Headache & Migraine

Migraine pathophysiology has been shown to be associated with vascular and inflammatory processes. Diet and lifestyle can have an effect on an individual's inflammatory process, and research regarding the steps between these factors and inflammation is vague and nonspecific. The Dietary Inflammation Score (DIS), which is calculated on the basis of a questionnaire, is used to score the inflammatory potential of an individual's diet. The Dietary and Lifestyle Inflammation Score (DLIS) includes the DIS questions, and also incorporates body mass index (BMI), physical activity, smoking, and alcohol consumption. A recent study, based on a secondary analysis of previous data, examined the correlation between migraine and DIS and DLIS among 285 women, 40% of whom had a chronic migraine diagnosis. Results published in Scientific Reports in July 2024 noted that participants with chronic migraine had a significantly higher DIS and DLIS than those who were not diagnosed with chronic migraine. It is important to note that migraine-associated inflammation can also result from genetic factors. A previous study, published in 2023 in Nature Genetics, described a correlation between genetic markers of inflammatory disorders, such as endometriosis, asthma, and migraine.¹ These results, consistent with our current understanding of the genetic contribution to migraine risk, emphasize that lifestyle modifications alone are not usually adequate for complete management of migraines.

Patients who experience chronic migraine may be inclined to reduce their time spent exercising and engaging in physical activity, as these activities can exacerbate migraine symptoms. Additionally, after recovering from a migraine, patients often need to catch up on tasks and responsibilities, which can squeeze out time for physical activity and exercise (often considered luxuries that can be done during leisure time). Results of a small cross-sectional retrospective study published in Scientific Reports in 2024 suggested a correlation between daily walking steps and response to calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb). According to the study, which included 22 patients who were diagnosed with migraine and treated with CGRP mAb, patients who experienced an improvement of their migraine symptoms also increased their average daily steps by almost 1000 steps per day. The authors suggested that steps can be used as a marker of treatment response in migraine.

Screen time is often blamed as a cause for a number of different ailments, including obesity, anxiety, depression, insomnia, and migraine. An article published in June 2024 in European Journal of Pain described results of a meta-analysis examining the association between sedentary lifestyle and migraine. The authors noted that time spent watching television could be causally associated with an increased risk for migraine.²Another study, with results published in July 2024 in The Journal of Headache and Pain, examined the relationship between migraine and leisure screen time. The researchers used data from 661,399 European individuals from 53 studies to look at genetically predicted leisure screen time, rather than actual leisure screen time. They reported that genetically predicted leisure screen time was associated with a 27.7% increase in migraine risk. While the results are consistent with what is already widely accepted about screen time and migraine, the inclusion of genetic predisposition to screen time is interesting in suggesting that some underlying drive could be contributing to increased screen time among patients who have migraine.

The results of these studies reemphasize the importance of the link between lifestyle factors and migraine but warn against oversimplifying the correlation. There is a bidirectional relationship between migraine and inflammation. We know that inflammation is mediated by diet as well as physical activity. During a migraine, patients may turn to foods that have a high inflammatory potential. Furthermore, migraine can influence a person's inclination to participate in physical activity, as the pain and discomfort can make it difficult engage in exercise. During a migraine, patients may prefer sedentary activities. Screen time can be appealing or relaxing while recovering from a migraine. Genetic predisposition is an interesting additional contributor to this link. Acknowledging genetic predisposition to inflammation or sedentary activity can be a step in helping patients recognize that it could be challenging to overcome these genetically inherent drives or conditions, while providing encouragement regarding the potential benefits of doing so.

Additional References

1. Rahmioglu N, Mortlock S, Ghiasi M, et al. The genetic basis of endometriosis and comorbidity with other pain and inflammatory conditions. Nat Genet. 2023;55(3):423-436. Doi: 10.1038/s41588-023-01323-z Source

2. Li P, Li J, Zhu H, et al. Causal effects of sedentary behaviours on the risk of migraine: A univariable and multivariable Mendelian randomization study. Eur J Pain. 2024 (Jun 4). Doi: 10.1002/ejp.2296  Source

Migraine pathophysiology has been shown to be associated with vascular and inflammatory processes. Diet and lifestyle can have an effect on an individual's inflammatory process, and research regarding the steps between these factors and inflammation is vague and nonspecific. The Dietary Inflammation Score (DIS), which is calculated on the basis of a questionnaire, is used to score the inflammatory potential of an individual's diet. The Dietary and Lifestyle Inflammation Score (DLIS) includes the DIS questions, and also incorporates body mass index (BMI), physical activity, smoking, and alcohol consumption. A recent study, based on a secondary analysis of previous data, examined the correlation between migraine and DIS and DLIS among 285 women, 40% of whom had a chronic migraine diagnosis. Results published in Scientific Reports in July 2024 noted that participants with chronic migraine had a significantly higher DIS and DLIS than those who were not diagnosed with chronic migraine. It is important to note that migraine-associated inflammation can also result from genetic factors. A previous study, published in 2023 in Nature Genetics, described a correlation between genetic markers of inflammatory disorders, such as endometriosis, asthma, and migraine.¹ These results, consistent with our current understanding of the genetic contribution to migraine risk, emphasize that lifestyle modifications alone are not usually adequate for complete management of migraines.

Patients who experience chronic migraine may be inclined to reduce their time spent exercising and engaging in physical activity, as these activities can exacerbate migraine symptoms. Additionally, after recovering from a migraine, patients often need to catch up on tasks and responsibilities, which can squeeze out time for physical activity and exercise (often considered luxuries that can be done during leisure time). Results of a small cross-sectional retrospective study published in Scientific Reports in 2024 suggested a correlation between daily walking steps and response to calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb). According to the study, which included 22 patients who were diagnosed with migraine and treated with CGRP mAb, patients who experienced an improvement of their migraine symptoms also increased their average daily steps by almost 1000 steps per day. The authors suggested that steps can be used as a marker of treatment response in migraine.

Screen time is often blamed as a cause for a number of different ailments, including obesity, anxiety, depression, insomnia, and migraine. An article published in June 2024 in European Journal of Pain described results of a meta-analysis examining the association between sedentary lifestyle and migraine. The authors noted that time spent watching television could be causally associated with an increased risk for migraine.²Another study, with results published in July 2024 in The Journal of Headache and Pain, examined the relationship between migraine and leisure screen time. The researchers used data from 661,399 European individuals from 53 studies to look at genetically predicted leisure screen time, rather than actual leisure screen time. They reported that genetically predicted leisure screen time was associated with a 27.7% increase in migraine risk. While the results are consistent with what is already widely accepted about screen time and migraine, the inclusion of genetic predisposition to screen time is interesting in suggesting that some underlying drive could be contributing to increased screen time among patients who have migraine.

The results of these studies reemphasize the importance of the link between lifestyle factors and migraine but warn against oversimplifying the correlation. There is a bidirectional relationship between migraine and inflammation. We know that inflammation is mediated by diet as well as physical activity. During a migraine, patients may turn to foods that have a high inflammatory potential. Furthermore, migraine can influence a person's inclination to participate in physical activity, as the pain and discomfort can make it difficult engage in exercise. During a migraine, patients may prefer sedentary activities. Screen time can be appealing or relaxing while recovering from a migraine. Genetic predisposition is an interesting additional contributor to this link. Acknowledging genetic predisposition to inflammation or sedentary activity can be a step in helping patients recognize that it could be challenging to overcome these genetically inherent drives or conditions, while providing encouragement regarding the potential benefits of doing so.

Additional References

1. Rahmioglu N, Mortlock S, Ghiasi M, et al. The genetic basis of endometriosis and comorbidity with other pain and inflammatory conditions. Nat Genet. 2023;55(3):423-436. Doi: 10.1038/s41588-023-01323-z Source

2. Li P, Li J, Zhu H, et al. Causal effects of sedentary behaviours on the risk of migraine: A univariable and multivariable Mendelian randomization study. Eur J Pain. 2024 (Jun 4). Doi: 10.1002/ejp.2296  Source

Migraine pathophysiology has been shown to be associated with vascular and inflammatory processes. Diet and lifestyle can have an effect on an individual's inflammatory process, and research regarding the steps between these factors and inflammation is vague and nonspecific. The Dietary Inflammation Score (DIS), which is calculated on the basis of a questionnaire, is used to score the inflammatory potential of an individual's diet. The Dietary and Lifestyle Inflammation Score (DLIS) includes the DIS questions, and also incorporates body mass index (BMI), physical activity, smoking, and alcohol consumption. A recent study, based on a secondary analysis of previous data, examined the correlation between migraine and DIS and DLIS among 285 women, 40% of whom had a chronic migraine diagnosis. Results published in Scientific Reports in July 2024 noted that participants with chronic migraine had a significantly higher DIS and DLIS than those who were not diagnosed with chronic migraine. It is important to note that migraine-associated inflammation can also result from genetic factors. A previous study, published in 2023 in Nature Genetics, described a correlation between genetic markers of inflammatory disorders, such as endometriosis, asthma, and migraine.¹ These results, consistent with our current understanding of the genetic contribution to migraine risk, emphasize that lifestyle modifications alone are not usually adequate for complete management of migraines.

Patients who experience chronic migraine may be inclined to reduce their time spent exercising and engaging in physical activity, as these activities can exacerbate migraine symptoms. Additionally, after recovering from a migraine, patients often need to catch up on tasks and responsibilities, which can squeeze out time for physical activity and exercise (often considered luxuries that can be done during leisure time). Results of a small cross-sectional retrospective study published in Scientific Reports in 2024 suggested a correlation between daily walking steps and response to calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb). According to the study, which included 22 patients who were diagnosed with migraine and treated with CGRP mAb, patients who experienced an improvement of their migraine symptoms also increased their average daily steps by almost 1000 steps per day. The authors suggested that steps can be used as a marker of treatment response in migraine.

Screen time is often blamed as a cause for a number of different ailments, including obesity, anxiety, depression, insomnia, and migraine. An article published in June 2024 in European Journal of Pain described results of a meta-analysis examining the association between sedentary lifestyle and migraine. The authors noted that time spent watching television could be causally associated with an increased risk for migraine.²Another study, with results published in July 2024 in The Journal of Headache and Pain, examined the relationship between migraine and leisure screen time. The researchers used data from 661,399 European individuals from 53 studies to look at genetically predicted leisure screen time, rather than actual leisure screen time. They reported that genetically predicted leisure screen time was associated with a 27.7% increase in migraine risk. While the results are consistent with what is already widely accepted about screen time and migraine, the inclusion of genetic predisposition to screen time is interesting in suggesting that some underlying drive could be contributing to increased screen time among patients who have migraine.

The results of these studies reemphasize the importance of the link between lifestyle factors and migraine but warn against oversimplifying the correlation. There is a bidirectional relationship between migraine and inflammation. We know that inflammation is mediated by diet as well as physical activity. During a migraine, patients may turn to foods that have a high inflammatory potential. Furthermore, migraine can influence a person's inclination to participate in physical activity, as the pain and discomfort can make it difficult engage in exercise. During a migraine, patients may prefer sedentary activities. Screen time can be appealing or relaxing while recovering from a migraine. Genetic predisposition is an interesting additional contributor to this link. Acknowledging genetic predisposition to inflammation or sedentary activity can be a step in helping patients recognize that it could be challenging to overcome these genetically inherent drives or conditions, while providing encouragement regarding the potential benefits of doing so.

Additional References

1. Rahmioglu N, Mortlock S, Ghiasi M, et al. The genetic basis of endometriosis and comorbidity with other pain and inflammatory conditions. Nat Genet. 2023;55(3):423-436. Doi: 10.1038/s41588-023-01323-z Source

2. Li P, Li J, Zhu H, et al. Causal effects of sedentary behaviours on the risk of migraine: A univariable and multivariable Mendelian randomization study. Eur J Pain. 2024 (Jun 4). Doi: 10.1002/ejp.2296  Source

Key clinical point: Rimegepant was more effective than placebo in reducing pain and most bothersome symptoms in patients with moderate to severe migraine, while also showing favorable safety and tolerability.

Major findings: At 2 hours post dose, rimegepant was more effective than placebo in providing freedom from pain (risk difference 4.9; P = .0298) and the most bothersome symptoms (risk difference 8.9; P = .0016). Similar proportions of participants in the rimegepant vs placebo group experienced at least one adverse event (12.6% vs 10.7%), with nausea (0.9% vs 1.1%) and dizziness (0.7% vs 0.4%) being the most common adverse events.

Study details: This randomized, double-blind, placebo-controlled trial (Safety and Efficacy Study in Adult Subjects With Acute Migraines, NCT03235479)  included 1084 patients with migraine with or without aura who were randomly assigned to receive 75 mg rimegepant (n = 543) or placebo (n = 541).

Disclosures: This study was supported by Biohaven Pharmaceuticals (acquired by Pfizer, Inc.). Four authors declared being employees or stockholders of Biohaven Pharmaceuticals, Pfizer, or having other ties with various sources.

Source: Lipton RB, Thiry A, Morris BA, Croop R. Efficacy and safety of rimegepant 75 mg oral tablet, a CGRP receptor antagonist, for the acute treatment of migraine: A randomized, double-blind, placebo-controlled trial. J Pain Res. 2024;17:2431-2441 (Jul 22). Doi: 10.2147/JPR.S453806 Source

Key clinical point: Rimegepant was more effective than placebo in reducing pain and most bothersome symptoms in patients with moderate to severe migraine, while also showing favorable safety and tolerability.

Major findings: At 2 hours post dose, rimegepant was more effective than placebo in providing freedom from pain (risk difference 4.9; P = .0298) and the most bothersome symptoms (risk difference 8.9; P = .0016). Similar proportions of participants in the rimegepant vs placebo group experienced at least one adverse event (12.6% vs 10.7%), with nausea (0.9% vs 1.1%) and dizziness (0.7% vs 0.4%) being the most common adverse events.

Study details: This randomized, double-blind, placebo-controlled trial (Safety and Efficacy Study in Adult Subjects With Acute Migraines, NCT03235479)  included 1084 patients with migraine with or without aura who were randomly assigned to receive 75 mg rimegepant (n = 543) or placebo (n = 541).

Disclosures: This study was supported by Biohaven Pharmaceuticals (acquired by Pfizer, Inc.). Four authors declared being employees or stockholders of Biohaven Pharmaceuticals, Pfizer, or having other ties with various sources.

Source: Lipton RB, Thiry A, Morris BA, Croop R. Efficacy and safety of rimegepant 75 mg oral tablet, a CGRP receptor antagonist, for the acute treatment of migraine: A randomized, double-blind, placebo-controlled trial. J Pain Res. 2024;17:2431-2441 (Jul 22). Doi: 10.2147/JPR.S453806 Source

Key clinical point: Rimegepant was more effective than placebo in reducing pain and most bothersome symptoms in patients with moderate to severe migraine, while also showing favorable safety and tolerability.

Major findings: At 2 hours post dose, rimegepant was more effective than placebo in providing freedom from pain (risk difference 4.9; P = .0298) and the most bothersome symptoms (risk difference 8.9; P = .0016). Similar proportions of participants in the rimegepant vs placebo group experienced at least one adverse event (12.6% vs 10.7%), with nausea (0.9% vs 1.1%) and dizziness (0.7% vs 0.4%) being the most common adverse events.

Study details: This randomized, double-blind, placebo-controlled trial (Safety and Efficacy Study in Adult Subjects With Acute Migraines, NCT03235479)  included 1084 patients with migraine with or without aura who were randomly assigned to receive 75 mg rimegepant (n = 543) or placebo (n = 541).

Disclosures: This study was supported by Biohaven Pharmaceuticals (acquired by Pfizer, Inc.). Four authors declared being employees or stockholders of Biohaven Pharmaceuticals, Pfizer, or having other ties with various sources.

Source: Lipton RB, Thiry A, Morris BA, Croop R. Efficacy and safety of rimegepant 75 mg oral tablet, a CGRP receptor antagonist, for the acute treatment of migraine: A randomized, double-blind, placebo-controlled trial. J Pain Res. 2024;17:2431-2441 (Jul 22). Doi: 10.2147/JPR.S453806 Source

Key clinical point: This Mendelian randomization study showed that leisure screen time (LST) worsens migraine, whereas moderate to vigorous physical activity (MVPA) alleviates it, with hypertension and diastolic blood pressure (DBP) being responsible for the effects of MVPA or LST on migraine.

Major findings: Genetically predicted LST was associated with a significantly increased risk for migraine (odds ratio [OR] 1.28; P < .001), whereas MVPA was linked to a significantly reduced risk (OR 0.73; P = .000006). Hypertension mediated 4.86% and 24.81% of the effects of MVPA and LST on migraine risk, respectively, and DBP accounted for 4.66% of the effects of MVPA on migraine risk.

Study details: This study included 18,477 patients with migraine and 287,837 control individuals without migraine from the FinnGen consortium and 26,052 patients with migraine and 487,214 control individuals without migraine from the large-scale genome-wide association studies.

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

Source: Gan Q, Song E, Zhang L, et al. The role of hypertension in the relationship between leisure screen time, physical activity and migraine: A 2-sample Mendelian randomization study. J Headache Pain. 2024;25:122 (Jul 24). Doi: 10.1186/s10194-024-01820-4 Source

Key clinical point: This Mendelian randomization study showed that leisure screen time (LST) worsens migraine, whereas moderate to vigorous physical activity (MVPA) alleviates it, with hypertension and diastolic blood pressure (DBP) being responsible for the effects of MVPA or LST on migraine.

Major findings: Genetically predicted LST was associated with a significantly increased risk for migraine (odds ratio [OR] 1.28; P < .001), whereas MVPA was linked to a significantly reduced risk (OR 0.73; P = .000006). Hypertension mediated 4.86% and 24.81% of the effects of MVPA and LST on migraine risk, respectively, and DBP accounted for 4.66% of the effects of MVPA on migraine risk.

Study details: This study included 18,477 patients with migraine and 287,837 control individuals without migraine from the FinnGen consortium and 26,052 patients with migraine and 487,214 control individuals without migraine from the large-scale genome-wide association studies.

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

Source: Gan Q, Song E, Zhang L, et al. The role of hypertension in the relationship between leisure screen time, physical activity and migraine: A 2-sample Mendelian randomization study. J Headache Pain. 2024;25:122 (Jul 24). Doi: 10.1186/s10194-024-01820-4 Source

Key clinical point: This Mendelian randomization study showed that leisure screen time (LST) worsens migraine, whereas moderate to vigorous physical activity (MVPA) alleviates it, with hypertension and diastolic blood pressure (DBP) being responsible for the effects of MVPA or LST on migraine.

Major findings: Genetically predicted LST was associated with a significantly increased risk for migraine (odds ratio [OR] 1.28; P < .001), whereas MVPA was linked to a significantly reduced risk (OR 0.73; P = .000006). Hypertension mediated 4.86% and 24.81% of the effects of MVPA and LST on migraine risk, respectively, and DBP accounted for 4.66% of the effects of MVPA on migraine risk.

Study details: This study included 18,477 patients with migraine and 287,837 control individuals without migraine from the FinnGen consortium and 26,052 patients with migraine and 487,214 control individuals without migraine from the large-scale genome-wide association studies.

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

Source: Gan Q, Song E, Zhang L, et al. The role of hypertension in the relationship between leisure screen time, physical activity and migraine: A 2-sample Mendelian randomization study. J Headache Pain. 2024;25:122 (Jul 24). Doi: 10.1186/s10194-024-01820-4 Source

Key clinical point: The meta-analysis showed that atogepant was effective and well tolerated in patients with migraine in a non–dose-dependent manner, with rare incidences of serious treatment-emergent adverse events (TEAE) reported.

Major findings: Atogepant vs placebo led to a significant reduction in monthly migraine days (standardized mean difference [SMD] −0.40; P = .00001) and headache days (SMD −0.39; P = .00001), with consistent results observed across all dosage groups. The risk for TEAE (relative risk [RR] 1.11; P = .02) was significantly higher in the atogepant vs placebo group, with constipation (RR 2.55; P < .00001), nausea (RR 2.19; P < .00001), and urinary tract infection (RR 1.49; P = .03) being the most common.

Study details: This meta-analysis of four randomized controlled trials included 2813 patients with migraine who were treated with atogepant (10 mg, 30 mg, or 60 mg).

Disclosures: This study was supported by the Chongqing Clinical Pharmacy Key Specialties Construction Project, China. The authors declared no conflicts of interest.

Source: Hou M, Luo X, He S, et al. Efficacy and safety of atogepant, a small molecule CGRP receptor antagonist, for the preventive treatment of migraine: A systematic review and meta-analysis. J Headache Pain. 2024;25:116 (Jul 19). Doi: 10.1186/s10194-024-01822-2 Source

Key clinical point: The meta-analysis showed that atogepant was effective and well tolerated in patients with migraine in a non–dose-dependent manner, with rare incidences of serious treatment-emergent adverse events (TEAE) reported.

Major findings: Atogepant vs placebo led to a significant reduction in monthly migraine days (standardized mean difference [SMD] −0.40; P = .00001) and headache days (SMD −0.39; P = .00001), with consistent results observed across all dosage groups. The risk for TEAE (relative risk [RR] 1.11; P = .02) was significantly higher in the atogepant vs placebo group, with constipation (RR 2.55; P < .00001), nausea (RR 2.19; P < .00001), and urinary tract infection (RR 1.49; P = .03) being the most common.

Study details: This meta-analysis of four randomized controlled trials included 2813 patients with migraine who were treated with atogepant (10 mg, 30 mg, or 60 mg).

Disclosures: This study was supported by the Chongqing Clinical Pharmacy Key Specialties Construction Project, China. The authors declared no conflicts of interest.

Source: Hou M, Luo X, He S, et al. Efficacy and safety of atogepant, a small molecule CGRP receptor antagonist, for the preventive treatment of migraine: A systematic review and meta-analysis. J Headache Pain. 2024;25:116 (Jul 19). Doi: 10.1186/s10194-024-01822-2 Source

Key clinical point: The meta-analysis showed that atogepant was effective and well tolerated in patients with migraine in a non–dose-dependent manner, with rare incidences of serious treatment-emergent adverse events (TEAE) reported.

Major findings: Atogepant vs placebo led to a significant reduction in monthly migraine days (standardized mean difference [SMD] −0.40; P = .00001) and headache days (SMD −0.39; P = .00001), with consistent results observed across all dosage groups. The risk for TEAE (relative risk [RR] 1.11; P = .02) was significantly higher in the atogepant vs placebo group, with constipation (RR 2.55; P < .00001), nausea (RR 2.19; P < .00001), and urinary tract infection (RR 1.49; P = .03) being the most common.

Study details: This meta-analysis of four randomized controlled trials included 2813 patients with migraine who were treated with atogepant (10 mg, 30 mg, or 60 mg).

Disclosures: This study was supported by the Chongqing Clinical Pharmacy Key Specialties Construction Project, China. The authors declared no conflicts of interest.

Source: Hou M, Luo X, He S, et al. Efficacy and safety of atogepant, a small molecule CGRP receptor antagonist, for the preventive treatment of migraine: A systematic review and meta-analysis. J Headache Pain. 2024;25:116 (Jul 19). Doi: 10.1186/s10194-024-01822-2 Source

Key clinical point: The presence of migraine aura exacerbated migraine-related disability, mainly due to concurrent non-pain symptoms of migraine rather than the aura itself.

Major findings: The presence of aura on the first day of the migraine episode was significantly associated with increased odds of disability across all migraine days (odds ratio [OR] 1.40; P < .001); and non-pain symptoms, such as allodynia, photophobia, phonophobia, and nausea or vomiting (P < .001 for all). No association was observed between aura and headache-related migraine symptoms.

Study details: This observational prospective cohort study included 554 adults with episodic migraine, with complete data on migraine symptoms and psychological variables collected daily for 90 days using the N-1 Headache™ digital app (N = 11,156 total migraine days).

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

Source: Denney DE, Lee AA, Landy SH, Smitherman TA. Headache-related disability as a function of migraine aura: A daily diary study. Headache. 2024 (Aug 1). Doi: 10.1111/head.14796 Source

Key clinical point: The presence of migraine aura exacerbated migraine-related disability, mainly due to concurrent non-pain symptoms of migraine rather than the aura itself.

Major findings: The presence of aura on the first day of the migraine episode was significantly associated with increased odds of disability across all migraine days (odds ratio [OR] 1.40; P < .001); and non-pain symptoms, such as allodynia, photophobia, phonophobia, and nausea or vomiting (P < .001 for all). No association was observed between aura and headache-related migraine symptoms.

Study details: This observational prospective cohort study included 554 adults with episodic migraine, with complete data on migraine symptoms and psychological variables collected daily for 90 days using the N-1 Headache™ digital app (N = 11,156 total migraine days).

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

Source: Denney DE, Lee AA, Landy SH, Smitherman TA. Headache-related disability as a function of migraine aura: A daily diary study. Headache. 2024 (Aug 1). Doi: 10.1111/head.14796 Source

Key clinical point: The presence of migraine aura exacerbated migraine-related disability, mainly due to concurrent non-pain symptoms of migraine rather than the aura itself.

Major findings: The presence of aura on the first day of the migraine episode was significantly associated with increased odds of disability across all migraine days (odds ratio [OR] 1.40; P < .001); and non-pain symptoms, such as allodynia, photophobia, phonophobia, and nausea or vomiting (P < .001 for all). No association was observed between aura and headache-related migraine symptoms.

Study details: This observational prospective cohort study included 554 adults with episodic migraine, with complete data on migraine symptoms and psychological variables collected daily for 90 days using the N-1 Headache™ digital app (N = 11,156 total migraine days).

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

Source: Denney DE, Lee AA, Landy SH, Smitherman TA. Headache-related disability as a function of migraine aura: A daily diary study. Headache. 2024 (Aug 1). Doi: 10.1111/head.14796 Source

Key clinical point: Patients with migraine and a history of abuse had a greater migraine burden than those without a history of abuse, with this association being mediated by depression and anxiety.

Major findings: Patients with migraine who did vs did not have a history of abuse had significantly higher migraine-specific disability (68 vs 49), subjective cognitive impairment (10 vs 7), and pain interference (65 vs 62.5) scores, as well as greater overall work impairment (47.6% vs 38.6%) and activity impairment (49.3% vs 39.3%; all P < .001). Depression and anxiety mediated the association between history of abuse and migraine burden.

Study details: This cross-sectional study included 866 patients with migraine from the American Registry for Migraine Research, of whom 316 (36.5 %) had a history of abuse.

Disclosures: This study was supported by the American Migraine Foundation and American Academy of Neurology. Some authors declared receiving research funding from or having other ties with various sources.

Source: Trivedi M, Dumkrieger G, Chong CD, et al. A history of abuse is associated with more severe migraine- and pain-related disability: Results from the American Registry for Migraine Research. Headache. 2024 (Jul 25). Doi: 10.1111/head.14787 Source

Key clinical point: Patients with migraine and a history of abuse had a greater migraine burden than those without a history of abuse, with this association being mediated by depression and anxiety.

Major findings: Patients with migraine who did vs did not have a history of abuse had significantly higher migraine-specific disability (68 vs 49), subjective cognitive impairment (10 vs 7), and pain interference (65 vs 62.5) scores, as well as greater overall work impairment (47.6% vs 38.6%) and activity impairment (49.3% vs 39.3%; all P < .001). Depression and anxiety mediated the association between history of abuse and migraine burden.

Study details: This cross-sectional study included 866 patients with migraine from the American Registry for Migraine Research, of whom 316 (36.5 %) had a history of abuse.

Disclosures: This study was supported by the American Migraine Foundation and American Academy of Neurology. Some authors declared receiving research funding from or having other ties with various sources.

Source: Trivedi M, Dumkrieger G, Chong CD, et al. A history of abuse is associated with more severe migraine- and pain-related disability: Results from the American Registry for Migraine Research. Headache. 2024 (Jul 25). Doi: 10.1111/head.14787 Source

Key clinical point: Patients with migraine and a history of abuse had a greater migraine burden than those without a history of abuse, with this association being mediated by depression and anxiety.

Major findings: Patients with migraine who did vs did not have a history of abuse had significantly higher migraine-specific disability (68 vs 49), subjective cognitive impairment (10 vs 7), and pain interference (65 vs 62.5) scores, as well as greater overall work impairment (47.6% vs 38.6%) and activity impairment (49.3% vs 39.3%; all P < .001). Depression and anxiety mediated the association between history of abuse and migraine burden.

Study details: This cross-sectional study included 866 patients with migraine from the American Registry for Migraine Research, of whom 316 (36.5 %) had a history of abuse.

Disclosures: This study was supported by the American Migraine Foundation and American Academy of Neurology. Some authors declared receiving research funding from or having other ties with various sources.

Source: Trivedi M, Dumkrieger G, Chong CD, et al. A history of abuse is associated with more severe migraine- and pain-related disability: Results from the American Registry for Migraine Research. Headache. 2024 (Jul 25). Doi: 10.1111/head.14787 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were effective and showed a similar time to onset in patients with chronic migraine (CM), irrespective of disease duration.

Major findings: At 10-12 months of follow-up, anti-CGRP mAb reduced monthly migraine days by an average of 12 days across all tertiles of CM duration (P = .946). Additionally, monthly headache days and acute medication use significantly decreased from baseline to 10-12 months (P < .001) across all tertiles of CM duration, indicating no difference in the time to onset of anti-CGRP mAb across tertiles.

Study details: This cohort study included 335 patients with CM treated with anti-CGRP mAb for at least 12 months. Patients were categorized into different tertiles of CM duration: 0-7 years, 8-18 years, and 18-60 years.

Disclosures: This study did not disclose any funding sources. Four authors declared receiving personal fees from or having other ties with various sources.

Source: Ornello R, Baldini F, Onofri A, et al. Impact of duration of chronic migraine on long-term effectiveness of monoclonal antibodies targeting the calcitonin gene-related peptide pathway-A real-world study. Headache. 2024 (Jul 16). Doi: 10.1111/head.14788 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were effective and showed a similar time to onset in patients with chronic migraine (CM), irrespective of disease duration.

Major findings: At 10-12 months of follow-up, anti-CGRP mAb reduced monthly migraine days by an average of 12 days across all tertiles of CM duration (P = .946). Additionally, monthly headache days and acute medication use significantly decreased from baseline to 10-12 months (P < .001) across all tertiles of CM duration, indicating no difference in the time to onset of anti-CGRP mAb across tertiles.

Study details: This cohort study included 335 patients with CM treated with anti-CGRP mAb for at least 12 months. Patients were categorized into different tertiles of CM duration: 0-7 years, 8-18 years, and 18-60 years.

Disclosures: This study did not disclose any funding sources. Four authors declared receiving personal fees from or having other ties with various sources.

Source: Ornello R, Baldini F, Onofri A, et al. Impact of duration of chronic migraine on long-term effectiveness of monoclonal antibodies targeting the calcitonin gene-related peptide pathway-A real-world study. Headache. 2024 (Jul 16). Doi: 10.1111/head.14788 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were effective and showed a similar time to onset in patients with chronic migraine (CM), irrespective of disease duration.

Major findings: At 10-12 months of follow-up, anti-CGRP mAb reduced monthly migraine days by an average of 12 days across all tertiles of CM duration (P = .946). Additionally, monthly headache days and acute medication use significantly decreased from baseline to 10-12 months (P < .001) across all tertiles of CM duration, indicating no difference in the time to onset of anti-CGRP mAb across tertiles.

Study details: This cohort study included 335 patients with CM treated with anti-CGRP mAb for at least 12 months. Patients were categorized into different tertiles of CM duration: 0-7 years, 8-18 years, and 18-60 years.

Disclosures: This study did not disclose any funding sources. Four authors declared receiving personal fees from or having other ties with various sources.

Source: Ornello R, Baldini F, Onofri A, et al. Impact of duration of chronic migraine on long-term effectiveness of monoclonal antibodies targeting the calcitonin gene-related peptide pathway-A real-world study. Headache. 2024 (Jul 16). Doi: 10.1111/head.14788 Source

Key clinical point: Childhood abuse was significantly associated with an increased risk for migraine, with specific types such as physical, sexual, and emotional abuse showing a positive association with migraine onset.

Major findings: Individuals who experienced childhood abuse had a higher risk for migraine than those who did not (odd ratio [OR] 1.60; 95% CI 1.49-1.71). This risk was increased in those who were exposed to sexual abuse (OR 1.71; 95% CI 1.43-2.04), physical abuse (OR 1.47; 95% CI 1.38-1.56), and emotional abuse (OR 1.71; 95% CI 1.52-1.93).

Study details: This meta-analysis of 12 studies evaluated the association between childhood abuse and migraine in 110,776 patients with migraine.

Disclosures: No funding source was disclosed for this study. The authors declared no conflicts of interest.

Source: Liu J, Guo Y, Huang Z, et al. Childhood abuse and risk of migraine: A systematic review and meta-analysis. Child Abuse Negl. 2024;155:106961 (Aug 2).  Doi: 10.1016/j.chiabu.2024.106961 Source

Key clinical point: Childhood abuse was significantly associated with an increased risk for migraine, with specific types such as physical, sexual, and emotional abuse showing a positive association with migraine onset.

Major findings: Individuals who experienced childhood abuse had a higher risk for migraine than those who did not (odd ratio [OR] 1.60; 95% CI 1.49-1.71). This risk was increased in those who were exposed to sexual abuse (OR 1.71; 95% CI 1.43-2.04), physical abuse (OR 1.47; 95% CI 1.38-1.56), and emotional abuse (OR 1.71; 95% CI 1.52-1.93).

Study details: This meta-analysis of 12 studies evaluated the association between childhood abuse and migraine in 110,776 patients with migraine.

Disclosures: No funding source was disclosed for this study. The authors declared no conflicts of interest.

Source: Liu J, Guo Y, Huang Z, et al. Childhood abuse and risk of migraine: A systematic review and meta-analysis. Child Abuse Negl. 2024;155:106961 (Aug 2).  Doi: 10.1016/j.chiabu.2024.106961 Source

Key clinical point: Childhood abuse was significantly associated with an increased risk for migraine, with specific types such as physical, sexual, and emotional abuse showing a positive association with migraine onset.

Major findings: Individuals who experienced childhood abuse had a higher risk for migraine than those who did not (odd ratio [OR] 1.60; 95% CI 1.49-1.71). This risk was increased in those who were exposed to sexual abuse (OR 1.71; 95% CI 1.43-2.04), physical abuse (OR 1.47; 95% CI 1.38-1.56), and emotional abuse (OR 1.71; 95% CI 1.52-1.93).

Study details: This meta-analysis of 12 studies evaluated the association between childhood abuse and migraine in 110,776 patients with migraine.

Disclosures: No funding source was disclosed for this study. The authors declared no conflicts of interest.

Source: Liu J, Guo Y, Huang Z, et al. Childhood abuse and risk of migraine: A systematic review and meta-analysis. Child Abuse Negl. 2024;155:106961 (Aug 2).  Doi: 10.1016/j.chiabu.2024.106961 Source

Key clinical point: The daily step count increased noticeably after initiating treatment with anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) in adults with chronic migraine, with a positive association seen between the increase in daily steps and the treatment response to CGRP mAbs.

Major findings: The average number of steps per day increased from 4421 before initiation of anti-CGRP mAb treatment to 5241 at 3 months after initiation of treatment (P = .039), reflecting a mean percentage increase of 21.3% (95% CI 0.5-42.1). There was a positive association between an increase in daily steps and a reduction in monthly migraine days (correlation coefficient 0.521; P = .013).

Study details: This single-center, cross-sectional, retrospective study included 22 patients with chronic migraine who were treated with anti-CGRP mAbs (erenumab or fremanezumab).

Disclosures: The study was supported by the Lundbeck Foundation. Several authors declared receiving grants, honoraria, or personal fees from or having other ties with various sources.

Source: Jantzen FT, Chaudhry BA, Younis S, et al. Average steps per day as marker of treatment response with anti-CGRP mAbs in adults with chronic migraine: A pilot study. Sci Rep. 2024;14:18068 (Aug 5). Doi: 10.1038/s41598-024-68915-5 Source

Key clinical point: The daily step count increased noticeably after initiating treatment with anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) in adults with chronic migraine, with a positive association seen between the increase in daily steps and the treatment response to CGRP mAbs.

Major findings: The average number of steps per day increased from 4421 before initiation of anti-CGRP mAb treatment to 5241 at 3 months after initiation of treatment (P = .039), reflecting a mean percentage increase of 21.3% (95% CI 0.5-42.1). There was a positive association between an increase in daily steps and a reduction in monthly migraine days (correlation coefficient 0.521; P = .013).

Study details: This single-center, cross-sectional, retrospective study included 22 patients with chronic migraine who were treated with anti-CGRP mAbs (erenumab or fremanezumab).

Disclosures: The study was supported by the Lundbeck Foundation. Several authors declared receiving grants, honoraria, or personal fees from or having other ties with various sources.

Source: Jantzen FT, Chaudhry BA, Younis S, et al. Average steps per day as marker of treatment response with anti-CGRP mAbs in adults with chronic migraine: A pilot study. Sci Rep. 2024;14:18068 (Aug 5). Doi: 10.1038/s41598-024-68915-5 Source

Key clinical point: The daily step count increased noticeably after initiating treatment with anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) in adults with chronic migraine, with a positive association seen between the increase in daily steps and the treatment response to CGRP mAbs.

Major findings: The average number of steps per day increased from 4421 before initiation of anti-CGRP mAb treatment to 5241 at 3 months after initiation of treatment (P = .039), reflecting a mean percentage increase of 21.3% (95% CI 0.5-42.1). There was a positive association between an increase in daily steps and a reduction in monthly migraine days (correlation coefficient 0.521; P = .013).

Study details: This single-center, cross-sectional, retrospective study included 22 patients with chronic migraine who were treated with anti-CGRP mAbs (erenumab or fremanezumab).

Disclosures: The study was supported by the Lundbeck Foundation. Several authors declared receiving grants, honoraria, or personal fees from or having other ties with various sources.

Source: Jantzen FT, Chaudhry BA, Younis S, et al. Average steps per day as marker of treatment response with anti-CGRP mAbs in adults with chronic migraine: A pilot study. Sci Rep. 2024;14:18068 (Aug 5). Doi: 10.1038/s41598-024-68915-5 Source

Key clinical point: Women with an increased adherence to a pro-inflammatory diet, as measured using a dietary inflammation score (DIS), had an increased risk for chronic migraine (CM).

Major findings: Women with CM had a significantly higher DIS than those with episodic migraine (EM) (0.08 vs 0.62; P = .002). The risk for CM was two times higher in women with a high DIS than in those with a low DIS (adjusted odd ratio 2.02; P_trend = .03).

Study details: This cross-sectional study included 285 women with migraine, of whom 169 (59.3%) had EM and 116 (40.7%) had CM.

Disclosures: This study was supported by the Student Research Committee of Ahvaz Jundishapur University of Medical Sciences. The authors declared no conflicts of interest.

Source: Bakhshimoghaddam F, Shalilahmadi D, Mahdavi R, et al. Association of dietary and lifestyle inflammation score (DLIS) with chronic migraine in women: A cross-sectional study. Sci Rep. 2024;14:16406 (Jul 16). Doi: 10.1038/s41598-024-66776-6 Source

Key clinical point: Women with an increased adherence to a pro-inflammatory diet, as measured using a dietary inflammation score (DIS), had an increased risk for chronic migraine (CM).

Major findings: Women with CM had a significantly higher DIS than those with episodic migraine (EM) (0.08 vs 0.62; P = .002). The risk for CM was two times higher in women with a high DIS than in those with a low DIS (adjusted odd ratio 2.02; P_trend = .03).

Study details: This cross-sectional study included 285 women with migraine, of whom 169 (59.3%) had EM and 116 (40.7%) had CM.

Disclosures: This study was supported by the Student Research Committee of Ahvaz Jundishapur University of Medical Sciences. The authors declared no conflicts of interest.

Source: Bakhshimoghaddam F, Shalilahmadi D, Mahdavi R, et al. Association of dietary and lifestyle inflammation score (DLIS) with chronic migraine in women: A cross-sectional study. Sci Rep. 2024;14:16406 (Jul 16). Doi: 10.1038/s41598-024-66776-6 Source

Key clinical point: Women with an increased adherence to a pro-inflammatory diet, as measured using a dietary inflammation score (DIS), had an increased risk for chronic migraine (CM).

Major findings: Women with CM had a significantly higher DIS than those with episodic migraine (EM) (0.08 vs 0.62; P = .002). The risk for CM was two times higher in women with a high DIS than in those with a low DIS (adjusted odd ratio 2.02; P_trend = .03).

Study details: This cross-sectional study included 285 women with migraine, of whom 169 (59.3%) had EM and 116 (40.7%) had CM.

Disclosures: This study was supported by the Student Research Committee of Ahvaz Jundishapur University of Medical Sciences. The authors declared no conflicts of interest.

Source: Bakhshimoghaddam F, Shalilahmadi D, Mahdavi R, et al. Association of dietary and lifestyle inflammation score (DLIS) with chronic migraine in women: A cross-sectional study. Sci Rep. 2024;14:16406 (Jul 16). Doi: 10.1038/s41598-024-66776-6 Source