecule monoclonal antibodies─be considered first-line treatment for migraine prevention. An estimated 40% of patients with migraine require prevention therapy. The soundness of the AHS recommendation is especially evident in the sizeable subset of that population with CM; for treatment of CM, this list of recommended first-line therapies logically can be extended to include onabotulinumtoxin A. In their consensus statement the AHS acknowledged the relatively higher cost of these therapies but noted the resulting reduction in direct and indirect costs could justify their use.
Migraine ranks near or at the top of the list of chronic medical disorders that adversely impact public health. CM, a common variant of migraine, is particularly adept at eroding quality of life. Presently available are 6 safe and typically well-tolerated therapies, known to be effective for treating CM and potentially capable of modifying its long-term course. Although the cost of these exceeds the cost of older generic therapies commonly used for migraine prophylaxis, those older therapies generally lack any meaningful evidence base for use in CM. In addition, prescription of these older therapies may delay easing the CM patient’s migraine burden without any associated reduction in long-term net cost. Both medically and financially, a strong case can be made for designating these 6 medications as first-line therapy for CM. Insurers, the ball is now in your court.
1Department of Neurology, Inova Health/the University of Virginia School of Medicine
2Department of Neurology, UCLA School of Medicine, Los Angeles
Disclosures:
Dr John Rothrock is a specialty care physician board certified in neurology and vascular neurology at Inova Health System. He joined Inova in 2022 and has been practicing since 1984.
Dr Rothrock is actively receiving funding for an educational grant from AbbVie and funding for clinical research from AbbVie, Lundbeck, and Ipsen.
Dr Alan Rapoport is a past-president of the International Headache Society (IHS) and is also the founder and Director-Emeritus of The New England Center for Headache in Stamford, Connecticut. Dr Rapoport does not have any financial disclosures.
Corresponding Author:
John Rothrock, MD
rothrockjf@gmail.com
1Department of Neurology, Inova Health/the University of Virginia School of Medicine
2Department of Neurology, UCLA School of Medicine, Los Angeles
Disclosures:
Dr John Rothrock is a specialty care physician board certified in neurology and vascular neurology at Inova Health System. He joined Inova in 2022 and has been practicing since 1984.
Dr Rothrock is actively receiving funding for an educational grant from AbbVie and funding for clinical research from AbbVie, Lundbeck, and Ipsen.
Dr Alan Rapoport is a past-president of the International Headache Society (IHS) and is also the founder and Director-Emeritus of The New England Center for Headache in Stamford, Connecticut. Dr Rapoport does not have any financial disclosures.
Corresponding Author:
John Rothrock, MD
rothrockjf@gmail.com
1Department of Neurology, Inova Health/the University of Virginia School of Medicine
2Department of Neurology, UCLA School of Medicine, Los Angeles
Disclosures:
Dr John Rothrock is a specialty care physician board certified in neurology and vascular neurology at Inova Health System. He joined Inova in 2022 and has been practicing since 1984.
Dr Rothrock is actively receiving funding for an educational grant from AbbVie and funding for clinical research from AbbVie, Lundbeck, and Ipsen.
Dr Alan Rapoport is a past-president of the International Headache Society (IHS) and is also the founder and Director-Emeritus of The New England Center for Headache in Stamford, Connecticut. Dr Rapoport does not have any financial disclosures.
Corresponding Author:
John Rothrock, MD
rothrockjf@gmail.com
In assessing chronic medical disorders that adversely affect quality of life, including disorders such as malaria, acquired immunodeficiency syndrome, and sickle cell anemia, the World Health Organization has ranked migraine as the number 1 disorder for women. The diagnosis of chronic migraine (CM) implies an established history of migraine, including 15 or more days of headache per month. This clinical variant accounts for a disproportionate share of the public health burden generally imposed by migraine. One of the great paradoxes of migraine is that, despite this outsized burden, as few as 5% of the millions of Americans with CM seek medical attention, are diagnosed accurately, and receive appropriate therapy.
Why is this? The answer lies in part with the relatively recent formal recognition of CM as a distinct primary headache disorder. Not until the 2006 revision of the International Classification of Headache Disorders were widely accepted diagnostic criteria for CM available. Without such criteria in place, meaningful clinical research (and therapeutic research in particular) is impossible. As recently as 2009, we consequently lacked any evidence-based therapies for suppression of CM. In what may be a therapeutic revolution unrivaled in almost any other area of clinical medicine, within 15 years we have identified and introduced into general clinical practice no fewer than 6 new evidence-based therapies for suppression of CM that are safe, generally well tolerated, and effective. Those therapies are onabotulinumtoxin A, an orally administered atogepant, the 3 subcutaneously self-administered anti–calcitonin gene-related peptide (CGRP) monoclonal antibodies (erenumab, galcanezumab, and fremanezumab), and the intravenously administered anti-CGRP monoclonal antibody eptinenzumab. A seventh and older therapy, topiramate, could be included in that group, except tolerability issues reduce its utility.
As we presently lack adequate active vs active comparator trials, at this point there is no “best” among these 6 CM therapies. Each is effective in reducing migraine burden substantially in a large proportion of patients. In many cases, the onset of the positive treatment response is gratifyingly rapid. Are they disease-modifying therapies (DMTs) that, in addition to suppressing symptoms, can alter the disorder’s biologic underpinnings and its long-term course? Put another way, does their benefit extend beyond the period of time the patient is actively on treatment? Given their relative newness, the answer is unknown. However, preliminary evidence suggests that onabotulinumtoxin A may qualify as a DMT. The US Food and Drug Administration indicated onabotulinumtoxin A for CM in 2010, and it is the first of the group introduced into clinical practice.
Complicating clinical use of these 6 therapies for suppression of CM have been various proscriptions emanating from the health care insurance industry. Chief among these has been the oft-encountered mandate that, for 1 of these 6 evidence-based treatments to be authorized for coverage, the patient with CM first must fail an “adequate” trial of multiple older, generic, and less costly therapies commonly used for prophylaxis in episodic migraine. But, with the exception of frequently difficult-to-tolerate topiramate, these therapies have no meaningful evidence base for use in CM. Furthermore, some limited evidence suggests that the efficacy of the evidence-based treatments may be less robust in patients whose CM has been longstanding. Therefore, spending many months prescribing a succession of therapies lacking an evidence base seems counterproductive and contrary to the patient’s best interests, when evidence-based therapies are available. In addition, the higher cost of evidence-based therapies may be offset by their reduction in the direct medical costs that result from clinical improvement.
The American Headache Society (AHS) recently published a position statement recommending that the CGRP-targeting medications─both the small molecule gepants and the large molecule monoclonal antibodies─be considered first-line treatment for migraine prevention. An estimated 40% of patients with migraine require prevention therapy. The soundness of the AHS recommendation is especially evident in the sizeable subset of that population with CM; for treatment of CM, this list of recommended first-line therapies logically can be extended to include onabotulinumtoxin A. In their consensus statement the AHS acknowledged the relatively higher cost of these therapies but noted the resulting reduction in direct and indirect costs could justify their use.
Migraine ranks near or at the top of the list of chronic medical disorders that adversely impact public health. CM, a common variant of migraine, is particularly adept at eroding quality of life. Presently available are 6 safe and typically well-tolerated therapies, known to be effective for treating CM and potentially capable of modifying its long-term course. Although the cost of these exceeds the cost of older generic therapies commonly used for migraine prophylaxis, those older therapies generally lack any meaningful evidence base for use in CM. In addition, prescription of these older therapies may delay easing the CM patient’s migraine burden without any associated reduction in long-term net cost. Both medically and financially, a strong case can be made for designating these 6 medications as first-line therapy for CM. Insurers, the ball is now in your court.
In assessing chronic medical disorders that adversely affect quality of life, including disorders such as malaria, acquired immunodeficiency syndrome, and sickle cell anemia, the World Health Organization has ranked migraine as the number 1 disorder for women. The diagnosis of chronic migraine (CM) implies an established history of migraine, including 15 or more days of headache per month. This clinical variant accounts for a disproportionate share of the public health burden generally imposed by migraine. One of the great paradoxes of migraine is that, despite this outsized burden, as few as 5% of the millions of Americans with CM seek medical attention, are diagnosed accurately, and receive appropriate therapy.
Why is this? The answer lies in part with the relatively recent formal recognition of CM as a distinct primary headache disorder. Not until the 2006 revision of the International Classification of Headache Disorders were widely accepted diagnostic criteria for CM available. Without such criteria in place, meaningful clinical research (and therapeutic research in particular) is impossible. As recently as 2009, we consequently lacked any evidence-based therapies for suppression of CM. In what may be a therapeutic revolution unrivaled in almost any other area of clinical medicine, within 15 years we have identified and introduced into general clinical practice no fewer than 6 new evidence-based therapies for suppression of CM that are safe, generally well tolerated, and effective. Those therapies are onabotulinumtoxin A, an orally administered atogepant, the 3 subcutaneously self-administered anti–calcitonin gene-related peptide (CGRP) monoclonal antibodies (erenumab, galcanezumab, and fremanezumab), and the intravenously administered anti-CGRP monoclonal antibody eptinenzumab. A seventh and older therapy, topiramate, could be included in that group, except tolerability issues reduce its utility.
As we presently lack adequate active vs active comparator trials, at this point there is no “best” among these 6 CM therapies. Each is effective in reducing migraine burden substantially in a large proportion of patients. In many cases, the onset of the positive treatment response is gratifyingly rapid. Are they disease-modifying therapies (DMTs) that, in addition to suppressing symptoms, can alter the disorder’s biologic underpinnings and its long-term course? Put another way, does their benefit extend beyond the period of time the patient is actively on treatment? Given their relative newness, the answer is unknown. However, preliminary evidence suggests that onabotulinumtoxin A may qualify as a DMT. The US Food and Drug Administration indicated onabotulinumtoxin A for CM in 2010, and it is the first of the group introduced into clinical practice.
Complicating clinical use of these 6 therapies for suppression of CM have been various proscriptions emanating from the health care insurance industry. Chief among these has been the oft-encountered mandate that, for 1 of these 6 evidence-based treatments to be authorized for coverage, the patient with CM first must fail an “adequate” trial of multiple older, generic, and less costly therapies commonly used for prophylaxis in episodic migraine. But, with the exception of frequently difficult-to-tolerate topiramate, these therapies have no meaningful evidence base for use in CM. Furthermore, some limited evidence suggests that the efficacy of the evidence-based treatments may be less robust in patients whose CM has been longstanding. Therefore, spending many months prescribing a succession of therapies lacking an evidence base seems counterproductive and contrary to the patient’s best interests, when evidence-based therapies are available. In addition, the higher cost of evidence-based therapies may be offset by their reduction in the direct medical costs that result from clinical improvement.
The American Headache Society (AHS) recently published a position statement recommending that the CGRP-targeting medications─both the small molecule gepants and the large molecule monoclonal antibodies─be considered first-line treatment for migraine prevention. An estimated 40% of patients with migraine require prevention therapy. The soundness of the AHS recommendation is especially evident in the sizeable subset of that population with CM; for treatment of CM, this list of recommended first-line therapies logically can be extended to include onabotulinumtoxin A. In their consensus statement the AHS acknowledged the relatively higher cost of these therapies but noted the resulting reduction in direct and indirect costs could justify their use.
Migraine ranks near or at the top of the list of chronic medical disorders that adversely impact public health. CM, a common variant of migraine, is particularly adept at eroding quality of life. Presently available are 6 safe and typically well-tolerated therapies, known to be effective for treating CM and potentially capable of modifying its long-term course. Although the cost of these exceeds the cost of older generic therapies commonly used for migraine prophylaxis, those older therapies generally lack any meaningful evidence base for use in CM. In addition, prescription of these older therapies may delay easing the CM patient’s migraine burden without any associated reduction in long-term net cost. Both medically and financially, a strong case can be made for designating these 6 medications as first-line therapy for CM. Insurers, the ball is now in your court.
Pharmacologic Treatment of Chronic Migraine: A Revolution in Progress
Pharmacologic Treatment of Chronic Migraine: A Revolution in Progress
Commentary: Comparing Migraine Treatments, November 2024
With increasing options for migraine therapy, the right choice for each patient might not be clear. And many individual patients could experience relief from any of the different choices, meaning that there is often more than one “right” answer when it comes to selecting a migraine treatment approach for each patient. Triptans and nonsteroidal anti-inflammatory drugs (NSAIDs), which have been around for decades, have shown consistent success in treating migraine episodes. Newer therapies could be safer for patients who have contraindications to triptans or NSAIDs, and these newer medications could be more effective for some patients, but we are still trying to fully understand which types of patients. Studies aimed at reaching conclusions regarding comparisons between triptans, calcitonin gene-related peptide inhibitors (CGRPi), and other treatments can help us determine which of the different categories of treatments are most effective for certain migraine populations (age or migraine subtype) or indications (acute vs preventive therapy).
A review published in 2023 in Aging and Disease described several markers of aging that are associated with migraine, including epigenetic aging and oxidative stress.2 The review authors noted that markers of cellular senescence (ie, irreversible inhibition of cellular division) were increased in association with migraine. Additionally, endothelial progenitor cells, which reflect an increased ability for cell renewal, were decreased among migraine patients compared with the control group.
Telomeres, composed of nucleotides, are part of chromosome structures, serving to protect the molecular integrity of DNA. It has been established that shortened telomeres, often considered a reflection of aging and a marker of high potential for genetic and cellular damage, are a risk factor for physiologic changes that occur with the aging process. The 2024 Scientific Reports cross-sectional study included data from 6169 participants in the National Health and Nutrition Survey (NHANES) from 1999 to 2002.1 The researchers used statistical analysis to determine whether there was an age-influenced telomere length in relation to migraine. They found that “telomere length was inversely associated with migraine risk in those aged 20-50 years, while no relationship was observed in those aged > 50 years.” The significance of this association among the younger group, but not among the older group, is not clear.
The limited research regarding the links between migraine and physiologic markers of aging has not untangled cause-and-effect distinctions. And while there is no evidence that preventing or treating migraine could slow down these pro-aging molecular processes, we do know that the distress of migraine episodes contributes to pain, anxiety, stress, depression, and sleep disruption. Given that we can’t change a patient’s hereditary predisposition to migraines, we can make an effort to alleviate the impact of migraine by using the tools that we have.
An article published in September 2024 in the BMJ described the results of a meta-analysis that included “137 randomized controlled trials with 89,445 participants allocated to 1 of 17 active interventions or placebo.”3 Treatments included NSAIDs, paracetamol, triptans, and CGRPi. The authors observed that triptans “had the best profiles and were more efficacious” than other treatment categories, including CGRPi. Interestingly, they observed that eletriptan and ibuprofen performed better for sustained pain freedom. Efficacy and sustained relief are crucial for patients with migraine, and for those who experience relief with simple over-the-counter ibuprofen, it makes sense to avoid making changes. But for those who are not getting the relief they need with established migraine therapies, trying the newer medications, such as CGRPi, could provide a solution. It is also important to keep in mind that triptans are contraindicated for some patients, such as those with a high-risk cardiovascular profile. Additionally, some patients may have contraindications to NSAIDs.
Prevention is another important aspect of migraine care. A September 2024 article in Headache: The Journal of Head and Face Pain used a retrospective cohort analysis of Patient-Reported Outcomes Measurement Information System (PROMIS) data, which included 1245 patients using a variety of migraine preventive therapies: antidepressants, antiseizure medications, beta-blockers, and CGRPi.4 The researchers reported that patients taking “CGRPi had a statistically significant reduction in pain T-scores (60.4 [standard deviation (SD) 7.4] to 58.4 [SD 8.2], p = 0.003), especially those who switched from other preventative medications to CGRPi.” This, along with the BMJ meta-analysis,3 helps in assessing relative benefits for treatments of acute migraine episodes and for migraine prevention. However, the efficacy of various types of therapy highlights the value of considering all options for each patient.
Individual patient characteristics, particularly contraindications, also play an important role in guiding therapeutic selection. And trial and error remain part of migraine treatment, given that there are no pretesting determinants that can predict treatment success for individual patients. We need to emphasize to patients that effective migraine therapy is obtainable and important — for comfort, quality of life, and possibly overall healthy aging.
References
- Geng D, Liu H, Wang H, Wang H. Telomere length exhibits inverse association with migraine among Americans aged 20-50 years, without implications beyond age 50: a cross-sectional study. Sci Rep. 2024;14:22597. Source
- Fila M, Pawlowska E, Szczepanska J, Blasiak J. Different aspects of aging in migraine. Aging Dis. 2023;14:6. Source
- Karlsson WK, Ostinelli EG, Zhuang ZA, et al. Comparative effects of drug interventions for the acute management of migraine episodes in adults: Systematic review and network meta-analysis. BMJ. 2024;386:e080107. Source
- Peasah SK, Soh YH, Huang Y, Nguyen J, Hanmer J, Good C. Patient reported outcomes and real-world use of calcitonin gene-related peptide medications in migraine. Headache. Published online September 30, 202 Source
With increasing options for migraine therapy, the right choice for each patient might not be clear. And many individual patients could experience relief from any of the different choices, meaning that there is often more than one “right” answer when it comes to selecting a migraine treatment approach for each patient. Triptans and nonsteroidal anti-inflammatory drugs (NSAIDs), which have been around for decades, have shown consistent success in treating migraine episodes. Newer therapies could be safer for patients who have contraindications to triptans or NSAIDs, and these newer medications could be more effective for some patients, but we are still trying to fully understand which types of patients. Studies aimed at reaching conclusions regarding comparisons between triptans, calcitonin gene-related peptide inhibitors (CGRPi), and other treatments can help us determine which of the different categories of treatments are most effective for certain migraine populations (age or migraine subtype) or indications (acute vs preventive therapy).
A review published in 2023 in Aging and Disease described several markers of aging that are associated with migraine, including epigenetic aging and oxidative stress.2 The review authors noted that markers of cellular senescence (ie, irreversible inhibition of cellular division) were increased in association with migraine. Additionally, endothelial progenitor cells, which reflect an increased ability for cell renewal, were decreased among migraine patients compared with the control group.
Telomeres, composed of nucleotides, are part of chromosome structures, serving to protect the molecular integrity of DNA. It has been established that shortened telomeres, often considered a reflection of aging and a marker of high potential for genetic and cellular damage, are a risk factor for physiologic changes that occur with the aging process. The 2024 Scientific Reports cross-sectional study included data from 6169 participants in the National Health and Nutrition Survey (NHANES) from 1999 to 2002.1 The researchers used statistical analysis to determine whether there was an age-influenced telomere length in relation to migraine. They found that “telomere length was inversely associated with migraine risk in those aged 20-50 years, while no relationship was observed in those aged > 50 years.” The significance of this association among the younger group, but not among the older group, is not clear.
The limited research regarding the links between migraine and physiologic markers of aging has not untangled cause-and-effect distinctions. And while there is no evidence that preventing or treating migraine could slow down these pro-aging molecular processes, we do know that the distress of migraine episodes contributes to pain, anxiety, stress, depression, and sleep disruption. Given that we can’t change a patient’s hereditary predisposition to migraines, we can make an effort to alleviate the impact of migraine by using the tools that we have.
An article published in September 2024 in the BMJ described the results of a meta-analysis that included “137 randomized controlled trials with 89,445 participants allocated to 1 of 17 active interventions or placebo.”3 Treatments included NSAIDs, paracetamol, triptans, and CGRPi. The authors observed that triptans “had the best profiles and were more efficacious” than other treatment categories, including CGRPi. Interestingly, they observed that eletriptan and ibuprofen performed better for sustained pain freedom. Efficacy and sustained relief are crucial for patients with migraine, and for those who experience relief with simple over-the-counter ibuprofen, it makes sense to avoid making changes. But for those who are not getting the relief they need with established migraine therapies, trying the newer medications, such as CGRPi, could provide a solution. It is also important to keep in mind that triptans are contraindicated for some patients, such as those with a high-risk cardiovascular profile. Additionally, some patients may have contraindications to NSAIDs.
Prevention is another important aspect of migraine care. A September 2024 article in Headache: The Journal of Head and Face Pain used a retrospective cohort analysis of Patient-Reported Outcomes Measurement Information System (PROMIS) data, which included 1245 patients using a variety of migraine preventive therapies: antidepressants, antiseizure medications, beta-blockers, and CGRPi.4 The researchers reported that patients taking “CGRPi had a statistically significant reduction in pain T-scores (60.4 [standard deviation (SD) 7.4] to 58.4 [SD 8.2], p = 0.003), especially those who switched from other preventative medications to CGRPi.” This, along with the BMJ meta-analysis,3 helps in assessing relative benefits for treatments of acute migraine episodes and for migraine prevention. However, the efficacy of various types of therapy highlights the value of considering all options for each patient.
Individual patient characteristics, particularly contraindications, also play an important role in guiding therapeutic selection. And trial and error remain part of migraine treatment, given that there are no pretesting determinants that can predict treatment success for individual patients. We need to emphasize to patients that effective migraine therapy is obtainable and important — for comfort, quality of life, and possibly overall healthy aging.
References
- Geng D, Liu H, Wang H, Wang H. Telomere length exhibits inverse association with migraine among Americans aged 20-50 years, without implications beyond age 50: a cross-sectional study. Sci Rep. 2024;14:22597. Source
- Fila M, Pawlowska E, Szczepanska J, Blasiak J. Different aspects of aging in migraine. Aging Dis. 2023;14:6. Source
- Karlsson WK, Ostinelli EG, Zhuang ZA, et al. Comparative effects of drug interventions for the acute management of migraine episodes in adults: Systematic review and network meta-analysis. BMJ. 2024;386:e080107. Source
- Peasah SK, Soh YH, Huang Y, Nguyen J, Hanmer J, Good C. Patient reported outcomes and real-world use of calcitonin gene-related peptide medications in migraine. Headache. Published online September 30, 202 Source
With increasing options for migraine therapy, the right choice for each patient might not be clear. And many individual patients could experience relief from any of the different choices, meaning that there is often more than one “right” answer when it comes to selecting a migraine treatment approach for each patient. Triptans and nonsteroidal anti-inflammatory drugs (NSAIDs), which have been around for decades, have shown consistent success in treating migraine episodes. Newer therapies could be safer for patients who have contraindications to triptans or NSAIDs, and these newer medications could be more effective for some patients, but we are still trying to fully understand which types of patients. Studies aimed at reaching conclusions regarding comparisons between triptans, calcitonin gene-related peptide inhibitors (CGRPi), and other treatments can help us determine which of the different categories of treatments are most effective for certain migraine populations (age or migraine subtype) or indications (acute vs preventive therapy).
A review published in 2023 in Aging and Disease described several markers of aging that are associated with migraine, including epigenetic aging and oxidative stress.2 The review authors noted that markers of cellular senescence (ie, irreversible inhibition of cellular division) were increased in association with migraine. Additionally, endothelial progenitor cells, which reflect an increased ability for cell renewal, were decreased among migraine patients compared with the control group.
Telomeres, composed of nucleotides, are part of chromosome structures, serving to protect the molecular integrity of DNA. It has been established that shortened telomeres, often considered a reflection of aging and a marker of high potential for genetic and cellular damage, are a risk factor for physiologic changes that occur with the aging process. The 2024 Scientific Reports cross-sectional study included data from 6169 participants in the National Health and Nutrition Survey (NHANES) from 1999 to 2002.1 The researchers used statistical analysis to determine whether there was an age-influenced telomere length in relation to migraine. They found that “telomere length was inversely associated with migraine risk in those aged 20-50 years, while no relationship was observed in those aged > 50 years.” The significance of this association among the younger group, but not among the older group, is not clear.
The limited research regarding the links between migraine and physiologic markers of aging has not untangled cause-and-effect distinctions. And while there is no evidence that preventing or treating migraine could slow down these pro-aging molecular processes, we do know that the distress of migraine episodes contributes to pain, anxiety, stress, depression, and sleep disruption. Given that we can’t change a patient’s hereditary predisposition to migraines, we can make an effort to alleviate the impact of migraine by using the tools that we have.
An article published in September 2024 in the BMJ described the results of a meta-analysis that included “137 randomized controlled trials with 89,445 participants allocated to 1 of 17 active interventions or placebo.”3 Treatments included NSAIDs, paracetamol, triptans, and CGRPi. The authors observed that triptans “had the best profiles and were more efficacious” than other treatment categories, including CGRPi. Interestingly, they observed that eletriptan and ibuprofen performed better for sustained pain freedom. Efficacy and sustained relief are crucial for patients with migraine, and for those who experience relief with simple over-the-counter ibuprofen, it makes sense to avoid making changes. But for those who are not getting the relief they need with established migraine therapies, trying the newer medications, such as CGRPi, could provide a solution. It is also important to keep in mind that triptans are contraindicated for some patients, such as those with a high-risk cardiovascular profile. Additionally, some patients may have contraindications to NSAIDs.
Prevention is another important aspect of migraine care. A September 2024 article in Headache: The Journal of Head and Face Pain used a retrospective cohort analysis of Patient-Reported Outcomes Measurement Information System (PROMIS) data, which included 1245 patients using a variety of migraine preventive therapies: antidepressants, antiseizure medications, beta-blockers, and CGRPi.4 The researchers reported that patients taking “CGRPi had a statistically significant reduction in pain T-scores (60.4 [standard deviation (SD) 7.4] to 58.4 [SD 8.2], p = 0.003), especially those who switched from other preventative medications to CGRPi.” This, along with the BMJ meta-analysis,3 helps in assessing relative benefits for treatments of acute migraine episodes and for migraine prevention. However, the efficacy of various types of therapy highlights the value of considering all options for each patient.
Individual patient characteristics, particularly contraindications, also play an important role in guiding therapeutic selection. And trial and error remain part of migraine treatment, given that there are no pretesting determinants that can predict treatment success for individual patients. We need to emphasize to patients that effective migraine therapy is obtainable and important — for comfort, quality of life, and possibly overall healthy aging.
References
- Geng D, Liu H, Wang H, Wang H. Telomere length exhibits inverse association with migraine among Americans aged 20-50 years, without implications beyond age 50: a cross-sectional study. Sci Rep. 2024;14:22597. Source
- Fila M, Pawlowska E, Szczepanska J, Blasiak J. Different aspects of aging in migraine. Aging Dis. 2023;14:6. Source
- Karlsson WK, Ostinelli EG, Zhuang ZA, et al. Comparative effects of drug interventions for the acute management of migraine episodes in adults: Systematic review and network meta-analysis. BMJ. 2024;386:e080107. Source
- Peasah SK, Soh YH, Huang Y, Nguyen J, Hanmer J, Good C. Patient reported outcomes and real-world use of calcitonin gene-related peptide medications in migraine. Headache. Published online September 30, 202 Source
Diabetes and Migraine May Have a Bidirectional Link
Key clinical point: Diabetes may have a bidirectional association with migraine risk. Type 1 diabetes (T1D) reduced the risk for migraine, whereas migraine without aura increased the risk for diabetes.
Major findings: Diabetes did not significantly affect the overall risk for migraine (odds ratio [OR], 0.85; P = .13). However, individuals with T1D had a lower risk for migraine (OR, 0.48; P = .002) than those without diabetes. Conversely, migraine did not significantly increase the risk for diabetes (OR, 1.00, P = .99), but individuals with migraine without aura had a higher risk for diabetes (OR, 1.19; P = .03) than those without migraine.
Study details: This meta-analysis included eight cross-sectional studies (131,361 patients with diabetes and 1,005,604 patients with migraine) and four cohort studies (103,205 patients with diabetes and 32,197 patients with migraine).
Disclosure: The study was funded by the Ministry of Health & Welfare, Republic of Korea, and the National Research Foundation of Korea. One author is a junior editor at The Journal of Headache and Pain, and another serves on its board and has received grants from the Korea Health Industry Development Institute.
Source: Ha WS, Nguyen VK, Chu MK. Epidemiological linkage between migraine and diabetes mellitus: A systematic review and meta-analysis. J Headache Pain. 2024;25:158. Source
Key clinical point: Diabetes may have a bidirectional association with migraine risk. Type 1 diabetes (T1D) reduced the risk for migraine, whereas migraine without aura increased the risk for diabetes.
Major findings: Diabetes did not significantly affect the overall risk for migraine (odds ratio [OR], 0.85; P = .13). However, individuals with T1D had a lower risk for migraine (OR, 0.48; P = .002) than those without diabetes. Conversely, migraine did not significantly increase the risk for diabetes (OR, 1.00, P = .99), but individuals with migraine without aura had a higher risk for diabetes (OR, 1.19; P = .03) than those without migraine.
Study details: This meta-analysis included eight cross-sectional studies (131,361 patients with diabetes and 1,005,604 patients with migraine) and four cohort studies (103,205 patients with diabetes and 32,197 patients with migraine).
Disclosure: The study was funded by the Ministry of Health & Welfare, Republic of Korea, and the National Research Foundation of Korea. One author is a junior editor at The Journal of Headache and Pain, and another serves on its board and has received grants from the Korea Health Industry Development Institute.
Source: Ha WS, Nguyen VK, Chu MK. Epidemiological linkage between migraine and diabetes mellitus: A systematic review and meta-analysis. J Headache Pain. 2024;25:158. Source
Key clinical point: Diabetes may have a bidirectional association with migraine risk. Type 1 diabetes (T1D) reduced the risk for migraine, whereas migraine without aura increased the risk for diabetes.
Major findings: Diabetes did not significantly affect the overall risk for migraine (odds ratio [OR], 0.85; P = .13). However, individuals with T1D had a lower risk for migraine (OR, 0.48; P = .002) than those without diabetes. Conversely, migraine did not significantly increase the risk for diabetes (OR, 1.00, P = .99), but individuals with migraine without aura had a higher risk for diabetes (OR, 1.19; P = .03) than those without migraine.
Study details: This meta-analysis included eight cross-sectional studies (131,361 patients with diabetes and 1,005,604 patients with migraine) and four cohort studies (103,205 patients with diabetes and 32,197 patients with migraine).
Disclosure: The study was funded by the Ministry of Health & Welfare, Republic of Korea, and the National Research Foundation of Korea. One author is a junior editor at The Journal of Headache and Pain, and another serves on its board and has received grants from the Korea Health Industry Development Institute.
Source: Ha WS, Nguyen VK, Chu MK. Epidemiological linkage between migraine and diabetes mellitus: A systematic review and meta-analysis. J Headache Pain. 2024;25:158. Source
Long-Term Safety of Dihydroergotamine Nasal Powder for Acute Treatment of Migraine
Key clinical point: Dihydroergotamine (DHE) nasal powder was well tolerated over the long term for the acute treatment of migraine.
Major findings: Treatment-emergent adverse events were reported in 48.5% of the participants, with nasal discomfort being the most common (11.3%). No deaths were reported. A serious adverse event related to treatment occurred in only one participant who did not disclose contraindications to DHE, and 4.4% of the participants discontinued the use of DHE. There were no new safety concerns.
Study details: The ASCEND trial involved 344 adults aged 18-65 years with a history of 4-12 migraine attacks per month for at least 1 year. Participants self-administered DHE (5.2 mg) as needed, with a maximum of 12 doses per month, for 1 year.
Disclosure: This study was funded by Satsuma Pharmaceuticals, Inc. Two authors declared being employees and stockholders of Satsuma, and others declared having ties with various sources, including Satsuma.
Sources: Tepper SJ, Albrecht D, Ailani J. Kirby L, Strom S, Rapoport AM. Long-term (12-Month) safety and tolerability of STS101 (dihydroergotamine nasal powder) in the acute treatment of migraine: Data from the phase 3 open-label ASCEND study. CNS Drugs. Published online October 7, 2024. Source
Key clinical point: Dihydroergotamine (DHE) nasal powder was well tolerated over the long term for the acute treatment of migraine.
Major findings: Treatment-emergent adverse events were reported in 48.5% of the participants, with nasal discomfort being the most common (11.3%). No deaths were reported. A serious adverse event related to treatment occurred in only one participant who did not disclose contraindications to DHE, and 4.4% of the participants discontinued the use of DHE. There were no new safety concerns.
Study details: The ASCEND trial involved 344 adults aged 18-65 years with a history of 4-12 migraine attacks per month for at least 1 year. Participants self-administered DHE (5.2 mg) as needed, with a maximum of 12 doses per month, for 1 year.
Disclosure: This study was funded by Satsuma Pharmaceuticals, Inc. Two authors declared being employees and stockholders of Satsuma, and others declared having ties with various sources, including Satsuma.
Sources: Tepper SJ, Albrecht D, Ailani J. Kirby L, Strom S, Rapoport AM. Long-term (12-Month) safety and tolerability of STS101 (dihydroergotamine nasal powder) in the acute treatment of migraine: Data from the phase 3 open-label ASCEND study. CNS Drugs. Published online October 7, 2024. Source
Key clinical point: Dihydroergotamine (DHE) nasal powder was well tolerated over the long term for the acute treatment of migraine.
Major findings: Treatment-emergent adverse events were reported in 48.5% of the participants, with nasal discomfort being the most common (11.3%). No deaths were reported. A serious adverse event related to treatment occurred in only one participant who did not disclose contraindications to DHE, and 4.4% of the participants discontinued the use of DHE. There were no new safety concerns.
Study details: The ASCEND trial involved 344 adults aged 18-65 years with a history of 4-12 migraine attacks per month for at least 1 year. Participants self-administered DHE (5.2 mg) as needed, with a maximum of 12 doses per month, for 1 year.
Disclosure: This study was funded by Satsuma Pharmaceuticals, Inc. Two authors declared being employees and stockholders of Satsuma, and others declared having ties with various sources, including Satsuma.
Sources: Tepper SJ, Albrecht D, Ailani J. Kirby L, Strom S, Rapoport AM. Long-term (12-Month) safety and tolerability of STS101 (dihydroergotamine nasal powder) in the acute treatment of migraine: Data from the phase 3 open-label ASCEND study. CNS Drugs. Published online October 7, 2024. Source
CGRP Inhibitors Outperform Other Migraine-Preventive Medications
Key clinical point: Patients with migraine who received calcitonin gene-related peptide inhibitors (CGRPi) showed improved pain reduction compared with those on other preventative medications.
Major findings: Patients who received only CGRPi or switched to CGRPi had significant reductions in mean pain scores (−2.0 and −2.7, respectively; both P < .001), whereas those on other migraine-preventative medications did not. Patients adhering to CGRPi, including those who received only CGRPi (−3.1; P = .005) and those who switched from other medications to CGRPi (−3.7; P = .002), had significantly reduced pain scores; however, no reduction in pain scores was noted in patients not adhering to CGRPi.
Study details: This retrospective study analyzed Patient Reported Outcomes Measurement Information System data for adults with migraine over 12 months, including 1245 patients on other preventive medications (antiseizures, antidepressants, or beta-blockers), 148 receiving only CGRPi, and 112 switching to CGRPi.
Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.
Source: Peasah SK, Soh YH, Huang Y, Nguyen J, Hanmer J, Good C. Patient reported outcomes and the real-world use of calcitonin gene–related peptide medications in migraine. Headache. Published online September 30, 2024. Source
Key clinical point: Patients with migraine who received calcitonin gene-related peptide inhibitors (CGRPi) showed improved pain reduction compared with those on other preventative medications.
Major findings: Patients who received only CGRPi or switched to CGRPi had significant reductions in mean pain scores (−2.0 and −2.7, respectively; both P < .001), whereas those on other migraine-preventative medications did not. Patients adhering to CGRPi, including those who received only CGRPi (−3.1; P = .005) and those who switched from other medications to CGRPi (−3.7; P = .002), had significantly reduced pain scores; however, no reduction in pain scores was noted in patients not adhering to CGRPi.
Study details: This retrospective study analyzed Patient Reported Outcomes Measurement Information System data for adults with migraine over 12 months, including 1245 patients on other preventive medications (antiseizures, antidepressants, or beta-blockers), 148 receiving only CGRPi, and 112 switching to CGRPi.
Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.
Source: Peasah SK, Soh YH, Huang Y, Nguyen J, Hanmer J, Good C. Patient reported outcomes and the real-world use of calcitonin gene–related peptide medications in migraine. Headache. Published online September 30, 2024. Source
Key clinical point: Patients with migraine who received calcitonin gene-related peptide inhibitors (CGRPi) showed improved pain reduction compared with those on other preventative medications.
Major findings: Patients who received only CGRPi or switched to CGRPi had significant reductions in mean pain scores (−2.0 and −2.7, respectively; both P < .001), whereas those on other migraine-preventative medications did not. Patients adhering to CGRPi, including those who received only CGRPi (−3.1; P = .005) and those who switched from other medications to CGRPi (−3.7; P = .002), had significantly reduced pain scores; however, no reduction in pain scores was noted in patients not adhering to CGRPi.
Study details: This retrospective study analyzed Patient Reported Outcomes Measurement Information System data for adults with migraine over 12 months, including 1245 patients on other preventive medications (antiseizures, antidepressants, or beta-blockers), 148 receiving only CGRPi, and 112 switching to CGRPi.
Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.
Source: Peasah SK, Soh YH, Huang Y, Nguyen J, Hanmer J, Good C. Patient reported outcomes and the real-world use of calcitonin gene–related peptide medications in migraine. Headache. Published online September 30, 2024. Source
Ubrogepant Offers Relief From Acute Migraine
Key clinical point: Ubrogepant showed real-world effectiveness for the acute treatment of migraine, with increased treatment satisfaction and a strong intention to continue using the medication.
Major findings: A high proportion of patients reported using ubrogepant for relief from migraine, with satisfaction rates of 75.8% at 2 hours, 83.4% at 4 hours, and 78.5% at 24 hours. Additionally, 85.1% were satisfied with their ability to think clearly and 83.8% were satisfied with returning to normal function. Overall, 90.7% participants intended to continue using ubrogepant and 87.4% reported switching to ubrogepant due to inadequate response to previous migraine treatments.
Study details: This observational cross-sectional study included 302 adults who had received ubrogepant for the acute treatment of migraine within the preceding 14 days; 120 participants reported taking 50 mg ubrogepant and 182 reported taking 100 mg ubrogepant.
Disclosure: The study was funded by AbbVie. Four authors declared being current or former employees of AbbVie and may hold stock in the company. Several authors reported having ties with various sources.
Source: Shewale AR, Poh W, Reed ML, et al. Ubrogepant users' real-world experience: Patients on ubrogepant, characteristics, and outcomes (UNIVERSE) study. Headache. Published online September 26, 2024. Source
Key clinical point: Ubrogepant showed real-world effectiveness for the acute treatment of migraine, with increased treatment satisfaction and a strong intention to continue using the medication.
Major findings: A high proportion of patients reported using ubrogepant for relief from migraine, with satisfaction rates of 75.8% at 2 hours, 83.4% at 4 hours, and 78.5% at 24 hours. Additionally, 85.1% were satisfied with their ability to think clearly and 83.8% were satisfied with returning to normal function. Overall, 90.7% participants intended to continue using ubrogepant and 87.4% reported switching to ubrogepant due to inadequate response to previous migraine treatments.
Study details: This observational cross-sectional study included 302 adults who had received ubrogepant for the acute treatment of migraine within the preceding 14 days; 120 participants reported taking 50 mg ubrogepant and 182 reported taking 100 mg ubrogepant.
Disclosure: The study was funded by AbbVie. Four authors declared being current or former employees of AbbVie and may hold stock in the company. Several authors reported having ties with various sources.
Source: Shewale AR, Poh W, Reed ML, et al. Ubrogepant users' real-world experience: Patients on ubrogepant, characteristics, and outcomes (UNIVERSE) study. Headache. Published online September 26, 2024. Source
Key clinical point: Ubrogepant showed real-world effectiveness for the acute treatment of migraine, with increased treatment satisfaction and a strong intention to continue using the medication.
Major findings: A high proportion of patients reported using ubrogepant for relief from migraine, with satisfaction rates of 75.8% at 2 hours, 83.4% at 4 hours, and 78.5% at 24 hours. Additionally, 85.1% were satisfied with their ability to think clearly and 83.8% were satisfied with returning to normal function. Overall, 90.7% participants intended to continue using ubrogepant and 87.4% reported switching to ubrogepant due to inadequate response to previous migraine treatments.
Study details: This observational cross-sectional study included 302 adults who had received ubrogepant for the acute treatment of migraine within the preceding 14 days; 120 participants reported taking 50 mg ubrogepant and 182 reported taking 100 mg ubrogepant.
Disclosure: The study was funded by AbbVie. Four authors declared being current or former employees of AbbVie and may hold stock in the company. Several authors reported having ties with various sources.
Source: Shewale AR, Poh W, Reed ML, et al. Ubrogepant users' real-world experience: Patients on ubrogepant, characteristics, and outcomes (UNIVERSE) study. Headache. Published online September 26, 2024. Source
Serostatus and Increased Migraine Risk in Patients With Rheumatoid Arthritis
Key clinical point: Patients with rheumatoid arthritis (RA) had a higher risk for migraine than those without RA, irrespective of the RA serologic status.
Major findings: Patients with vs without RA had a 1.2-fold higher risk for migraine (adjusted hazard ratio (aHR), 1.21; 95% CI, 1.17-1.26). Both seropositive RA (aHR 1.20; 95% CI, 1.15-1.24) and seronegative RA (aHR, 1.26; 95% CI, 1.20-1.34) were associated with an increased risk for migraine. However, the risk was not significantly different between patients with seropositive RA and those with seronegative RA.
Study details: This longitudinal retrospective cohort study included 42,674 patients with RA (29,774 with seropositive RA and 12,900 with seronegative RA) and 213,370 age- and sex-matched control individuals without RA. Overall, 22,294 new migraine cases were reported during a mean follow-up of 4.4 years, following a 1-year lag period.
Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.
Source: Kang S, Eun Y, Han K, et al. Heightened migraine risk in patients with rheumatoid arthritis: A national retrospective cohort study. Headache. Published online September 13, 2024. Source
Key clinical point: Patients with rheumatoid arthritis (RA) had a higher risk for migraine than those without RA, irrespective of the RA serologic status.
Major findings: Patients with vs without RA had a 1.2-fold higher risk for migraine (adjusted hazard ratio (aHR), 1.21; 95% CI, 1.17-1.26). Both seropositive RA (aHR 1.20; 95% CI, 1.15-1.24) and seronegative RA (aHR, 1.26; 95% CI, 1.20-1.34) were associated with an increased risk for migraine. However, the risk was not significantly different between patients with seropositive RA and those with seronegative RA.
Study details: This longitudinal retrospective cohort study included 42,674 patients with RA (29,774 with seropositive RA and 12,900 with seronegative RA) and 213,370 age- and sex-matched control individuals without RA. Overall, 22,294 new migraine cases were reported during a mean follow-up of 4.4 years, following a 1-year lag period.
Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.
Source: Kang S, Eun Y, Han K, et al. Heightened migraine risk in patients with rheumatoid arthritis: A national retrospective cohort study. Headache. Published online September 13, 2024. Source
Key clinical point: Patients with rheumatoid arthritis (RA) had a higher risk for migraine than those without RA, irrespective of the RA serologic status.
Major findings: Patients with vs without RA had a 1.2-fold higher risk for migraine (adjusted hazard ratio (aHR), 1.21; 95% CI, 1.17-1.26). Both seropositive RA (aHR 1.20; 95% CI, 1.15-1.24) and seronegative RA (aHR, 1.26; 95% CI, 1.20-1.34) were associated with an increased risk for migraine. However, the risk was not significantly different between patients with seropositive RA and those with seronegative RA.
Study details: This longitudinal retrospective cohort study included 42,674 patients with RA (29,774 with seropositive RA and 12,900 with seronegative RA) and 213,370 age- and sex-matched control individuals without RA. Overall, 22,294 new migraine cases were reported during a mean follow-up of 4.4 years, following a 1-year lag period.
Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.
Source: Kang S, Eun Y, Han K, et al. Heightened migraine risk in patients with rheumatoid arthritis: A national retrospective cohort study. Headache. Published online September 13, 2024. Source
Epilepsy May Not Increase Migraine Risk but May Worsen Severity
Key clinical point: Patients with epilepsy showed no significant increase in the overall prevalence of migraine or non-migraine headaches, but those with epilepsy and migraine had an increased frequency of headaches.
Major findings: Compared with individuals without epilepsy, patients with epilepsy had no significant increase in the overall prevalence of migraine (odds ratio [OR], 0.95; P = .78) or non-migraine headaches (OR, 1.18; P = .17). However, among patients with migraine, those with epilepsy were more likely to experience highly frequent headaches than those without epilepsy (OR, 1.73; P = .024).
Study details: This population-based case-control study included 63,622 participants (age, ≥ 20 years); 364 had epilepsy, including 210 without headaches, 46 with migraine, and 108 with non-migraine headaches.
Disclosure: The study was funded by the Norwegian Research Council. The authors declared no conflicts of interest.
Source: Engstrand H, Revdal E, Argren MB, et al. Relationship between migraine and epilepsy in a large population-based cohort: The HUNT Study. Eur J Neurol. Published online September 27, 2024. Source
Key clinical point: Patients with epilepsy showed no significant increase in the overall prevalence of migraine or non-migraine headaches, but those with epilepsy and migraine had an increased frequency of headaches.
Major findings: Compared with individuals without epilepsy, patients with epilepsy had no significant increase in the overall prevalence of migraine (odds ratio [OR], 0.95; P = .78) or non-migraine headaches (OR, 1.18; P = .17). However, among patients with migraine, those with epilepsy were more likely to experience highly frequent headaches than those without epilepsy (OR, 1.73; P = .024).
Study details: This population-based case-control study included 63,622 participants (age, ≥ 20 years); 364 had epilepsy, including 210 without headaches, 46 with migraine, and 108 with non-migraine headaches.
Disclosure: The study was funded by the Norwegian Research Council. The authors declared no conflicts of interest.
Source: Engstrand H, Revdal E, Argren MB, et al. Relationship between migraine and epilepsy in a large population-based cohort: The HUNT Study. Eur J Neurol. Published online September 27, 2024. Source
Key clinical point: Patients with epilepsy showed no significant increase in the overall prevalence of migraine or non-migraine headaches, but those with epilepsy and migraine had an increased frequency of headaches.
Major findings: Compared with individuals without epilepsy, patients with epilepsy had no significant increase in the overall prevalence of migraine (odds ratio [OR], 0.95; P = .78) or non-migraine headaches (OR, 1.18; P = .17). However, among patients with migraine, those with epilepsy were more likely to experience highly frequent headaches than those without epilepsy (OR, 1.73; P = .024).
Study details: This population-based case-control study included 63,622 participants (age, ≥ 20 years); 364 had epilepsy, including 210 without headaches, 46 with migraine, and 108 with non-migraine headaches.
Disclosure: The study was funded by the Norwegian Research Council. The authors declared no conflicts of interest.
Source: Engstrand H, Revdal E, Argren MB, et al. Relationship between migraine and epilepsy in a large population-based cohort: The HUNT Study. Eur J Neurol. Published online September 27, 2024. Source